摘要
目的分析经皮冠状动脉介入治疗(PCI)的老年非ST段抬高型急性冠状动脉综合征(NSTE-ACS)患者入院时的炎症标志物水平对围术期心肌梗死(PMI)的预测价值。方法回顾性收集连续入选2014年1月至2017年12月我院老年心血管病房接受PCI治疗的206例老年NSTE-ACS患者的临床数据,包括危险因素、临床表现、术前肌钙蛋白、炎症相关标志物以及PCI术后的肌钙蛋白水平(c TnI)。依据术后c TnI水平将患者分为PMI组(n=28)和对照组(n=178)。对样本进行倾向评分匹配,使2组患者具有可比性。最终,2组分别纳入26例和90例患者,分析影响PMI的危险因素及预测因子。结果与对照组相比,PMI组血小板淋巴细胞比值(PLR)明显升高[159.43 (105.81,196.13) vs 123.86 (92.46,149.60),P=0.021];多因素分析比较PLR四分位极值发现,PLR(OR=13.11,95%CI:2.42,70.92,P=0.003)、非ST段抬高型心肌梗死(OR=4.56,95%CI:1.24,16.78,P=0.022)、支架植入数(OR=2.83,95%CI:1.52,5.25,P=0.001)、高密度脂蛋白胆固醇(OR=0.07,95%CI:0.01,0.66,P=0.020)均是PMI的独立影响因素;趋势分析发现PLR越高,则PMI的发生风险也越高(OR=13.11,95%CI:2.42,70.92,P-trend=0.017);PLR>149.92预测PMI发生的敏感度和特异度分别为57.70%和75.60%。结论老年NSTE-ACS患者PCI术前PLR升高是PMI发生的独立危险因素,能够较特异地预测老年NSTE-ACS患者的PMI风险。
Objective To analyze the predictive value of inflammatory markers for periprocedural myocardial infarction(PMI) in elderly patients who underwent percutaneous coronary intervention(PCI) for non-ST-segment elevation acute coronary syndrome(NSTE-ACS).Methods This retrospective study enrolled 206 consecutive elderly patients with NSTE-ACS who underwent PCI in the Department of Geriatric Cardiology of The First Hospital of China Medical University between January 2014 and December 2017. The Clinical data of the patients,including risk factors,clinical presentation,lipid profiles,inflammatory markers,and troponin I level(before and after PCI),were collected. The patients were divided into PMI group(n = 28) and control group(n = 178) according to serum troponin I level. Finally,26 and 90 patients were matched according to propensity scores to make them comparable,and the risk factors and predictors of PMI were analyzed. Results Compared with the control group,the PMI group had significantly increased platelet-to-lymphocyte ratio [PLR:159.43(105.81-196.13) vs 123.86(92.46-149.60),P = 0.021]. In the multivariable analyses,PLR [odds ratio(OR)= 13.11;95% confidence interval(CI):2.42,70.92;P = 0.003],non-ST-segment elevation myocardial infarction(OR = 4.56,95% CI:1.24,16.78;P = 0.022),number of stents used(OR = 2.83;95% CI:1.52,5.25;P = 0.001),and low high-density lipoprotein cholesterol level(OR = 0.07;95% CI:0.01,0.66;P = 0.020) were revealed as the independent risk factors of PMI. The trend analysis revealed that the risk of PMI was increasing,accompanied by increasing PLR(OR = 13.11;95% CI:2.42,70.92;P-trend = 0.017). A PLR of >149.92 had a sensitivity of 57.70%and a specificity of 75.60% in predicting PMI. Conclusion Increased PLR is an independent risk factor of PMI and might predict PMI risk in elderly patients with NSTE-ACS who are undergoing PCI.
作者
徐健
赵世杰
牛一蒙
齐国先
田文
XU Jian;ZHAO Shijie;NIU Yimeng;QI Guoxian;TIAN Wen(Department of Geriatric Cardiology,The First Hospital,China Medical University,Shenyang 110001,China)
出处
《中国医科大学学报》
CAS
CSCD
北大核心
2019年第8期719-725,共7页
Journal of China Medical University
基金
辽宁省科学技术计划（2015225027）
