中性粒细胞与淋巴细胞比值联合GRACE评分对急性STEMI患者PCI术后发生院内主要不良心血管事件的预测价值

doi:10.3969/j.issn.1004-583X.2022.05.004

摘要/Abstract

摘要：

目的探讨中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio, NLR)联合全球急性冠状动脉事件注册(global registry of acute coronary events,GRACE)评分对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者接受直接经皮冠状动脉介入(percutaneous coronary intervention,PCI)术治疗后发生院内主要不良心血管事件(major adverse cardiovascular events,MACE)的预测价值。方法纳入2018年9月1日-2019年12月31日就诊于河北省人民医院心血管内科行直接PCI治疗的急性STEMI患者275例。根据PCI术后是否发生院内MACE(包括全因死亡、心源性休克、院内再次血运重建、恶性心律失常及心脏骤停),分为MACE组(35例)和非MACE组(240例)。收集两组临床资料,分析STEMI患者PCI术后发生院内MACE的独立危险因素,并绘制受试者工作特征(receiver operating characteristic, ROC)曲线分析NLR、GRACE评分及二者联合对急性STEMI患者PCI术后发生院内MACE的预测价值。结果 MACE组年龄、GRACE评分、CRUSADE评分及NLR均高于非MACE组,估算的肾小球滤过率低于非MACE组(均P<0.05)。多因素Logistic回归分析提示,GRACE评分、NLR是急性STEMI患者PCI术后发生院内MACE的独立危险因素(均P<0.05)。ROC曲线提示,GRACE评分、NLR对急性STEMI患者PCI术后发生院内MACE有一定预测能力,但两者联合的曲线下面积更大,可更好地预测急性STEMI患者PCI术后是否发生院内MACE。结论 GRACE评分、NLR是急性STEMI患者PCI术后发生院内MACE的独立危险因素,两者联合对急性STEMI患者PCI术后发生院内MACE具有较好的预测价值。

关键词: ST段抬高型心肌梗死, 经皮冠状动脉介入治疗, 主要不良心血管事件, GRACE评分, 中性粒细胞与淋巴细胞比值

Abstract:

Objective To explore the predicting value of neutrophil to lymphocyte ratio (NLR) combined with global registry of acute coronary events (GRACE) score on in-hospital major adverse cardiovascular events (MACE) of postoperative primary percutaneous coronary intervention (PCI) of patients with acute ST-segment elevation myocardial infarction (STEMI). Methods From September 1, 2018 to December 31, 2019, a total of 275 patients with acute STEMI underwent primary PCI who visited the Department of Cardiology, Hebei General Hospital were enrolled and divided into the MACE group (n=35) and the non-MACE group (n=240), postoperative PCI in-hospital MACE included all-cause mortality, cardiogenic shock, in-hospital repeat revascularization, fatal arrhythmia, cardiac arrest. The clinical data was recored, the independent risk factors of in-hospital MACE were analyzed. The receiver operating characteristic (ROC) curve was plotted to analyze the predictive value of NLR, GRACE score and the two combined for in-hospital MACE of postoperative PCI in acute STEMI patients. Results Compared with the non-MACE group, increased age, GRACE score, CRUSADE score and NLR and decreased estimated glomerular filtration rate were detected in the MACE group (all P<0.05). Multivariate Logistic regression analysis showed that GRACE score and NLR were independent risk factors of in-hospital MACE of postoperative PCI in patients with acute STEMI (all P<0.05). ROC curve indicated that GRACE score, NLR had certain predictive value for in-hospital MACE, while the two combined had a greater areas under curve for better predicting in-hospital MACE. Conclusion GRACE score and NLR are independent risk factors for in-hospital MACE of postoperative PCI in acute STEMI patients, the two combined has a greater predictive value for in-hospital MACE.

Key words: ST elevation myocardial infarction, percutaneous coronary intervention, major adverse cardiovascular events, GRACE score, neutrophil to lymphocyte ratio

中图分类号:

R542.22

王家琦, 高曼, 张飞飞, 李英肖, 党懿, 齐晓勇. 中性粒细胞与淋巴细胞比值联合GRACE评分对急性STEMI患者PCI术后发生院内主要不良心血管事件的预测价值[J]. 临床荟萃, 2022, 37(5): 412-417.

