休克指数与血小板分布宽度预测中老年急性心肌梗死患者中远期预后的临床价值

Clinical Value of Shock Index and Platelet Distribution Width in Predicting Medium and Long-term Prognosis of Middle-aged and Elderly Patients with Acute Myocardial Infarction

目的探讨休克指数(shock index,SI)与血小板分布宽度(platelet distribution width,PDW)预测中老年急性心肌梗死(acute myocardial infarction,AMI)患者中远期预后的临床价值。方法选取2014年12月—2019年3月收治的2376例中老年AMI,依据随访期间是否出现终点事件分为预后不良组415例与预后良好组1961例。比较两组一般资料、入院时临床特征、治疗情况,采用多因素Cox回归分析观察影响中老年AMI患者中远期预后的相关因素,利用受试者工作特征(ROC)曲线分析SI、PDW预测中老年AMI患者中远期预后的临床价值。结果与预后良好组比较,预后不良组年龄>65岁、合并高血压病、Killip分级为Ⅲ或Ⅳ级所占比例升高,收缩压、舒张压降低,SI、PDW水平升高,差异有统计学意义(P<0.01);两组治疗情况比较差异无统计学意义(P>0.05)。多因素Cox回归分析结果显示,年龄、SI、PDW是影响中老年AMI患者中远期预后的相关因素(P<0.05或P<0.01)。ROC曲线分析显示,PDW以15.50%为临界值,预测中老年AMI患者中远期预后不良的曲线下面积(AUC)为0.756,敏感度为56.62%,特异度为86.38%;SI以0.65为临界值,预测中老年AMI患者中远期预后不良的AUC为0.793,敏感度为86.27%,特异度51.50%;两者联合预测中老年AMI患者中远期预后不良的AUC为0.855,敏感度为89.40%,特异度为95.21%。结论SI、PDW是影响中老年AMI患者中远期预后的相关因素,两者联合检测预测中老年AMI患者中远期预后不良的临床价值较高。

Objective To explore the clinical value of shock index(SI)combined with platelet distribution width(PDW)in predicting medium-and long-term prognosis of acute myocardial infarction(AMI)patients.Methods A total of 2376 middle-aged and elderly patients with AMI admitted from December 2014 to March 2019 were selected and divided into poor prognosis group(n=415)and good prognosis group(n=1961)according to the presence or absence of end-point event during follow-up.The general data,and clinical characteristics and treatment status of the two groups at admission were compared,and multivariate Cox regression analysis was used to observe the related factors affecting the medium-and long-term prognosis of middle-aged and elderly patients with AMI.Receiver operating characteristic curve(ROC)was used to analyze the predictive value of SI and PDW in poor medium-and long-term prognosis in elderly AMI patients.Results Compared with the good prognosis group,the percentage of age>65 years,combined high blood pressure,and Killip gradesⅢtoⅣin the poor prognosis group was increased,systolic and diastolic blood pressure was decreased,and SI and PDW levels were increased(P<0.01).There was no statistically significant difference in treatment between the two groups(P>0.05).Multivariate Cox regression analysis results showed that age,SI,and PDW were related factors that affected the medium-and long-term prognosis of middle-aged and elderly patients with AMI(P<0.05 or P<0.01).ROC curve analysis showed that PDW of 15.50%was the cut-off value.AUC for predicting poor medium-and long-term prognosis in AMI patients was 0.756,and sensitivity and specificity were 56.62%and 86.38%respectively.SI of 0.65 was the cut-off value,the AUC for predicting poor medium-and long-term prognosis in middle-aged and elderly AMI patients was 0.793,with the sensitivity of 86.27%and the specificity of 51.50%.The AUC of combined detection of the two was 0.855,the sensitivity was 89.40%,and specificity was 95.21%.Conclusion SI and PDW are related factors impacting medium-and long-term prognosis in middle-aged and elderly AMI patients.Combined detection has a higher clinical value in the prediction of poor medium-and long-term prognosis in AMI patients.