在急诊胸痛患者中急性炎症指数与入院即刻hs-cTNⅠ相关分析

Correlation analysis of acute inflammation indexs and Hs-cTNⅠ(T_0) in emergency patients with chest pain

目的:探讨急诊胸痛患者炎症指数变化,为早期缩小筛查急性心肌梗死提供有效预测指标。方法:纳入2016-11—2018-06期间就诊于我院的急诊胸痛患者310例,最终诊断为急性心肌梗死(AMI)患者169例,不稳定性心绞痛(UA)患者80例,并选择同期健康体检者61例作为健康对照组。采用直接化学发光免疫分析法检测3组患者入院即刻(T_0)血清hs-cTnⅠ值和一般生化检查。结果:(1)3组组间比较发现,AMI患者中N%、NLR、CRP指数均高于UA组、健康对照组;L%指数均低于UA组、健康对照组,差异均具有统计学意义。以年龄65岁分层后研究发现,≥65岁患者中UA组WBC、N%明显高于健康对照组;UA组L%明显低于健康对照组,差异均具有统计学意义。(2)以年龄65岁为界分组,组间比较炎症指数发现,AMI组、UA组内≥65岁患者中仅有NLR指数明显高于<65岁患者,且差异有统计学意义。而健康对照组内炎症指数比较差异无统计学意义。(3)以年龄分层,炎症指数与入院即刻(T_0)hs-cTnⅠ相关研究发现:在≥65岁AMI患者中:NLR与hs-cTnⅠ呈独立相关,Y=0.112NRL+0.034WBC+0.076N(F=6.366,P=0.013);在<65岁AMI患者中:NLR与hs-cTnⅠ呈独立相关关系,Y=3.832NRL+0.087WBC+0.020N-0.124L(F=10.147,P=0.003);而在UA组和健康对照组研究未发现NLR与hs-cTnⅠ呈独立相关的关系。结论:急诊胸痛患者,尤其≥65岁中老年患者,需同时结合NLR炎症指数,缩小急性心肌梗死筛查范围,警惕急性心肌梗死、心源性猝死的发生。

Objective:To explore the change of inflammatory indexes in emergency patients with chest pain,which may provide an effective screening predictive tool in patients of acute myocardial infarction.Method:A total of 310 chest paining patients were admitted to our hospital from 2016-11 to 2018-06.The patients were divided into3 groups.AMI group(n=169)、UA group(n=80)and the health control group(n=90).We detect hs-cTnⅠ(T0)with direct chemiluminescence immunoassay and other general biochemical examination indicators.Result:N%,NLR and CRP were significantly higher in AMI group than in UA group and health control group,L%index in AMI group was lower than UA group and health control group(P<0.01,respectively).Layered by age 65,WBC and N% were significantly higher in UA group than the healthy control group.The L% was significantly lower in UA group than the healthy control group(P<0.01,respectively).1 Layered by age 65,only NLR index was significantly higher in ≥ 65 AMI and UA group than that of<65 AMI and UA patients(P <0.05;P <0.01 respectively).There was no other inflammation indexes difference in the healthy control group.(3)Layered by age 65,in the≥ 65 AMI group:NLR independent positive correlate with hs-cTnⅠ(T0):Y=0.112 NLR+0.034 WBC+0.076 N(F=6.366,P=0.013).In the<65 AMI group:NLR independent positive correlate with hscTnⅠ(T0)too,Y=3.832 NRL+0.087 WBC+0.020 N-0.124 L(F=10.147,P=0.003);However,no independent correlation between NLR and hs-cTnⅠ(T0)was found in the UA group and the health control group.Conclusion:The emergency patients with chest pain,especially those aged 65 and older,need to combine the NLR index,reduce the screening range of acute myocardial infarction.Alert should be used for the occurrence of acute myocardial infarction and sudden cardiac death.