摘要
目的:ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者无复流的发生率高,同时无复流又与炎症密切相关。本研究探索全身免疫炎症指数(systemic immune inflammatory index,SII)对STEMI患者无复流发生的影响。方法:回顾性研究2020年1月至2023年1月,于西安交通大学第一附属医院诊断为STEMI患者546例。根据SII的四分位数分为四组:组1(SII<518.8)、组2(518.8≤SII<1096.2),组3(1096.2≤SII<2217.6),组4(SII≥2217.6)。研究的主要终点是无复流的发生。通过多元Logistic回归分析探究SII对无复流的影响,结果使用比值比(OR)和95%置信区间(CI)表示。使用亚组分析探究在不同亚组中SII对无复流结局的影响。绘制限制性立方样条函数(RCS)直观反映SII与无复流之间的关系。结果:随着SII的增高,患者无复流发生率显著增高[组1 vs.组2 vs.组3 vs.组4:14(10.2%)vs.20(14.7%)vs.26(19.1%)vs.36(26.3%),P=0.004]。整多元Logistic回归分析表明:随着SII的增加,患者无复流(组1作为参考;组2 OR=1.79,95%CI:0.79~4.19,P=0.169;组3 OR=2.40,95%CI:1.09~5.52,P=0.033;组4 OR=4.15,95%CI:1.97~9.28,P<0.001)的发生风险显著增加。RCS结果表明SII与无复流的关系是非线性的,无复流风险随着SII的上升而增加。亚组分析表明,所有亚组均无显著的交互作用。结论:SII作为临床易获取的指标,可预测STEMI患者无复流的发生风险,可能有助于及时识别STEMI术后无复流发生的高危患者,指导积极治疗,并改善患者预后。
Objective:Patients with ST-segment elevation myocardial infarction(STEMI)have a high incidence of no-reflow,which is closely associated with inflammation.This study explored the effect of the systemic immune inflammatory index(SII)on the incidence of no-reflow in STEMI patients.Methods:This was a retrospective cohort study,enrolling 546 patients with STEMI who met the study entry row criteria.The patients were divided into four groups according to the quartiles of SII:group 1(SII<518.8),group 2(518.8≤SII<1096.2),group 3(1096.2≤SII<2217.6),and group 4(SII≥2217.6).The primary endpoint of the study was the incidence of no-reflow.The effect of SII on no-reflow was explored by multivariate logistic regression analysis,and the results were expressed using ratio(OR)and 95%CI.Subgroup analysis was used to explore the effect of SII on the adverse outcome in different subgroups.Restricted cubic spline functions(RCS)were plotted to visualize the relationship between SII and no-reflow.Results:The incidence of no-reflow increased significantly with increasing SII[group 1 vs.group 2 vs.group 3 vs.group 4:14(10.2%)vs.20(14.7%)vs.26(19.1%)vs.36(26.3%),P=0.004].Multivariate logistic regression analysis showed that:as SII increased,the risk of no-reflow was significantly increased(group 1 as reference;group 2 OR=1.79,95%CI:0.79-4.19,P=0.169;group 3 OR=2.40,95%CI:1.09-5.52,P=0.033;group 4 OR=4.15,95%CI:1.97-9.28,P<0.001).The RCS indicated that the relationship between SII and no-reflow was nonlinear,and the risk of no-reflow increased with increasing SII.Subgroup analysis revealed no significant interactions across all subgroups.Conclusions:SII,as a clinically accessible index,had the potential to serve as a valuable predictor of no-reflow risk in STEMI patients.It may aid in identifying those at high risk for this complication and guide proactive treatment strategies to improve patient outcomes.
作者
马晨
张祎
张晶
刘亚东
余航
MA Chen;ZHANG Wei;ZHANG Jing;LIU Yadong;YU Hang(Department of Laboratory,Xi'an Jiaotong University First Affiliated Hospital Xi'an,Xi'an 710061,China)
出处
《心肺血管病杂志》
CAS
2023年第12期1219-1225,共7页
Journal of Cardiovascular and Pulmonary Diseases
关键词
急性心肌梗死
全身免疫炎症指数
无复流
冠心病
Acute myocardial infarction
Systemic immune inflammatory index
No-reflow
Coronary artery disease
