摘要
目的 探讨平均血小板体积与淋巴细胞比值(MPVLR)联合中性粒细胞与淋巴细胞比值(NLR)对急性ST段抬高型心肌梗死(STEMI)患者急诊行经皮冠状动脉介入治疗(PCI)术后发生短期心血管不良事件(MACE)的预测价值.方法 选取石河子大学医学院第一附属医院2017年7月至2018年12月明确诊断为急性STEMI并成功接受PCI的患者445例.分别根据入院时外周血MPVLR联合NLR的水平、全球急性冠脉综合征注册评分(GRACE)危险分层、短期MACE的发生情况进行分组,分析各组之间的差异.通过ROC曲线评估和比较MPVLR、NLR、MPVLR联合NLR对急性STEMI患者PCI术后发生短期MACE的预测效能;应用Kaplan-Meier法比较各组累计无MACE生存率;应用Cox回归模型分析急性STEMI患者PCI术后发生短期MACE的独立危险因素.结果 高MPVLR且高NLR组患者PCI术后发生无复流及短期MACE比率明显高于高MPVLR且低NLR组(23.73% vs.10.34%,22.88% vs.8.60%,P均<0.01)、低MPVLR且高NLR组(23.73% vs.9.84%,22.88% vs.9.84%,P均<0.01)、低MPVLR且低NLR组(23.73% vs.4.81%,22.88% vs.3.84%,P均<0.01).ROC曲线分析显示,MPVLR联合NLR、MPVLR、NLR预测STEMI患者PCI术后发生短期MACE的AUC(95% CI)分别为0.851(0.816 ~0.887)、0.800(0.755 ~0.845)、0.766(0.706~0.827),且MPVLR联合NLR与MPVLR、NLR比较差异均有统计学意义(分别为Z=2.172,P=0.025;Z=2.451,P=0.011).MPVLR与NLR存在明显的相关性(r=0.671,P<0.01).Kaplan-Meier法分析显示,高MPVLR且高NLR组患者累积无MACE生存率较其余三组明显降低(P Log-rank<0.001).多因素Cox回归模型分析显示,高MPVLR(HR 1.757,95%CI1.235~1.986,P=0.003)、高NLR(HR1.887,95% CI1.204~2.909,P<0.01)、高MPVLR联合高NLR(HR 2.048,95%CI1.414~3.589,P<0.01)均是急性STEMI患者短期MACE的独立预测因子.结论 入院早期MPVLR与NLR呈正相关,且高MPVLR、高NLR、高MPVLR联合高NLR均是急性STEMI患者PCI术后发生短期MACE的独立危险因素.MPVLR与NLR的联合应用能够更加高效地预测短期MA
Objective To investigate the predictive value of mean platelet volune to lymphocyte ratio(MPVLR)combined with neutrophil to lymphocyte ratio(NLR)for short-term adverse outcomes after percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 445 patients diagnosed as STEMI and successfully underwent PCI were selected from the first affiliated hospital of Shihezi university school of medicine from July 2017 to December 2018.Groups were divided according to the level of MPVLR combined with NLR in peripheral blood at admission,risk stratification of GRACE and occurrence of short-term MACE,and the differences between groups were analyzed.ROC curve was used to evaluate and compare the predictive efficacy of MPVLR,NLR,MPVLR combined with NLR for short-term MACE after PCI in acute STEMI patients.Kaplan-Meier method was used to compare the cumulative MACE-free survival rate of each group.Cox regression model was used to analyze the independent risk factors for short-term MACE after PCI in STEMI patients.Results Patients with high MPVLR combined with high NLR had significantly higher rates of no reflow and short-term MACE after PCI than those in other groups with high MPVLR combined with low NLR(23.13%vs 10.34%,22.88%vs 8.60%,all P<0.01),the group with low MPVLR combined with high NLR(23.13%vs 9.84%,22.88%vs 9.84%,all P<0.01),and the group with low MPVLR combined with low NLR(23.73%vs 4.81%,22.88%vs 3.84%,all P<0.01).ROC curve analysis showed that MPVLR combined with NLR,MPVLR,NLR predicts the AUC(95%CI)of short-term MACE after PCI in patients with acute STEMI was 0.851(0.816-0.887),0.800(0.755-0.845),0.766(0.706-0.827),respectively,and MPVLR combined with NLR was statistically different compared with MPVLR and NLR(Z=2.172,P=0.025;Z=2.451,P=0.011).There was a significant correlation between MPVLR and NLR(r=0.671,P<0.01).Kaplan-Meier analysis showed that the cumulative MACE-free survival rate of patients with high MPVLR and high NLR was significantly l
作者
陈鑫森
邵萌
张天
张鸿雁
李尧炜
海花
李桂花
Chen Xin-sen;Shao Meng;Zhang Tian;Zhang Hong-yan;Li Yao-wei;Hai Hua;Li Gui-hua(Department of Emergency,the First Affiliated Hospital of Shihezi University School of Medicine,Shihezi 832000,China)
出处
《中国急救医学》
CAS
CSCD
北大核心
2020年第1期35-43,共9页
Chinese Journal of Critical Care Medicine
