急性冠脉综合征患者全身免疫炎症指数与冠状动脉病变严重程度的相关性

doi:10.3969/j.issn.1004-583X.2024.06.005

摘要/Abstract

摘要：

目的探究急性冠脉综合征(acute coronary artery,ACS)患者全身免疫炎症指数(systemic immune inflammation index,SII)与冠状动脉病变严重程度的相关性。方法纳入2021年9月至2023年3月因出现典型胸痛、胸闷症状在鞍山市中心医院心血管内科就诊,行冠状动脉造影符合诊断标准的ACS患者206例,收集患者临床资料,计算各免疫炎症指数。根据冠状动脉造影结果分为单支病变组(n=51)和多支病变组(n=155);根据改良Gensini评分分为轻度病变组(n=89)和中重度病变组(n=117)。比较组间临床资料的差异,筛选冠状动脉病变严重程度的独立危险因素,并评价其预测价值。结果 SII预测ACS患者多支病变的曲线下面积为0.93,当SII为631.31时,对ACS患者冠状动脉多支病变的预测能力最高,敏感度和特异度分别为81.9%和96.1%。结论 SII是ACS患者多支病变的独立危险因素,且预测价值较高。

关键词: 急性冠脉综合征, 全身免疫炎症指数, 多支病变, 中重度病变

Abstract:

Objective To investigate the correlation between systemic immune inflammation (SII) index and severity of coronary artery disease in patients with acute coronary syndrome (ACS). Methods A total of 206 ACS patients with typical symptoms of chest pain and chest tightness underwent coronary angiography in the Department of Cardiology of Anshan Central Hospital from September 2021 to March 2023 were enrolled. The clinical data and the immune inflammation indexes were assessed. According to the coronary angiography results or the modified Gensini score, the patients were divided into single-vessel disease group (n=51) and multi-vessel disease group (n=155), or mild lesion group (n=89) and advanced lesion group (n=117). The inter-group differences in clinical data were compared, and the independent risk factors for severity of coronary artery disease were screened for evaluating their predictive value. Results The area under the curve of SII in predicting severity of coronary artery disease in ACS patients was 0.93. When SII was 631.31, the predictive ability for severity of coronary artery disease in ACS patients was the highest, with 81.9% of the sensitivity and 96.1% of specificity. Conclusion SII is an independent risk factor for severity of coronary artery disease in ACS patients, and it has a high predictive value.

Key words: acute coronary syndrome, systemic immune inflammation index, multiple vessel lesions, moderate to severe lesions

中图分类号:

R541.4

王忠奇, 李今朝, 吴南. 急性冠脉综合征患者全身免疫炎症指数与冠状动脉病变严重程度的相关性[J]. 临床荟萃, 2024, 39(6): 512-517.

Wang Zhongqi, Li Jinzhao, Wu Nan. Correlation between systemic immune inflammation index and multivessel coronary disease in patients with acute coronary syndrome[J]. Clinical Focus, 2024, 39(6): 512-517.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.06.005

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I6/512

图/表 5

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项目	单支病变组(n=51)	多支病变组(n=155)	χ²/t/Z值	P值
年龄(岁)	59±10	63±11	-2.477	0.014
男性[例(%)]	36(70.6)	105(67.7)	0.311	0.577
高血压[例(%)]	16(31.4)	131(84.5)	65.592	<0.01
糖尿病[例(%)]	6(11.8)	47(30.3)	8.623	0.003
吸烟[例(%)]	18(35.3)	59(38.1)	0.694	0.405
饮酒[例(%)]	2(3.9)	12(7.7)	1.183	0.277
BMI(kg/m²)	25.70±0.66	24.94±0.27	-0.557	0.578
TG(mmol/L)	1.8(1.39,2.27)	1.69(1.22,2.54)	-0.842	0.400
TC(mmol/L)	5.49±1.09	5.35±1.26	0.723	0.470
HDL-C(mmol/L)	1.01(0.88,1.16)	1.01(0.84,1.24)	-0.367	0.714
LDL-C(mmol/L)	3.59(2.75,4.25)	3.46(2.96,4.1)	-0.179	0.858
CRP(mg/L)	2.43(0.67,6.24)	4.14(1.5,5.02)	2.149	0.032
WBC(×10⁹/L)	6.07(5.52,7.14)	8.61(7.47,10.2)	8.411	<0.01
NEU(×10⁹/L)	3.65(3.1,4.19)	6.08(4.93,7.55)	8.801	<0.01
MON(×10⁹/L)	0.46(0.37,0.59)	0.81(0.64,1.03)	7.741	<0.01
LYM(×10⁹/L)	1.69(1.56,2.04)	1.49(1.32,1.74)	-4.893	<0.01
PLT(×10⁹/L)	187(168,201)	227(205,253)	7.749	<0.01
NLR(×10⁹/L)	2.06(1.72,2.5)	4.13(3.16,5.04)	8.659	<0.01
MLR(×10⁹/L)	0.27(0.2,0.33)	0.56(0.42,0.7)	7.811	<0.01
PLR(×10⁹/L)	104.27(88.73,120)	154.29(131.94,183.56)	7.583	<0.01
SII(×10⁹/L)	371.9(320.2,460.34)	964.5(721.73,1227.71)	9.136	<0.01

