摘要
目的:探讨急性ST段抬高型心肌梗死(STEMI)患者的中性粒细胞/淋巴细胞比值(NLR与介入术后无复流的相关性。方法:选取2015年10月-2017年12月本院心内科收治的急性ST段抬高型心肌梗死患者198例,所有患者均行介入术治疗。术前根据TIMI分级标准评估结果分组,TIMI 0、Ⅰ级者为血管未通组,TIMIⅡ、Ⅲ级者为自发再通组。采用ROC曲线评估无复流发生的NLR临界值,并采用logistic回归法分析患者发生无复流的相关独立危险影响因素。结果:血管未通组中既往冠脉疾病史、介入术前TIMI血流分级0级、合并多支血管病变的比例均显著高于自发再通组(P<0.05);同时,血管未通组的空腹血糖、中性粒细胞百分比、肌酸激酶同工酶及NLR均显著高于自发再通组(P<0.05);血管未通组使用血栓抽吸比例、淋巴细胞百分比均低于自发再通组(P<0.05);ROC曲线分析显示曲线下面积(AUC)为0.79,当NLR值为3.2时其约登指数水平最高,提示NLR=3.2为其风险临界值;NLR水平(>3.2)是影响STEMI患者发生冠状动脉无复流的相关独立风险因素(P<0.05);除此之外,既往冠状动脉血管病史、血栓抽吸、介入术前TIMI血流分级也是影响STEMI患者发生冠状动脉无复流的相关风险因素(P<0.05)。结论:NLR>3.2是影响STEMI患者介入术后发生无复流的一项危险因素,对STEMI患者的早期危险分级具有一定参考意义。
Objective:To investigate the correlation between neutrophil/lymphocyte ratio(NLR)and no reflow after intervention in patients with acute ST-segment elevation myocardial infarction(STEMI).Method:198 patients with STEMI admitted to the department of cardiology of our hospital from October2015 to December 2017 were selected,they were treated with interventional therapy.TIMI grade 0 andⅠpatients were classified as vascular impassable group,and TIMI gradeⅡandⅢpatients were classified as spontaneous recanalization group according to the evaluation results of TIMI grading criteria before operation.The critical value of NLR without reflux was evaluated by ROC curve,and the independent risk factors were analyzed by logistic regression method.Result:Previous history of coronary artery disease and preoperative TIMI grade 0 with multiple vessel lesions in vascular impassable group were significantly higher than those in spontaneous recanalization group(P<0.05).The levels of fasting blood glucose,neutrophil percentage,creatine kinase isozyme and NLR in vascular impassable group were significantly higher than those in spontaneous recanalization group(P<0.05).The proportion of thrombus aspiration and lymphocyte percentage in vascular impassable group were lower than those in spontaneous recanalization group(P<0.05).ROC curve analysis showed that AUC was 0.79.When NLR value was 3.2,its Youden index level was the highest,suggesting that NLR=3.2 was its risk threshold.NLR level(>3.2)was an independent risk factor for coronary artery no-reflow in STEMI patients(P<0.05).In addition,previous history of coronary artery disease,thrombus aspiration and TIMI grade before interventional surgery were also related risk factors influencing the occurrence of non-reflux of coronary artery in STEMI patients(P<0.05).Conclusion:NLR>3.2 is a risk factor for no-reflow in STEMI patients after interventional therapy,which has a certain reference value for the early risk grade of STEMI patients.
作者
戴冬霞
梁建光
李艳丽
潘婉玲
李婉媚
DAI Dongxia;LIANG Jianguang;LI Yanli(Foshan Sanshui District People’s Hospital,Foshan 528100,China)
出处
《中国医学创新》
CAS
2019年第17期18-22,共5页
Medical Innovation of China
