血小板与淋巴细胞比值对老年急性心肌梗死患者冠状动脉介入术后造影剂肾病发生的预测价值

The predictive value of the platelet/lymphocyte ratio for contrast-induced nephropathy after percutaneous coronary intervention in older patients with acute myocardial infarction

目的探讨血小板与淋巴细胞比值（PLR）对老年急性心肌梗死患者冠状动脉介入治疗（PCI）术后造影剂。肾病（CIN）发生的预测价值。方法前瞻性连续选取2013年1月至2015年6月至我院就诊并行急诊PCI的老年急性心肌梗死患者（年龄〉60岁）768例，评估术前PLR及术后72h内血肌酐水平变化。CIN定义为应用造影剂48～72h内肌酐升高≥44．2μmol／L，或较基础水平升高25％以上。将患者分为CIN组108例（14．1％）及非CIN组660例（85．9％），分析两组患者间的基线资料差异，采用多因素Logistic回归分析评价PLR与CIN的相关性，并采用受试者工作特征（R0c）曲线法进一步评估PLR对CIN发生的预测价值。结果CIN组PLR142．8±33．2高于非CIN组123．5±36．9（t=5．08，P〈0．01），多因素分析结果显示，PLR是发生CIN的独立危险因素（OR=3．85，95％CI：1．44～8．24，P〈0．01），其他因素包括肾功能降低、糖尿病和胱抑素C水平亦是CIN发生的独立危险因素。当以PLR的检测截点〉119．3作为CIN的诊断点，PLR预测CIN的敏感性和特异性分别为76．9％和51．1％（曲线下面积ROC=0．655，95％CI：0．605～0．704，P〈0．01）。结论PLR是急性心肌梗死患者PCI术后CIN发生的独立危险因素，对CIN的早期诊断具有一定的预测价值。

Objective To assess the predictive value of the platelet/lymphocyte ratio （PLR） for contrast-induced nepbropathy （CIN） after percutaneous coronary intervention （PCI） in older patients with acute myocardial infarction （AMI）. Methods A total of 768 older AMI patients （〉60 yrs） undergoing urgent PCI, between Jan 2013 and Jun 2015, were enrolled to analyze the preoperative PLR and levels of serum creatinine 72 h after operation in a prospective cohort. CIN was defined by increased levels of serum creatinine （≥44.2 μmol/L or 25%above baseline） at 48-72 h after PCI. Patients were divided into 2 groups： the CIN group （108 cases, 14.1%） and the non-CIN group （660 cases, 85.9%）. Baseline data were compared between the two groups, and multivariate Logistic regression analysis was used to analyze the correlation of PLR with CIN. Furthermore, receiver operating characteristic （ROC） analysis was performed to determine the value of PLR for predicting the development of CIN. Results Baseline PLR was significantly higher in patients who developed CIN than in those who did not （142.8±33.2 vs. 123.5±36.9, respectively, t=5.08, P〈0.01）. Multivariate analysis showed that PLR Eodds ratio （OR） 3.85, 95% confidence interval （CI） ： 1.4± 8.24, P〈0. 011, renal dysfunction, diabetes mellitus and Cystatin C were independent predictors for CIN. When a PLR （〉119.3） predicted CIN was conducted, the sensitivity and specificity in PLR predicted CIN were 76.9% and 51.1% （AUCROC =0.655, 95% CI： 0.605-0.704, P〈0.01）,respectively. Conclusion The baseline PLR level is an independent predictor for the development of ClN in AMI after urgent PCI and has predictive value for early prognosis of CIN.