CD16+单核细胞对中重度慢性缺血性二尖瓣关闭不全患者二尖瓣成形术后远期预后的预测价值

Predictive value of CD16+monocytes on long-term prognosis of patients with moderate to severe chronic ischemic mitral regurgitation after mitral angioplasty

目的探讨CD16+单核细胞对中重度慢性缺血性二尖瓣关闭不全(IMR)患者二尖瓣成形术后远期预后的预测价值。方法选择2015年1月至2017年1月多中心因中重度IMR行二尖瓣成形术的患者200例,随访3年,根据随访结局分为死亡组(26例)和生存组(174例)。分别于术前(T0)、术后1d(T1)、3d(T2)和7d(T3)检测患者外周血CD16+单核细胞比例;多因素Cox回归分析影响患者全因死亡和主要不良心血管事件(MACE)的独立危险因素;分析CD16+单核细胞比例与高敏C反应蛋白(hs-CRP)、左室射血分数(LVEF)的相关性;通过受试者工作特征曲线分析CD16+单核细胞比例预测患者术后死亡的最佳临界值;根据临界值将患者分为CD16+单核细胞高比例组和低比例组,绘制Kaplan-Meier生存曲线,比较两组患者3年生存率和MACE未发生率。结果死亡组患者的年龄、hs-CRP水平、二尖瓣瓣环扩张比例和T0~T3时CD16+单核细胞比例均显著高于生存组,而LVEF和左室舒张末期内径均显著低于生存组(均为P<0.05);hs-CRP升高、LVEF降低和CD16+单核细胞比例(T0)升高同为患者全因死亡和MACE发生的独立危险因素(均为P<0.05);CD16+单核细胞比例(T0)与hs-CRP呈显著正相关(RP=0.825,P=0.001),而与LVEF呈显著负相关(RP=-0.802,P=0.001);CD16+单核细胞比例(T0)预测患者术后死亡的最佳临界值为11.47%,CD16+单核细胞高比例组患者的3年生存率和MACE未发生率均显著低于低比例组(均为P<0.05)。结论术前CD16+单核细胞比例升高是中重度IMR患者全因死亡和MACE发生的独立危险因素,并可作为其二尖瓣成形术后远期预后的独立预测因子。

Objective To investigate the predictive value of CD16~+ monocytes on the long-term prognosis of mitral angioplasty in patients with moderate to severe chronic ischemic mitral regurgitation(IMR).Methods The 200 patients from multi-center who underwent mitral angioplasty due to moderate to severe IMR between January 2015 and January 2017 were enrolled in this study and followed up for 3 years.Patients were divided into the death group(26 cases) and the survival group(174 cases) based on the follow-up outcome.The proportion of CD16~+ monocytes was detected before operation(T0) and 1 d(T1),3 d(T2),7 d(T3) after operation.Multivariate Cox regression model was used to analyze independent risk factors affecting all-cause death and major adverse cardiovascular events(MACE).The correlation between the proportion of CD16~+ monocytes and high-sensitivity C-reactive protein(hs-CRP) and left ventricular ejection fraction(LVEF) was analyzed.Receiver operating characteristic(ROC) curve was used to explore the optimal cutoff value of the CD16~+ monocytes ratio for prediction of survival.According to the cutoff value,patients were divided into a CD16~+ monocyte high proportion group and a low proportion group.Kaplan-Meier analysis was used to compare the 3-year survival rate and the MACE incidence between the two groups.Results The average age,hs-CRP level,mitral annulus dilation ratio,and CD16~+ monocytes proportion in T0-T3 in the death group were significantly higher than those in the survival group,while LVEF and left ventricular end-diastolic diameter(LVEDD) were significantly lower than those in the survival group(all P<0.05).Increased hs-CRP,decreased LVEF and increased CD16~+ monocytes proportion in T0 were independent risk factors for all-cause death and MACE in patients(all P <0.05).CD16~+ monocytes proportion in T0 was significantly positively correlated with hs-CRP(RP=0.825,P=0.001) and significantly negatively correlated with LVEF(RP=-0.802,P=0.001).The optimal cut-off value of CD16~+monocyte proportion for prediction of death was 11.47%.The 3-year survival rate and non-MACE incidence in patients with high CD16~+ monocytes proportion in T0 were significantly lower than those in low proportion groups(both P<0.05).Conclusions Preoperative increase in the proportion of CD16~+ monocytes is an independent risk factor for all-cause death and MACE incidence in patients with moderate to severe IMR.It also could be used as an independent predictor for long-term prognosis after mitral valvuloplasty.