Hcy、NLR与急性心肌梗死PCI术后心律失常的相关性分析

Correlation between Hcy and NLR and arrhythmia after PCI intervention in patients with acute myocardial infarction

目的探讨同型半胱氨酸(Hcy)、中性粒细胞与淋巴细胞比值(NLR)与急性心肌梗死(AMI)经皮冠状动脉介入(PCI)术后心律失常的相关性。方法本研究为单中心、回顾性、观察性队列研究,纳入成都医学院第二附属医院·核工业四一六医院收治的无心律失常史的AMI患者112例,时间为2021年3月—2023年3月,随访12个月,统计112例AMI患者PCI术后心律失常发生率。比较心律失常组与非心律失常组基线特征、实验室指标、冠状动脉造影及超声心动图检查;运用单变量、多变量逻辑回归模型分析变量与心律失常发生的关系;绘制受试者工作特征(ROC)曲线检测Hcy、NLR单一及联合检测对心律失常的预测能力;将Hcy、NLR分别按照四分位数进行分组,并应用Mantel-Haenszel卡方检验,明确两指标与心律失常发生率之间是否存在线性关联。结果112例AMI患者,实际随访人数为110例。110例AMI患者PCI术后发生心律失常人数为28例,发生率为25.45%。心律失常组舒张压、糖尿病占比、Hcy、NLR、B型利钠肽(BNP)水平、左回旋支(LCX)占比、Killip分级≥Ⅲ级占比均高于非心律失常组;高密度脂蛋白胆固醇(HDL-C)、左室射血分数(LVEF)水平均低于非心律失常组(P<0.05)。单变量回归分析,上述指标与心律失常发生相关(P<0.05);行多变量分析之前,多重共线性分析表明,Hcy、NLR、LVEF、LCX及Killip分级≥Ⅲ级存在多重共线性。进一步选择上述变量行多变量分析,调整混杂因素后发现,高Hcy、NLR是AMI患者PCI术后心律失常发生的独立预测因子。多变量Logistic回归分析显示,其他显著预测因素包括LVEF、LCX及Killip分级≥Ⅲ级(P<0.05)。Hcy+NLR检测的曲线下面积(AUC)(95%CI)、敏感性、特异性分别为0.797(0.714~0.880)、88.26%、87.11%,均显著高于单一检测。Hcy、NLR与心律失常发生率之间存在线性关联(趋势P<0.001)。结论Hcy、NLR水平升高与AMI患者PCI术后心律失常发生具有显著相关性,且二者联合能够更精确地预测心律失常发生风险。

Objective Toinvestigate the correlation between homocysteine(Hcy)andneutrophil-to-lymphocyteratio(NLR)and arrhythmias after percutaneous coronary intervention(PCI)inacutemyocardialinfarction(AMI).Methods This was a single-centre,retrospective,observational cohort study that included 112 patients with AMI without a history of arrhythmia who were admitted to our hospital from March 2021 to March 2023.The incidence of post-PCI arrhythmias in 112 AMI patients was counted at 12 months of follow-up.The baseline characteristics,laboratory indexes,coronary coronary angiography and echocardiography were compared between the arrhythmia group and the non-arrhythmia group;the relationship between the variables and the incidence of arrhythmia was analyzed using univariate and multivariate logistic regression models;ROC curves was drew to test the predictive ability of Hcy and NLR for the single and combined detection of arrhythmia;group Hcy and NLR according to the quartiles respectively,and apply the Mantel-Haenszel chi-square test to clarify whether there is a linear correlation between the two indicators and the incidence of arrhythmia.Results There were 112 AMI patients,and the actual number of follow-up was 110.The number of arrhythmia after PCI in 110 AMI patients was 28,and the incidence rate was 25.45%.Diastolic blood pressure,percentage of diabetes mellitus,Hcy,NLR,BNP level,percentage of LCX,and percentage of Killip classification≥grade Ⅲ in the arrhythmia group were higher than those in the non-arrhythmia group;HDL-C,LVEF levels were lower than those in the non-arrhythmia group(P<0.05).On univariate regression analysis,the above indicators were associated with the occurrence of arrhythmias(P<0.05);before multivariate analysis was performed,multiple covariance analysis showed the presence of multiple covariance for Hcy,NLR,LVEF,LCX,and Killip classification≥grade Ⅲ.Therefore,the above variables were selected for multivariate analysis,and after adjusting for confounders,high Hcy and NLR were found to be independent predictors of arrhythmia occurrence after PCI in AMI patients.In addition,multivariate logistic regression analysis showed other significant predictors,including LVEF,LCX and Killip classification≥grade Ⅲ(P<0.05).The AUC(95%CI),sensitivity,and specificity of the Hcy+NLR assay were 0.797(0.714-0.880),88.26%,and 87.11%,respectively;all of which were significantly higher than the single assay.There was a linear correlation between Hcy,NLR,and the incidence of arrhythmias(P<0.001 for trend).Conclusion Elevated levels of Hcy and NLR are significantly correlated with the occurrence of post-PCI arrhythmias in patients with AMI,and the combination of the two tests can more accurately predict the risk of arrhythmia.