摘要
目的 探讨术前不规则趋化因子(fractalkine,FKN)、中性粒细胞与淋巴细胞比值(neutrophil lymphocyte ratio,NLR)在急性心肌梗死合(acute myocardial infarction,AMI)合并射血分数保留型心力衰竭(heart failure with preserved ejection fraction,HFpEF)患者直接经皮冠状动脉介入(primary percutaneous coronary intervention,PCI)治疗后无复流中的预测价值及相关影响因素。方法 选取2018年1月至2020年10月河北北方学院附属第一医院收治的210例AMI合并HFpEF患者作为研究对象,根据PPCI治疗后是否发生复流而分为正常血流组(n=162)和无复流组(n=48)。对两组患者PPCI治疗前FKN和NLR进行比较,并绘制受试者工作特征曲线(receiver operating characteristic curve,ROC)探讨其预测价值;同时根据ROC分析中各指标截断值将研究对象又分为高FKN组和低FKN组、高NLR组和低NLR组;对比各组患者有无复流情况。先后通过单因素分析和Logistic回归分析探讨术后无复流的影响因素。结果 无复流组患者PPCI治疗前FKN和NLR均明显高于正常血流组,且差异有统计学意义(P<0.05)。ROC分析结果显示,术前NLR预测AMI合并HFpEF患者PPCI治疗后无复流的曲线下面积(area under the curve,AUC)是0.715(95%CI:0.684~0.746),截断值为3.86,此时特异度和敏感度最佳,分别为73.6%和68.5%。术前FKN预测AMI合HFpEF患者PPCI治疗后无复流的AUC是0.728(95%CI:0.697~0.769),截断值为4.17μg/L,此时特异度和敏感度最佳,分别为60.4%和75.2%;两者联合预测AMI合并HFpEF患者PCI治疗后无复流的AUC是0.868(95%CI:0.841~0.893),最佳特异度和敏感度分别为87.9%和64.7%。高FKN组和低FKN组PPCI治疗后无复流患者分别为22例和26例,两组比较差异有统计学意义(χ;=6.447,P=0.011)。高NLR组和低NLR组PPCI治疗后无复流患者分别为20例和28例,两组比较差异有统计学意义(χ;=5.228,P=0.022)。经单因素分析,正常血流组和无复流组在术前心肌梗死溶栓试验(thrombolysis
Objectives To investigate the predictive value of preoperative fractalkine(FKN)and neutrophil to lymphocyte ratio(NLR)in no reflow after percutaneous coronary intervention(PCI)in patients with acute myocardial infarction(AMI)and heart failure with preserved ejection fraction(HFpEF).Methods Totally 210 patients with AMI complicated with HFpEF were selected and divided into normal blood flow group(n=162)and no reflow group(n=48)according to whether reflow occurred after primary percutaneous coronary intervention(PPCI). FKN and NLR were compared between the two groups before PPCI,and receiver operating characteristic curve(ROC)was drawn to explore the predictive value. At the same time,according to the cut-off value of each index in ROC analysis,the subjects were divided into high FKN group and low FKN group,high NLR group and low NLR group,and whether there was reflow in each group was compared. Univariate analysis and Logistic regression analysis were used to explore the influencing factors of no reflow.Results blood flow group(P<0.05). The ROC analysis showed that the AUC of preoperative NLR in predicting no reflow after PPCI was 0.715(95%CI:0.684-0.746),and the cutoff value was 3.86 with the specificity and sensitivity were 73.6% and68.5%,respectively;the AUC of preoperative FKN in predicting no reflow after PPCI in patients with AMI and HFpEF was 0.728(95%CI:0.697-0.769),and the cut-off value was 4.17 μg/L with the specificity and sensitivity were 60.4%and 75.2%,respectively;the AUC of the two methods for predicting no reflow after PPCI was 0.868(95%CI:0.841-0.893),and the best specificity and sensitivity were 87.9% and 64.7%,respectively. There were 22 cases of no reflow after PPCI in high FKN group and 26 cases in low FKN group,the difference between the two groups was statistically significant(χ;=6.447,P=0.011);there were 20 cases of no reflow after PPCI in high NLR group and 28 cases in low NLR group and the difference between the two groups was statistically significant(χ;=5.228,P=0.022). By univariate
作者
孙志广
王春光
赵小祺
赵社海
姚楠
张爱婷
程佳媛
SUN Zhi-guang;WANG Chun-guang;ZHAO Xiao-qi;ZHAO She-hai;YAO Nan;ZHANG Ai-ting;CHENG Jia-yuan(Department of Cardiac Function,The First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China;School of Basic Medicine,Hebei North University,Zhangjiakou 075000,China;Mingde North Community Health Service Center,Qiaoxi District,Zhangjiakou 075000,China)
出处
《岭南心血管病杂志》
CAS
2022年第2期102-106,132,共6页
South China Journal of Cardiovascular Diseases
基金
河北省2019年度医学科学研究课题计划项目(项目编号:20190873)
河北北方学院附属第一医院2018年度医学科研课题计划项目(项目编号:1811032D-3)。