Wang Jiaqi, Gao Man, Zhang Feifei, Li Yingxiao, Dang Yi, Qi Xiaoyong. Predicting value of neutrophil to lymphocyte ratio combined with GRACE score on in-hospital major adverse cardiovascular events of postoperative PCI in acute STEMI patients[J]. Clinical Focus, 2022, 37(5): 412-417.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.05.004

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I5/412

图/表 8

参考文献 20

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组别	例数			年龄 (岁)			男性 [例(%)]		BMI (kg/m²)			GRACE评分 (分)				CRUSADE评分 (分)		TIMI危险评分 (分)		高血压 [例(%)]
MACE组	35			65.80±12.68			26(74.3)		25.60(24.49,27.40)			148(134,173)				26.50(19.00,40.75)		3.5(2,5.75)		19(54.3)
非MACE组	240			59.46±12.77			187(77.9)		25.34(23.10,27.10)			125(102.25,147.00)				20(13.25,30.00)		3(2,5)		127(52.9)
χ²/Z/t值				2.760			0.231		-1.460			-4.163				-2.891		-1.520		0.023
P值				0.008			0.631		0.144			<0.01				0.004		0.128		0.879
组别		例数			糖尿病 [例(%)]			高脂血症 [例(%)]			吸烟史 [例(%)]		饮酒史 [例(%)]		家族史 [例(%)]		心率 (次/min)		收缩压 (mmHg)
MACE组		35			7(20.0)			12(34.3)			15(42.9)		10(28.6)		5(14.3)		74.31±17.69		125.40±27.79
非MACE组		240			43(17.9)			72(30.0)			119(49.6)		70(29.2)		26(10.8)		77.19±17.26		132.20±25.38
χ²/Z/t值					0.089			0.264			0.553		0.005		0.101		-0.901		-1.463
P值					0.765			0.607			0.457		0.942		0.751		0.373		0.145
组别			例数			舒张压 (mmHg)				D2B时间 (min)		TIT (h)		Killip分级[例(%)]					院前心脏骤停 [例(%)]
组别			例数			舒张压 (mmHg)				D2B时间 (min)		TIT (h)		Ⅰ级			Ⅱ~Ⅳ级		院前心脏骤停 [例(%)]
MACE组			35			80.37±14.79				60(44, 72)		4(2.5, 6)		23(65.7)			12(34.3)		2(5.7)
非MACE组			240			81.91±14.91				60(46,77)		3.5(2, 5.5)		194(80.8)			46(19.2)		4(1.7)
χ²/Z/t值						-0.572				-0.594		-1.114		3.336					0.832
P值						0.568				0.553		0.265		0.068					0.362

组别	例数			年龄 (岁)			男性 [例(%)]		BMI (kg/m²)			GRACE评分 (分)				CRUSADE评分 (分)		TIMI危险评分 (分)		高血压 [例(%)]
MACE组	35			65.80±12.68			26(74.3)		25.60(24.49,27.40)			148(134,173)				26.50(19.00,40.75)		3.5(2,5.75)		19(54.3)
非MACE组	240			59.46±12.77			187(77.9)		25.34(23.10,27.10)			125(102.25,147.00)				20(13.25,30.00)		3(2,5)		127(52.9)
χ²/Z/t值				2.760			0.231		-1.460			-4.163				-2.891		-1.520		0.023
P值				0.008			0.631		0.144			<0.01				0.004		0.128		0.879
组别		例数			糖尿病 [例(%)]			高脂血症 [例(%)]			吸烟史 [例(%)]		饮酒史 [例(%)]		家族史 [例(%)]		心率 (次/min)		收缩压 (mmHg)
MACE组		35			7(20.0)			12(34.3)			15(42.9)		10(28.6)		5(14.3)		74.31±17.69		125.40±27.79
非MACE组		240			43(17.9)			72(30.0)			119(49.6)		70(29.2)		26(10.8)		77.19±17.26		132.20±25.38
χ²/Z/t值					0.089			0.264			0.553		0.005		0.101		-0.901		-1.463
P值					0.765			0.607			0.457		0.942		0.751		0.373		0.145
组别			例数			舒张压 (mmHg)				D2B时间 (min)		TIT (h)		Killip分级[例(%)]					院前心脏骤停 [例(%)]
组别			例数			舒张压 (mmHg)				D2B时间 (min)		TIT (h)		Ⅰ级			Ⅱ~Ⅳ级		院前心脏骤停 [例(%)]
MACE组			35			80.37±14.79				60(44, 72)		4(2.5, 6)		23(65.7)			12(34.3)		2(5.7)
非MACE组			240			81.91±14.91				60(46,77)		3.5(2, 5.5)		194(80.8)			46(19.2)		4(1.7)
χ²/Z/t值						-0.572				-0.594		-1.114		3.336					0.832
P值						0.568				0.553		0.265		0.068					0.362

