新型炎症标记物对首发急性非ST段抬高型心肌梗死患者经皮冠状动脉介入治疗术后心肌灌注不良的预测价值  

Predictive value of different novel infl ammatory markers for poor myocardial perfusion in first-episode acute non ST segment elevation myocardial infarction patients after PCI

作　　者：王睿 王媛 李芳 Wang Rui;Wang Yuan;Li Fang(Department of Cardiology,Liaoning Jinqiu Hospital,Liaoning Geriatric Hospital,Shenyang Liaoning 110016,China)

机构地区：[1]辽宁省金秋医院(辽宁省老年病研究院)心血管内科,辽宁沈阳110000

出　　处：《中国医刊》2025年第1期18-22,共5页Chinese Journal of Medicine

基　　金：2024年辽宁省科学事业公益研究基金(2024JH2/102500032)。

摘　　要：目的探讨新型炎症标记物对首发急性非ST段抬高型心肌梗死(NSTEMI)患者经皮冠状动脉介入治疗(PCI)术后发生心肌灌注不良的预测价值。方法选择2020年1月至2022年5月于辽宁省金秋医院行PCI治疗的NSTEMI患者224例为研究对象,根据PCI术后是否出现慢血流/无复流(SF/NRF)分组,出现SF/NRF的36例患者为SF/NRF组,余下的188例患者为对照组。比较两组患者的临床资料、生化指标、炎症标记物及手术相关特征,采用单因素筛选与多因素logistic回归分析新型炎症标记物对NSTEMI患者PCI术后心肌灌注不良的影响,并分析各指标的预测价值。结果SF/NRF组患者Killip≥2级比例、白细胞计数、中性粒细胞、淋巴细胞、单核细胞、纤维蛋白原水平、GRACE评分以及纤维蛋白原/白蛋白比值(FAR)、系统免疫炎症指数(SII)和系统炎症反应指数(SIRI)、多支血管病变和血栓负荷分级≥4级的患者比例均显著高于对照组(P<0.05)。多因素logistic回归分析显示,血栓负荷分级≥4级、FAR、SII和SIRI是NSTEMI患者PCI术后心肌灌注不良的影响因素。受试者操作特征工作(ROC)曲线分析显示,FAR、SII/100和SIRI预测NSTEMI患者PCI术后发生心肌灌注不良的曲线下面积分别为0.733、0.854和0.842,均具有预测效能(P<0.05),其中SII的预测价值最高,敏感度为0.861,特异度为0.782。结论新型炎症标记物FAR、SII和SIRI是NSTEMI患者PCI术后心肌灌注不良的影响因素,其中SII具有更高的预测价值。Objective To explore the predictive value of different novel inflammatory markers for poor myocardial perfusion after PCI in first-episode acute non ST segment elevation myocardial infarction(NSTEMI)patients.Method A total of 224 patients diagnosed with NSTEMI and treated with PCI were selected consecutively from January 2020 to May 2022 in Liaoning Jinqiu Hospital.Among them,36 patients developed slowflow/no reflow after PCI(slowflow/no reflow group),and the other 188 patients were in the control group.The clinical data,blood biochemical indicators,inflammatory markers,and surgical related characteristics of the patients were recorded,so as to explore the predictive value of novel inflammatory markers for postoperative slowflow/no reflow in NSTEMI patients undergoing PCI.Result The proportion of Killip≥2,white blood cells,neutrophils,lymphocytes,monocytes,fibrinogen,the GRACE score,fibrinogen to albumin ratio(FAR),systemic immune inflammation index(SII)and systemic inflammatory response index(SIRI),multi vessel lesions,and thrombus burden grading≥4 were significantly higher in poor myocardial perfusion group(P<0.05).Multivariate logistic regression analysis showed that the thrombus burden grading was≥4 FAR,SII/100,and SIRI are independent predictors of post PCI slowflow/no reflow in NSTEMI patients.Receiver Operating Curve(ROC)analysis showed the area under the curve(AUC)were 0.733,0.854,and 0.842 for FAR,SII/100 and SIRI,respectively.SII/100 has the best predictive value for postoperative slowflow/no reflow in NSTEMI patients after PCI,with a sensitivity of 0.861 and a specificity of 0.782.Conclusion The novel inflammatory marker FAR SII/100 and SIRI are independent predictors for slowflow/no reflow after PCI in NSTEMI patients,with SII/100 having the highest predictive value.

关 键 词：炎症标记物 纤维蛋白原/白蛋白比值 系统免疫炎症指数 系统炎症反应指数 非ST段抬高型心肌梗死 

分 类 号：R542.2[医药卫生—心血管疾病]