新型炎症指标对急性ST段抬高型心肌梗死患者冠状动脉病变程度及不良预后的评估

The evaluation value of novel inflammatory index in the severity and adverse prognosis after intervention in patients with ST segment elevation myocardial infarction

目的检测新型炎症指标系统免疫炎症指数(SII)对急性ST段抬高型心肌梗死(STEMI)患者冠状动脉(冠脉)病变程度及不良预后的评估。方法选取重庆医科大学附属璧山医院于2018年1月至2020年3月于住院期间接受经皮冠状动脉介入治疗(PCI)的272例STEMI患者。根据SII的中位数(621.38)进行二等分组,分为低SII组(SII<621.38)和高SII组(SII≥621.38),收集两组患者的临床数据,分析SII与STEMI患者PCI术后不良预后的关系。结果与低SII组患者比较,高SII组患者的年龄和心率更高,血压更低,合并高血压病病史和2型糖尿病史的比例更大,发生MACE事件的比例更高(P<0.05)。与低SII组患者比较,高SII组STEMI患者的白细胞计数、中性粒细胞计数、血小板计数、Gensini评分、GRACE评分、高敏C反应蛋白(hs-CRP)、血糖、左室射血分数(LVEF)和肌酐含量更高(P<0.05),而淋巴细胞计数更低(P<0.05)。相关性分析显示,SII与Gensini评分、GRACE评分均呈显著正相关性(P<0.05)。相较于低SII组,高SII组患者MACE事件的发生率明显升高(P<0.05)。ROC曲线结果表明,SII联合GRACE评分对STEMI患者PCI术后MACE的预测价值高于二者单独应用,AUC为0.935。结论SII联合GRACE评分在评估急性心肌梗死患者冠脉病变程度及PCI术后不良预后方面,具有良好的预测价值。

Objective To assess the the prognostic and diagnostic value of systemic immune-inflammation index(SII)in evaluating coronary artery disease severity and adverse outcomes following percutaneous coronary intervention(PCI)in patients with ST-segment Elevation Myocardial Infarction(STEMI).Methods From January 2018 to March 2020,272 STEMI patients who underwent PCI during their hospitalization at our institution were selected.These patients were divided into two groups based on the median SII value of 621.38:a low SII group(SII<621.38)and a high SII group(SII≥621.38)Clinical data were collected,and the relationship between SII levels and adverse post-intervention outcomes in STEMI patients was analyzed.Results Patients in the high SII group were found to be older and to have higher heart rates and lower blood pressures.They also had a greater prevalence of hypertension and type 2 diabetes,as well as a higher incidence of Major Adverse Cardiovascular Events(MACE)(P<0.05).Compared to the low SII group,the high SII group exhibited elevated levels of white blood cell,neutrophils,platelets,Gensini score,GRACE score,high-sensitivity C-reactive protein(hs-CRP),Glu,left ventricular ejection fraction(LVEF),and creatinine,with a reduction in lymphocyte counts(P<0.05).Correlation analyses demonstrated a significant positive relationship between SII andboth Gensini and GRACE scores(P<0.05).Kaplan-Meier analysis showed that the rate of MACE occurrence was significantly higher in the high SII group(P<0.05).The combination of SII and GRACE scores has a higher predictive value for MACE after PCI in STEMI patients compared to the two alone,with an AUC of 0.935.Conclusion The combination of SII and GRACE score has good predictive value in evaluating the degree and adverse prognosis in patients with STEMI.