多种血清学指标与老年急性心肌梗死患者经皮冠状动脉介入术后发生心力衰竭的相关性

Correlation between multiple serological indicators and the occurrence of heart failure after percutaneous coronary intervention in elderly patients with acute myocardial infarction

目的探讨多种血清学指标对老年急性心肌梗死(AMI)患者行经皮冠状动脉介入治疗(PCI)术后发生心力衰竭(HF)的预测价值。方法回顾性纳入276例老年AMI患者作为研究对象,根据6个月内是否发生HF,分为HF组65例和非HF组211例。采用多因素Logistic回归分析法筛选AMI合并HF的影响因素。采用受试者工作特征(ROC)曲线评估血清学指标预测HF的效能。结果HF组的年龄、尿酸、纤维蛋白原、超敏C反应蛋白(hs-CRP)、系统免疫炎症指数(SII)、白细胞介素-6(IL-6)水平高于非HF组,左心室射血分数、心肌梗死溶栓试验(TIMI)血流3级占比低于非HF组,差异具有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄(OR=1.401,95%CI:1.103~1.937)、hs-CRP(OR=1.428,95%CI:1.108~1.839)、SII(OR=1.645,95%CI:1.262~2.145)、尿酸(OR=1.376,95%CI:1.123~1.685)和TIMI血流分级(OR=0.502,95%CI:0.335~0.752)是AMI患者PCI术后合并HF的独立影响因素。ROC曲线显示,hs-CRP、SII和尿酸预测AMI患者PCI术后合并HF的曲线下面积(AUC)分别为0.694(95%CI:0.619~0.768)、0.854(95%CI:0.796~0.912)和0.716(95%CI:0.646~0.786),灵敏度分别为75.38%、81.54%和66.15%,特异度分别为57.32%、74.88%和73.93%。结论SII对老年AMI患者PCI术后发生HF的预测价值最高,其有助于辅助临床对HF高风险人群进行管理。

Objective To investigate the predictive effect of multiple serological indicators on the occurrence of heart failure(HF)after percutaneous coronary intervention(PCI)in elderly patients with acute myocardial infarction(AMI).Methods A retrospective study was conducted on 276 elderly AMI patients.Based on whether HF occurred within 6 months,they were divided into HF group(n=65)and non-HF group(n=211).Multivariate Logistic regression was used to screen the influencing factors of AMI complicated with HF.The receiver operating characteristic(ROC)curve was applied to evaluate the efficacy of serological indicators in predicting HF.Results Age,uric acid,fibrinogen,high-sensitivity C-reactive protein(hs-CRP),systemic immune-inflammation index(SII)and level of interleukin-6(IL-6)in the HF group were significantly higher than those in the non-HF group,while the left ventricular ejection fraction and the proportion of TIMI grade 3 blood flow in the HF group were significantly lower(P<0.05).Multivariate Logistic regression analysis showed that age(OR=1.401,95%CI,1.103 to 1.937),hs-CRP(OR=1.428,95%CI,1.108 to 1.839),SII(OR=1.645,95%CI,1.262 to 2.145),uric acid(OR=1.376,95%CI,1.123 to 1.685)and TIMI grade 3 blood flow(OR=0.502,95%CI,0.335 to 0.752)were independent influencing factors for HF after PCI in AMI patients.The ROC curve demonstrated that the area under the curve(AUC)of hs-CRP,SII and uric acid for predicting HF after PCI in AMI patients were 0.694(95%CI,0.619 to 0.768),0.854(95%CI,0.796 to 0.912)and 0.716(95%CI,0.646 to 0.786),respectively,with sensitivities of 75.38%,81.54%and 66.15%,and specificities of 57.32%,74.88%and 73.93%.Conclusion SII has the highest predictive value for HF after PCI in elderly AMI patients,which is helpful for assisting clinical management of high-risk HF populations.