摘要
背景中性粒细胞/淋巴细胞比值(NLR)、平均血小板体积(MPV)均为新型的炎性反应标志物,可用来预测急性ST段抬高型心肌梗死(STEMI)患者的预后,但目前国内外鲜有研究探讨NLR联合MPV在预测STEMI患者预后方面的临床价值。目的探讨NLR联合MPV对急性STEMI患者急诊行经皮冠状动脉介入(PCI)术后发生院内主要不良心血管事件(MACE)的预测价值。方法连续选取2015年10月—2018年9月于石河子大学医学院第一附属医院明确诊断为STEMI并急诊行PCI的患者516例。依据患者急诊入院时外周血NLR、MPV的中位数将其分为低NLR且低MPV组(NLR≤2.51且MPV≤10.70 fl,n=135)、低NLR且高MPV组(NLR≤2.51且MPV>10.70 fl,n=123)、高NLR且低MPV组(NLR>2.51且MPV≤10.70 fl,n=137)、高NLR且高MPV组(NLR>2.51且MPV>10.70 fl,n=121)。依据全球急性冠脉综合征注册评分(GRACE评分)将其分为高危组(GRACE评分>140分,212例)、中危组(108分<GRACE评分≤140分,222例)、低危组(GRACE评分≤108分,82例)。依据住院期间MACE发生情况将其分为发生MACE组(n=71)、未发生MACE组(n=445)。比较不同NLR、MPV组,发生MACE组和未发生MACE组患者PCI术前临床资料、PCI术后用药情况及PCI术前和术后24 h内实验室检查、PCI术后24 h心脏彩超数据;采用多因素Logistic回归分析探究STEMI患者PCI术后发生院内MACE的影响因素;通过受试者工作特征曲线(ROC曲线)评估NLR、MPV及NLR联合MPV预测STEMI患者PCI术后发生院内MACE的价值;分析STEMI患者PCI术前NLR与MPV的相关性;比较不同GRACE评分组患者PCI术前NLR、MPV;比较不同NLR、MPV组,不同GRACE评分组患者PCI术后无复流、院内MACE发生率。结果低NLR且高MPV组患者合并前驱心绞痛率低于低NLR且低MPV组,GRACE评分高于低NLR且低MPV组(P<0.05)。高NLR且低MPV组患者合并高血压率、GRACE评分高于低NLR且低MPV组,合并前驱心绞痛率低于低NLR且低MPV组(P<0.05)。高NLR且低MPV组患者合并高血压率高于低NLR且高MPV组,合并前驱心绞痛率低于低NLR且高MPV组(P<0.05)。高NLR且高MPV组患者合并高血压率、GRACE评分高于低NLR且低MPV组、低NLR且高MPV组、高NLR且低MPV组,合并前驱心绞痛率低于低NLR且低MPV组、低NLR且高MPV组、高NLR且低MPV组(P<0.05)。低NLR且高MPV组患者红细胞比容(HCT)、肌钙蛋白T(TnT)峰值高于低NLR且低MPV组,高密度脂蛋白胆固醇(HDL-C)、C反应蛋白(CRP)低于低NLR且低MPV组(P<0.05)。高NLR且低MPV组患者中性粒细胞计数、NLR、MPV、肌酸激酶同工酶(CK-MB)峰值、TnT峰值高于低NLR且高MPV组,淋巴细胞计数、左心室射血分数(LVEF)低于低NLR且高MPV组(P<0.05)。高NLR且低MPV组患者中性粒细胞计数、NLR、MPV、CK-MB峰值、血肌酐(Scr)、HDL-C、CRP高于低NLR且低MPV组,淋巴细胞计数、LVEF低于低NLR且低MPV组(P<0.05)。高NLR且高MPV组患者中性粒细胞计数、NLR、MPV、CK-MB峰值、TnT峰值、CRP高于低NLR且低MPV组,淋巴细胞计数、LVEF低于低NLR且低MPV组(P<0.05)。高NLR且高MPV组患者中性粒细胞计数、NLR、MPV、CK-MB峰值、TnT峰值、Scr、HDL-C、CRP高于低NLR且高MPV组,淋巴细胞计数、LVEF低于低NLR且高MPV组(P<0.05)。高NLR且高MPV组患者NLR、MPV、TnT峰值、CRP高于高NLR且低MPV组,淋巴细胞计数、LVEF低于高NLR且低MPV组(P<0.05)。多因素Logistic回归分析结果显示,心率(OR=1.025)、Killip分级Ⅱ~Ⅳ级(OR=4.231)、GRACE评分(OR=1.031)、NLR(OR=2.716)、MPV(OR=2.106)、TnT峰值(OR=1.215)、CRP(OR=1.011)、LVEF(OR=0.923)是STEMI患者发生院内MACE的影响因素(P<0.05)。NLR、MPV及NLR联合MPV预测STEMI患者PCI术后发生院内MACE的ROC曲线下面积(AUC)分别为0.670〔95%CI(0.609,0.730)〕、0.678〔95%CI(0.616,0.741)〕、0.732〔95%CI(0.671,0.791)〕。NLR联合MPV与NLR、MPV单独预测STEMI患者PCI术后发生院内MACE的AUC比较,差异有统计学意义(P值分别为0.012、0.023)。STEMI患者NLR与MPV呈正相关(rs=0.168,P=0.008)。中危组、低危组患者NLR、MPV低于高危组患者(P<0.05);低危组患者NLR、MPV低于中危组患者(P<0.05)。低NLR且高MPV组、高NLR且低MPV组、高NLR且高MPV组患者PCI术后无复流、院内MACE发生率高于低NLR且低MPV组(P<0.05);高NLR且低MPV组、高NLR且高MPV组患者PCI术后无复流、院内MACE发生率高于低NLR且高MPV组(P<0.05);高NLR且高MPV组患者PCI术后无复流、院内MACE发生率高于高NLR且低MPV组(P<0.05)。中危组、低危组患者PCI术后无复流、院内MACE发生率均低于高危组(P<0.05)。结论入院早期高NLR、高MPV是STEMI患者PCI术后发生院内MACE的独立危险因素,NLR联合MPV能够更加高效地预测院内MACE的发生,可作为早期STEMI患者预后评估的良好指标。