组别	例数	桡动脉入路	预扩张	后扩张	术前TIMI血流		GPⅡb/Ⅲa 受体拮抗剂	血栓抽吸	支架数量(个)		冠状动脉内溶栓	前降支病变
组别	例数	桡动脉入路	预扩张	后扩张	0~1	2~3	GPⅡb/Ⅲa 受体拮抗剂	血栓抽吸	0~1	2~3	冠状动脉内溶栓	前降支病变
MACE组	35	30(85.7)	29(82.9)	20(57.1)	26(74.3)	9(25.7)	7(20.0)	12(34.3)	29(82.9)	6(17.1)	3(8.6)	20(57.1)
非MACE组	240	214(89.2)	205(85.4)	102(42.5)	179(74.6)	61(25.4)	55(22.9)	84(35.0)	194(80.8)	46(19.2)	24(10.0)	142(59.2)
χ²值		0.364	0.158	2.653	0.019		0.149	0.007	2.568		0.070	0.052
P值		0.546	0.691	0.103	0.999		0.700	0.934	0.463		0.791	0.820

组别	例数	桡动脉入路	预扩张	后扩张	术前TIMI血流		GPⅡb/Ⅲa 受体拮抗剂	血栓抽吸	支架数量(个)		冠状动脉内溶栓	前降支病变
组别	例数	桡动脉入路	预扩张	后扩张	0~1	2~3	GPⅡb/Ⅲa 受体拮抗剂	血栓抽吸	0~1	2~3	冠状动脉内溶栓	前降支病变
MACE组	35	30(85.7)	29(82.9)	20(57.1)	26(74.3)	9(25.7)	7(20.0)	12(34.3)	29(82.9)	6(17.1)	3(8.6)	20(57.1)
非MACE组	240	214(89.2)	205(85.4)	102(42.5)	179(74.6)	61(25.4)	55(22.9)	84(35.0)	194(80.8)	46(19.2)	24(10.0)	142(59.2)
χ²值		0.364	0.158	2.653	0.019		0.149	0.007	2.568		0.070	0.052
P值		0.546	0.691	0.103	0.999		0.700	0.934	0.463		0.791	0.820

组别	例数		白细胞计数 (×10⁹/L)		血红蛋白 (g/L)		NLR		eGFR[ml·min^-1· (1.73 m²)^-1]		空腹血糖 (mmol/L)		血小板计数 (×10⁹/L)		TC (mmol/L)		TG (mmol/L)
MACE组	35		11.21 (7.35,15.07)		135 (123,151)		7.217 (5.556,10.339)		89.57 (56.69,99.73)		5.94 (5.22, 7.31)		204 (168,258)		4.52 (4.02,5.03)		1.23 (0.93,1.92)
非MACE组	240		9.94 (7.87,12.75)		143 (129,155)		5.04 (3.575,7.362)		92.86 (81.77,102.77)		5.85 (4.99,7.37)		222 (188, 269)		4.5 (3.95,5.20)		1.32 (0.94,1.94)
Z值			-1.095		-1.861		-4.025		-2.337		-0.271		-1.161		-0.341		-0.404
P值			0.273		0.063		<0.01		0.019		0.787		0.245		0.733		0.686
组别		例数		HDL-C (mmol/L)		LDL-C (mmol/L)		脂蛋白a (mg/L)		CK-MB (U/L)		NT-proBNP (μg/L)		尿酸 (μmol/L)		LVEF (%)
MACE组		35		0.96 (0.86,1.19)		3.01 (2.56,3.31)		251.00 (101.10,502.90)		164 (83.7,290.6)		763 (464,1455)		359.6 (297.6,407.5)		54 (44, 59)
非MACE组		240		1.00 (0.87,1.12)		2.95 (2.52, 3.48)		212.64 (105.80,389.30)		120.50 (54, 235.07)		610.7 (354, 1152)		320.10 (267.5,394.5)		55 (48, 59)
Z值				-0.297		-0.444		-0.820		-1.686		-1.457		-1.772		-0.944
P值				0.767		0.657		0.412		0.092		0.145		0.076		0.345