血清炎性标记物对急性心肌梗死患者冠状动脉介入术后无复流的预测价值

Value of serum inflammatory markers in predicting no reflow in AMI patients after PCI

目的研究急性ST段抬高型心肌梗死（STEMI）患者PCI术后无复流的血清炎性指标及其价值。方法选择行急诊冠状动脉造影和直接PCI的初发STEMI患者260例,按照TIMI分级分为A组209例（TIMI 3级）和B组51例（TIMI 0~2级）。比较2组中性粒细胞/淋巴细胞比值（NLR）、血小板平均容积（MPV）以及高敏C反应蛋白（hs-CRP）等指标,使用logistic多因素回归分析评价无复流的影响因素。结果 A组患者NLR、MPV、hs-CRP、替罗非班、症状至球囊时间、支架长度、住院期间病死率和术后1年病死率明显低于B组,差异有统计学意义（P〈0.05,P〈0.01）。logistic多因素回归分析显示,NLR（OR=1.941,95%CI：1.276~2.953,P=0.002）、MPV（OR=1.755,95%CI：1.269~2.427,P=0.001）和hs-CRP（OR=1.085,95%CI：1.031~1.141,P=0.002）是无复流的影响因素。结论 NLR、MPV和hs-CRP对于无复流可能有一定的预测价值。

Objective To study the value of serum inflammatory markers in predicting no reflow in STEMI patients after PCI.Methods Two hundred and sixty STEMI patients undergoing coronary angiography（CAG）and PCI were divided into group A（n=209）and group B（n=51）according to their TIMI flow grade.The neutrophil/lymphocyte ratio（NLR）,mean platelet volume（MPV）and high sensitivity C-reactive protein（hs-CRP）were compared between the two groups.The influencing factors of no reflow were analyzed by multivariate logistic regression analysis.Results The NLR,MPV,hs-CRP and tirofiban were significantly lower,the pain-balloon time and stent length were significantly shorter,the in-hospital mortality and 1-year mortality were significantly lower in group A than in group B（P〈0.05,P〈0.01）.Multivariate logistic regression analysis showed that NLR,MPV and hs-CRP were the influencing factors of no reflow in STEMI patients after PCI（OR=1.941,95%CI：1.276-2.953,P=0.002;OR=1.755,95%CI：1.269-2.427,P=0.001;OR=1.085,95%CI：1.031-1.141,P=0.002）.Conclusion NLR,MPV and hs-CRP can predict no reflow in STEMI patients after PCI.