Background Neutrophil-to-lymphocyte ratio(NLR)and mean platelet volume(MPV)are novel inflammatory response markers that can be used to predict the prognosis of patients with acute ST-segment elevation myocardial infarction(STEMI).However,there are few studies exploring the clinical value of NLR combined with MPV in predicting the prognosis of STEMI patients.Objective To investigate the predictive value of NLR combined with MPV in the occurrence of nosocomial major adverse cardiovascular events(MACE)after emergency percutaneous coronary intervention(PCI)in patients with acute STEMI.Methods A total of 516 consecutive patients diagnosed as STEMI with emergency PCI in the First Affiliated Hospital of the Medical College,Shihezi University from October 2015 to September 2018 were selected.According to the median peripheral blood NLR and MPV on emergency admission,our cohort was divided into low NLR combined with low MPV group(NLR≤2.51 and MPV≤10.70 fl,n=135),low NLR and high MPV group(NLR≤2.51 and MPV>10.70 fl,n=123),high NLR combined with low MPV group(NLR>2.51 and MPV≤10.70 fl,n=137),high NLR combined with high MPV group(NLR>2.51 and MPV>10.70 fl,n=121).Our cohort was divided into high-risk group(GRACE score>140 points,n=212),medium-risk group(108<GRACE score≤140 points,n=222),low-risk group(GRACE score≤108 points,n=82)according to baseline GRACE score.According to the occurrence of MACE during hospitalization,our cohort was divided into MACE group(n=71)and non-MACE group(n=445).Comparisons of pre-PCI clinical and laboratory data,post-PCI medication,laboratory and color Doppler echocardiography data within 24 hours after PCI were performed by NLR with MPV,and the incidence of MACE,respectively.Logistic regression analysis was used to investigate the influencing factors of post-PCI MACE.ROC curve analysis was used to evaluate the value of NLR,MPV and NLR combined with MPV in predicting the occurrence of post-PCI MACE.The correlation between NLR and MPV before PCI was analyzed.The pre-PCI NLR and MPV were compared by GRACE score.Compared the incidence of no reflow and in-hospital MACE in hospital after PCI by NLR with MPV,and GRACE score,respectively.Results Low NLR combined with high MPV group showed lower rate of pre-infarction angina and higher mean GRACE score than low NLR combined with low MPV group(P<0.05).High NLR combined with low MPV group showed higher prevalence of hypertension and higher mean GRACE score,and lower rate of pre-infarction angina than than other three groups stratified by NLR and MPV(P<0.05).Low NLR combined with high MPV group had higher mean HCT,and higher mean peak values of HCT and TnT,and lower mean HDL-C and CRP than low NLR combined with low MPV group(P<0.05).High NLR combined with low MPV group showed higher mean neutrophil count,NLR