泛免疫炎症值与急性心肌梗死患者PCI术后左室重构的关系

Relationship between pan-immune inflammation value and left ventricular remodeling of patients with AMI

目的分析急性心肌梗死(AMI)患者泛免疫炎症值(PIIV)与经皮冠状动脉介入治疗(PCI)术后左室重构的关系。方法选取于住院期间接受PCI的AMI患者150例为AMI组、同期进行体检的健康成人150例为对照组,收集入选者的一般临床资料[性别、年龄和体质量指数(BMI)]、血细胞计数(中性粒细胞、淋巴细胞、单核细胞和血小板)、实验室检查数据[肌酸肌酶同工酶(CK-MB)、氨基末端脑钠素前体(NT-proBNP)、血糖和血脂],AMI患者分别于PCI术前、出院后第6个月时进行心脏超声检查获取左心室收缩末期容积(LVESV)、左室舒张末期容积指数(LVEDV)、左心室射出分率(LVEF);根据PIIV值的中位数(681.32),将AMI组患者分为低PIIV组(≤681.32)和高PIIV组(>681.32);于出院12个月内对AMI患者进行随访,以6个月内LVESV增加>15%为发生左室重构,收集患者12个月内再发AMI、心源性再住院和全因死亡;采用Pearson相关分析PIIV与LVEDV、LVESV和LVEF的相关性,ROC曲线分析PIIV评估AMI患者左室重构的价值,logistic回归分析AMI患者左室重构的影响因素。结果与对照组比较,AMI组患者的PIIV值升高(P<0.05);与低PIIV组比较,高PIIV组AMI患者的中性粒细胞计数、单核细胞计数、血小板计数、血糖、LVESV、LVEDV和LVEF更高,而淋巴细胞计数更低(P<0.05);与低PIIV组比较,高PIIV组AMI患者的左室重构、再发AMI和心源性再住院升高(P<0.05);PIIV与LVESV和LVEDV呈明显的正相关性(P<0.05),与LVEF呈显著负相关(P<0.05);ROC曲线提示PIIV预测AMI患者PCI术后左室重构的AUC为0.868(95%CI为0.821~0.915,P<0.05),其敏感性为89.2%、特异性为76.7%。结论PIIV在评估AMI患者PCI术后发生左室重构方面具有良好的预测价值。

Objective To observe the relationship between pan-immune inflammation value(PIIV)of left ventricular remodeling of patients with acute myocardial infarction(AMI)after the operation of percutaneous coronary intervention(PCI).Methods A total of 150 patients with AMI were selected as AMI group and 150 healthy adults as the control group.The PIIV levels were detected,and the correlation between the PIIV levels and left ventricular remodeling of the patients with AMI were analyzed.According to the median PIIV levels(681.32),the patients with AMI were divided into low PIIV group(≤681.32)and high PIIV group(>681.32).Results Compared with the control group,the PIIV value of AMI group increased significantly(P<0.05).Compared with low PIIV group,high PIIV group had higher white blood cell count,neutrophil count,monocyte count,platelet count,blood glucose,LVESV,LVEDV,and LVEF,while the lymphocyte count was lower(P<0.05).The ROC curve results showed that the AUC of PIIV predicting left ventricular remodeling of AMI patients was 0.868,with sensitivity of 89.2%and specificity of 76.7%.The results of the Logistic proportional risk model show that PIIV was a influencing factor for left ventricular remodeling of AMI patients after PCI.Conclusion PIIV is an independent predictor of left ventricular remodeling of AMI patients after PCI and has good predictive value.