全身免疫炎症指数对急性ST段抬高型心肌梗死患 者急诊经皮冠状动脉介入术后发生微血管阻塞的 预测价值  

Predictive value of systemic immune inflammation index for micro vascular occlusion after emergency percutaneous coronary intervention in patients with acute ST segment elevation myocardial infarction

作　　者：毕梦婷 苗浩 李佳正 段洋 张敏 张卓琦 陆远 BI Meng-ting;MIAO Hao;LI Jia-zheng;DUAN Yang;ZHANG Min;ZHANG Zhuo-qi;LU Yuan(Department of Cardiology,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221004,China)

机构地区：[1]徐州医科大学附属医院心内科,江苏省徐州市221002

出　　处：《中国心血管病研究》2025年第2期140-145,共6页Chinese Journal of Cardiovascular Research

基　　金：江苏省健康科研项目(F202116);徐州市重点研发计划(社会发展)[KC20105]。

摘　　要：目的探讨全身免疫炎症指数(SII)对急性ST段抬高型心肌梗死(STEMI)患者在接受急诊经皮冠状动脉介入(PCI)术后微血管阻塞(MVO)的预测价值。方法回顾性分析徐州医科大学附属医院2019年1月至2021年7月收治的279例STEMI患者,这些患者在PCI术后1周内接受了心脏磁共振检查,并根据有无MVO分为阳性组(157例)和阴性组(122例)。结果与MVO阴性组相比,阳性组患者在住院期间的肌钙蛋白T峰值[4943(2847,7366)ng/L比1506(729.95,3526.50)ng/L]、磷酸肌酸激酶同工酶(CK-MB)峰值[(80.28,300.00)ng/ml比78.82(24.93,204.45)ng/ml]、SII峰值[1787.55(1267.24,2784.53)比1213.59(775.40,1956.83)mg/L]及C反应蛋白(CRP)水平[18.1(8.1,40.1)mg/L比8.0(3.4,26.4)mg/L]显著更高(P<0.05),而左心室射血分数(LVEF)水平[(43.65±9.51)%比(49.16±9.28)%]显著更低(P<0.05)。多因素Logistic回归分析显示,肌钙蛋白T峰值(OR=2.416,95%CI 1.692~3.450,P<0.01)和SII(OR=2.445,95%CI 1.510~3.991,P<0.01)是STEMI患者PCI术后发生MVO的独立危险因素。ROC曲线分析表明,肌钙蛋白T和SII联合预测MVO的效能高于单独使用任一指标,联合指标诊断MVO发生的曲线下面积(AUC)为0.806,高于cTnT峰值的0.783和SII峰值的0.689。结论肌钙蛋白T和SII是STEMI患者PCI术后MVO发生的独立预测因子,联合使用这两个指标可以更准确地预测MVO,为评估急诊PCI术后MVO风险提供依据。Objective To investigate the predictive value of the systemic immunoinflammatory index(SII)for microvascular obstruction(MVO)in patients with acute ST-segment elevation myocardial infarction(STEMI)after emergency percutaneous coronary intervention(PCI).Methods 279 STEMI patients admitted to the Affiliated Hospital of Xuzhou Medical University from January 2019 to July 2021,who underwent cardiac magnetic resonance imaging within one week after PCI,were retrospectively analyzed and they were divided into the MVO positive(157 cases)and MVO negative groups(122 cases)based on wether the presence of MVO.Results Compared with the MVO negative group,the MVO positive group had significantly higher peak values of troponin T[4943(2847,7366)ng/L vs.1506(729.95,3526.50)ng/L],creatine kinase-MB(CK-MB)[176.70(80.28,300.00)ng/ml vs.78.82(24.93,204.45)ng/ml],SII[1787.55(1267.24,2784.53)vs.1213.59(775.40,1956.83)mg/L],and C-reactive protein(CRP)levels[18.1(8.1,40.1)mg/L vs.8.0(3.4,26.4)mg/L]during hospitalization(P<0.05).In contrast,the left ventricular ejection fraction(LVEF)was significantly lower in the MVO positive group[(43.65±9.51)%vs.(49.16±9.28)%,P<0.05].Multivariate Logistic regression analysis revealed that the peak values of troponin T(OR=2.416,95%CI 1.692-3.450,P<0.01)and SII(OR=2.445,95%CI 1.510-3.991,P<0.01)were the independent risk factors for MVO after PCI in STEMI patients.ROC curve analysis indicated that the combined predictive efficacy of troponin T and SII for MVO was higher than that of either marker alone,with the area under the curve(AUC)for the combined indicators being 0.806,higher than the AUC of 0.783 for troponin T and 0.689 for SII.Conclusion Troponin T and SII are the independent predictive factors for the occurrence of MVO after PCI in STEMI patients.The combined use of these two indicators can more accurately predict MVO,providing a basis for assessing the risk of MVO after emergency PCI.

关 键 词：全身免疫炎症指数 急性ST段抬高型心肌梗死 微血管阻塞 

分 类 号：R542.22[医药卫生—心血管疾病]