and MPV,and higher mean peak values of CK-MB and TnT,as well as lower mean lymphocyte count and LVEF than low NLR combined with high MPV group(P<0.05).In comparison with high NLR combined with high MPV group,low NLR combined with low MPV group had lower mean neutrophil count,NLR,MPV,peak CK-MB and peak TnT,and CRP,and higher mean lymphocyte count and LVEF(P<0.05),low NLR combined with high MPV group showed lower mean neutrophil count,NLR,MPV,peak CK-MB and peak TnT,Scr,HDL-C and CRP,as well as higher mean lymphocyte count and LVEF(P<0.05),and high NLR combined with low MPV group demonstrated lower mean NLR,MPV,peak TnT,and CRP,and higher mean lymphocyte count and LVEF(P<0.05).Multivariate Logistic regression analysis showed that heart rate(OR=1.025),Killip classⅡ-Ⅳ(OR=4.231),GRACE score(OR=1.031),NLR(OR=2.716),MPV(OR=2.106),TnT peak(OR=1.215),CRP(OR=1.011),LVEF(OR=0.923)were independent influencing factors for the occurrence of in-hospital MACE in STEMI patients(P<0.05).The AUC of NLR,MPV and NLR combined with MPV for predicting MACE in STEMI patients after PCI was 0.670〔95%CI(0.609,0.730)〕,0.678〔95%CI(0.616,0.741)〕,and 0.732〔95%CI(0.671,0.791)〕,respectively.There was significant difference between NLR with MPV and NLR or MPV alone in predicting AUC of post-PCI MACE(P=0.012,0.023,respectively).NLR was positively correlated with MPV(rs=0.168,P=0.008).Mean NLR and MPV increased successively in low-risk,mediumrisk,and high-risk groups(P<0.05).Low NLR combined with low MPV group showed lower incidence of no-reflow and inhospital MACE after PCI compared with other three groups stratified by NLR and MPV(P<0.05).The incidence of no-reflow and in-hospital MACE in both high NLR combined with low MPV and high NLR combined with high MPV groups was higher than that of low NLR combined with high MPV group(P<0.05).High NLR combined with high MPV group showed higher incidence of no-reflow and in-hospital MACE than high NLR combined with low MPV group(P<0.05).The incidence of no-reflow and inhospital MACE in both low-risk and medium-risk groups was lower than that in the high-risk group(P<0.05).Conclusion High NLR and high MPV at the early stage of admission are independent risk factors for nosocomial MACE in patients with STEMI after PCI.And NLR combined with MPV can more effectively predict the occurrence of in-hospital MACE,which can be used as a good indicator for prognosis evaluation of early STEMI patients.
作者
陈鑫森
黄钟
李桂花
CHEN Xinsen;HUANG Zhong;LI Guihua(Department of Emergency,the First Affiliated Hospital of the Medical College,Shihezi University,Shihezi 832000,China)
出处
《中国全科医学》
CAS
北大核心
2020年第9期1117-1126,共10页
Chinese General Practice