项目	单支病变组(n=51)	多支病变组(n=155)	χ²/t/Z值	P值
年龄(岁)	59±10	63±11	-2.477	0.014
男性[例(%)]	36(70.6)	105(67.7)	0.311	0.577
高血压[例(%)]	16(31.4)	131(84.5)	65.592	<0.01
糖尿病[例(%)]	6(11.8)	47(30.3)	8.623	0.003
吸烟[例(%)]	18(35.3)	59(38.1)	0.694	0.405
饮酒[例(%)]	2(3.9)	12(7.7)	1.183	0.277
BMI(kg/m²)	25.70±0.66	24.94±0.27	-0.557	0.578
TG(mmol/L)	1.8(1.39,2.27)	1.69(1.22,2.54)	-0.842	0.400
TC(mmol/L)	5.49±1.09	5.35±1.26	0.723	0.470
HDL-C(mmol/L)	1.01(0.88,1.16)	1.01(0.84,1.24)	-0.367	0.714
LDL-C(mmol/L)	3.59(2.75,4.25)	3.46(2.96,4.1)	-0.179	0.858
CRP(mg/L)	2.43(0.67,6.24)	4.14(1.5,5.02)	2.149	0.032
WBC(×10⁹/L)	6.07(5.52,7.14)	8.61(7.47,10.2)	8.411	<0.01
NEU(×10⁹/L)	3.65(3.1,4.19)	6.08(4.93,7.55)	8.801	<0.01
MON(×10⁹/L)	0.46(0.37,0.59)	0.81(0.64,1.03)	7.741	<0.01
LYM(×10⁹/L)	1.69(1.56,2.04)	1.49(1.32,1.74)	-4.893	<0.01
PLT(×10⁹/L)	187(168,201)	227(205,253)	7.749	<0.01
NLR(×10⁹/L)	2.06(1.72,2.5)	4.13(3.16,5.04)	8.659	<0.01
MLR(×10⁹/L)	0.27(0.2,0.33)	0.56(0.42,0.7)	7.811	<0.01
PLR(×10⁹/L)	104.27(88.73,120)	154.29(131.94,183.56)	7.583	<0.01
SII(×10⁹/L)	371.9(320.2,460.34)	964.5(721.73,1227.71)	9.136	<0.01

因素	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
因素	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
CRP	-0.052	0.051	1.057	0.304	0.949	0.860	1.048
NEU	2.489	1.118	4.959	0.026	12.043	1.347	107.645
MON	18.864	6.652	8.042	0.005	0.280	0.128	0.609
LYM	-3.090	1.967	2.468	0.116	0.046	0.001	2.149
PLT	0.103	0.040	6.585	0.010	1.108	1.025	1.199
NLR	4.912	2.435	4.070	0.044	0.938	0.835	1.054
MLR	-20.057	8.961	5.010	0.025	0.000	0.000	0.083
PLR	0.081	0.056	2.133	0.144	1.085	0.973	1.209
SII	-0.033	0.009	14.074	<0.01	0.968	0.952	0.985

因素	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
因素	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
CRP	-0.052	0.051	1.057	0.304	0.949	0.860	1.048
NEU	2.489	1.118	4.959	0.026	12.043	1.347	107.645
MON	18.864	6.652	8.042	0.005	0.280	0.128	0.609
LYM	-3.090	1.967	2.468	0.116	0.046	0.001	2.149
PLT	0.103	0.040	6.585	0.010	1.108	1.025	1.199
NLR	4.912	2.435	4.070	0.044	0.938	0.835	1.054
MLR	-20.057	8.961	5.010	0.025	0.000	0.000	0.083
PLR	0.081	0.056	2.133	0.144	1.085	0.973	1.209
SII	-0.033	0.009	14.074	<0.01	0.968	0.952	0.985

项目	轻度病变组(n=89)	中重度病变组(n=117)	χ²/t/Z值	P值
年龄(岁)	59±10	64±11	-3.311	0.001
男性[例(%)]	62(69.7)	79(67.5)	0.107	0.743
高血压[例(%)]	43(48.3)	104(88.9)	40.717	<0.01
糖尿病[例(%)]	10(11.2)	43(36.8)	17.227	<0.01
吸烟[例(%)]	31(34.8)	46(39.3)	0.434	0.510
饮酒[例(%)]	3(3.4)	11(9.4)	2.903	0.088
BMI(kg/m²)	24.8(22.9, 28)	24.7(22.4, 27.1)	-0.691	0.489
TC(mmol/L)	5.52±1.19	5.3±1.24	1.344	0.180
TG(mmol/L)	1.85(1.37,2.65)	1.65(1.22,2.4)	-1.496	0.249
HDL-C(mmol/L)	1.08(0.87,1.26)	0.99(0.85,1.21)	-1.206	0.228
LDL-C(mmol/L)	3.54(2.87,4.26)	3.46(2.94,4.08)	-0.433	0.665
CRP(mg/L)	2.47(0.8,4.55)	5.27(1.61,8.95)	3.613	<0.01
WBC(×10⁹/L)	6.7(5.91,7.76)	9.03(7.85,10.51)	8.129	<0.01
NEU(×10⁹/L)	4.08(3.42,5.04)	6.38(5.29,7.87)	8.939	<0.01
MON(×10⁹/L)	0.54(0.41,0.69)	0.87(0.69,1.14)	8.575	<0.01
LYM(×10⁹/L)	1.74(1.54,2.04)	1.41(1.29,1.58)	-7.208	<0.01
PLT(×10⁹/L)	195(182.5,211)	234(213,267)	8.320	<0.01
NLR(×10⁹/L)	2.33(1.93,2.87)	4.52(3.78,5.41)	10.291	<0.01
MLR(×10⁹/L)	0.28(0.22,0.39)	0.61(0.49,0.79)	9.764	<0.01
PLR(×10⁹/L)	112.43(92.59,130.19)	165.15(144.45,201)	9.774	<0.01
SII(×10⁹/L)	441.76(355.61,549.66)	1074.29(859.28,1346.5)	10.763	<0.01