摘要
目的 研究急性ST段抬高型心肌梗死（ST-segment elevation myocardial infarction,STEMI）患者冠状动脉侧支循环（coronary collateral circulation,CCC）形成的预测因素及与血清炎性标志物的相关性。方法 选择初发STEMI患者885例,按照CCC形成与否分为CCC形成组679例和CCC未形成组206例,再根据具体CCC Rentrop分级分为CCC 0级组679例、CCC 1级组52例、CCC 2级组90例和CCC 3级组64例。比较各组血清炎性标志物血小板平均容积（MPV）、白细胞计数、中性粒细胞/淋巴细胞比值（NLR）、超敏C反应蛋白（hs CRP）水平,采用多因素logistic回归分析评价CCC未形成的影响因素,再采用受试者工作特征曲线（receiver operating characteristic,ROC）分析影响因素对CCC未形成的预测价值。结果 CCC未形成组术前hs CRP、MPV、白细胞计数、中性粒细胞计数和NLR明显高于CCC形成组,差异均有统计学意义（P〈0.01）。随着CCC分级的升高,hs CRP、MPV、中性粒细胞计数和NLR逐渐降低（P〈0.05或P〈0.01）。多因素logistic回归分析结果示：MPV[OR=2.966,95%可信区间（CI）：2.072~4.244,P〈0.001]、NLR（OR=4.652,95%CI：2.966~7.296,P〈0.001）和hs CRP（OR=1.019,95%CI：1.003~1.036,P=0.018）是CCC未形成的独立影响因素。ROC分析结果示,MPV、NLR和hs CRP联合检测对CCC未形成诊断的最佳界值为0.782,敏感度为87.6%,特异度为87.5%,曲线下面积为0.949,95%CI为0.931~0.966。结论 MPV、NLR和hs CRP联合检测对STEMI患者CCC未形成可能有一定的预测价值,三者联合检测价值优于单独检测。
Objective To study the predictor for coronary collateral circulation （CCC） in patients with acute ST-seg- ment elevation myocardial infarction （STEMI） and the relationship between CCC and the serum inflammatory markers. Meth- ods A total of 885 patients with incipient STEMI were enrolled and according to the CCC formation or not, divided into the CCC formation group 679 cases and CCC non-formation group 206 cases, and according to the Rentrop CCC classification, di- vided into CCC 0 grade group 679 cases, CCC 1 grade group 52 cases, CCC 2 grade group 90 cases, CCC 3 grade group 64 cases. The serum inflammatory markers, including mean platelet volume （MPV）, and neutrophil/lymphocyte ratio （NLR） and high-sensitivity c-reactive protein （hsCRP） were measured. Multivariate logistic regression analysis was performed to identify independent variables. The receiver operating characteristic （ROC） was used to analyze the factors on the CCC forma- tion. Results The MPV, NLR and hsCRP were significantly higher in CCC non-formation group, compared with that of CCC formation group （P 〈 0. 01 ）. With the increase of CCC classification, hsCRP, MPV, neutrophil counts and NLR gradually decreased （ P 〈 0.05 or P 〈 O. 01 ）. In multivariate logistic regression analysis, MPV （ OR = 2. 966,95 % CI ： 2. 072-4. 244, P〈0.001）, NLR （OR =4.652,95% CI：2.966-7.296,P〈0.001） and hsCRP （OR=1.019,95% CI：1.003-1.036,P= 0. 018） were independent predictors for poor CCC. The receiver-operating characteristic curve （ROC） analysis for MPV,NLR, and hsCRP combined in predicting poor CCC showed the best border index of 0. 782, of sensitivity of 87.6% , specifici- ty of 87.5% , and AUC = 0. 949, 95% CI：0. 931-0. 966. Conclusion The results suggest that MPV, NLR and hsCRP com- bined detection in poor CCC development has certain predictive value in patients with STEMI.
出处
《临床误诊误治》
2016年第1期75-79,共5页
Clinical Misdiagnosis & Mistherapy
关键词
心肌梗死
冠状血管
侧支循环
血小板平均容积
超敏C反应蛋白
Myocardial infarction
Coronary vessel
Collateral circulation
Mean platelet volume
High-sensitivityC-reactive protein
