中间型单核细胞比例对稳定性冠心病患者经皮冠状动脉介入治疗术后预后的影响

Impact of Intermediate Monocytes Ratio on Prognosis in Patients With Stable Coronary Artery Disease After Percutaneous Coronary Intervention

目的:探究外周血中间型单核细胞(IM,CD14++CD16+)比例对稳定性冠心病(SCAD)患者经皮冠状动脉介入治疗(PCI)术后预后的影响。方法:本研究为前瞻性观察研究,连续纳入2017年1月至2017年12月于成都医学院第一附属医院行PCI的258例SCAD患者,均于清晨空腹采集外周静脉血行三色流式细胞术分析单核细胞亚型。根据IM预测SCAD患者PCI术后1年全因死亡的最佳临界值,将患者分为IM高比例组、IM低比例组。观察随访两组患者1年预后情况,主要终点为全因死亡,次要终点为主要不良心脑血管事件(MACCE)及住院期间出血事件。结果:ROC曲线显示,IM比例预测SCAD患者PCI术后1年全因死亡的最佳临界值是10.37%(AUC=0.865,95%CI:0.783~0.924,P<0.01),敏感度为71.43%,特异度为87.63%。以此最佳临界值区分患者,IM高比例(≥10.37%)组69例,IM低比例(<10.37%)组189例。IM高比例组的吸烟、高血压、多支血管病变、慢性完全闭塞病变比例及年龄、低密度脂蛋白胆固醇、高敏C反应蛋白、尿酸水平均高于IM低比例组(P<0.01或0.05)。IM高比例组的全因死亡、MACCE、心血管死亡等事件的发生率均高于IM低比例组(P均<0.05),与Kaplan-Meier生存曲线结果一致。多因素Cox回归分析显示,IM比例是全因死亡(HR=1.715)、MACCE(HR=2.136)、心血管死亡(HR=1.382)的独立相关因素。结论:外周血IM比例对SCAD患者PCI术后全因死亡、MACCE等的发生具有一定预测价值。

Objectives: To investigate the impact of peripheral blood intermediate monocytes(IM, CD14++CD16+) on the prognosis of patients with stable coronary artery disease(SCAD) after percutaneous coronary intervention(PCI). Methods: This study was a prospective observational study. 258 consecutive SCAD patients who underwent PCI in The First Affiliated Hospital of Chengdu Medical College from January to December 2017 were enrolled. Peripheral venous blood was obtained from the patients in the morning after overnight fast, monocyte subsets were analyzed by flow cytometry. Patients were followed up for one year after PCI. The primary endpoint was all-cause death, and the secondary endpoint was major adverse cardiac and cerebrovascular events(MACCE) and bleeding during hospitalization. Results: The ROC curve showed that the optimal cut-off IM for all-cause death in SCAD patients after PCI was 10.37%(AUC=0.865, 95% CI: 0.783-0.924, P<0.01). The sensitivity was 71.43%, specificity was 87.63%. Based on the optimal cut-off value, the patients were divided into high IM ratio group(IM≥10.37%, n=69) and low IM ratio group(IM<10.37%, n=189). Baseline and interventional data showed that smoking, hypertension, multivessel disease and chronic total occlusion ratio, age, low density lipoprotein cholesterol, hypersensitive C-reactive protein, uric acid and other indicators were higher in high IM ratio group than in the low ratio group(P<0.01 or 0.05). The follow-up results showed that the incidence of all-cause death, MACCE, and cardiovascular death were significantly higher in high IM ratio group than in the low ratio group(P<0.05). Multivariate Cox regression analysis showed that the IM ratio was independently related to all-cause death(HR=1.715), MACCE(HR=2.136), cardiovascular death(HR=1.382).Conclusions: IM ratio in peripheral blood is an independent predictor of all-cause death and MACCE in SCAD patients after PCI.