外周血嗜酸粒细胞百分率联合高敏C反应蛋白对ST段抬高型心肌梗死患者PCI术后院内主要不良心脏事件的预测价值

Predictive value of peripheral blood eosinophil percentage combined with high sensitivity C-reactive protein for major adverse cardiac events in patients with ST segment elevation myocardial infarction after PCI

目的:研究嗜酸粒细胞百分率联合高敏C反应蛋白(EOS%-hsCRP)对ST段抬高型心肌梗死(STEMI)经皮冠状动脉介入治疗(PCI)术后院内主要不良心脏事件(MACEs)的预测价值。方法:回顾性分析2018年1月—2020年6月在溧阳市人民医院接受PCI的427例STEMI患者的临床资料,根据住院期间MACEs(心肌再梗死、严重的心力衰竭、恶性心律失常、心源性休克、心源性死亡)的发生情况,分为MACEs组(41例)与非MACEs组(386例)。比较MACEs组与非MACEs组患者的基线资料,通过受试者工作特征(ROC)曲线计算EOS%、hsCRP的最佳截点,分析EOS%-hsCRP与临床、实验室指标的关系,采用多因素Logistic回归分析影响STEMI患者院内MACEs发生的因素。结果:(1)MACEs组患者年龄、心率、入院时Killip≥Ⅲ级比例、中性粒细胞计数、hsCRP及血肌酐水平,显著高于非MACEs组(均P<0.05);MACEs组EOS%、左心室射血分数,显著低于非MACEs组(均P<0.05)。(2)EOS%-hsCRP预测STEMI患者院内发生MACEs的ROC曲线下面积(AUC)均高于单指标EOS%、hsCRP(Z=2.350,P=0.019;Z=2.910,P=0.004)。(3)EOS%、hsCRP最佳截点分别为0.2%、10.52 mg/L。患者分为3组:2分组(EOS%<0.2%,且hsCRP≥10.52 mg/L);1分组[(EOS%<0.2%,且hsCRP<10.52 mg/L)或(EOS%≥0.2%,hsCRP≥10.52 mg/L)];0分组(EOS%≥0.2%,且hsCRP<10.52 mg/L)。EOS%-hsCRP与年龄、缺血时间、心率、入院时Killip分级(≥Ⅲ级)、中性粒细胞计数、血肌酐、左心室射血分数及MACEs发生均有关(均P<0.05)。(4)入院时Killip≥Ⅲ级(OR=4.788,95%CI:1.165~19.683,P=0.030)、EOS%≥0.2%(OR=0.231,95%CI:0.057~0.939,P=0.041)、hsCRP≥10.52 mg/L(OR=4.625,95%CI:1.196~17.881,P=0.026)、EOS%-hsCRP 1分组(OR=6.692,95%CI:1.013~44.192,P=0.048)、EOS%-hsCRP 2分组(OR=7.632,95%CI:1.367~42.607,P=0.021)是STEMI患者PCI术后发生MACEs的独立危险因素。结论:EOS%-hsCRP对STEMI患者院内MACEs的发生具有一定的预测价值。

Objective: To investigate the predictive value of eosinophil percentage combined with high sensitivity C-reactive protein(EOS%-hsCRP) in predicting major adverse cardiac events(MACEs) after percutaneous coronary intervention(PCI) in patients with ST segment elevation myocardial infarction(STEMI). Methods: From January 2018 to June 2020, clinical data of 427 STEMI patients who received PCI in Liyang People’s Hospital were retrospectively analyzed. According to the incidence of MACEs(myocardial reinfarction, severe heart failure, malignant arrhythmia, cardiogenic shock and cardiac death) during hospitalization, the patients were divided into MACEs group(41 cases) and non-MACEs group(386 cases). The baseline data of MACEs group and non-MACEs group were compared. The optimal cut-off values of EOS% and hsCRP were calculated by receiver operating characteristic(ROC) curve. The relationship between EOS%-hsCRP and clinical and laboratory indexes was analyzed, and multivariate logistic regression was used to analyze the factors affecting the occurrence of MACEs in STEMI patients. Results:(1) Age, heart rate, proportion of Killip ≥ Ⅲ, neutrophil count, hsCRP and serum creatinine in MACEs group were significantly higher than those in non-MACEs group(all P<0.05);EOS% and left ventricular ejection fraction in MACEs group were significantly lower than those in non-MACEs group(all P<0.05).(2) The area under ROC curve(AUC) of EOS%-hsCRP in predicting MACEs in STEMI patients was higher than that of EOS% and hsCRP(Z=2.350, P=0.019;Z=2.910, P=0.004).(3) The optimal cut-off values of EOS and hsCRP were 0.2 mg/L and 10.52 mg/L, respectively. The patients were divided into three groups: Group 2 scores(EOS%<0.2%, and hsCRP ≥10.52 mg/L);Group 1 score([EOS%<0.2%, and hsCR P<10.52 mg/L) or [EOS%≥0.2%, and hsCRP≥10.52 mg/L]);Group 0 score(EOS%≥0.2%, and hsCR P<10.52 mg/L). EOS%-hsCRP was associated with age, ischemic time, heart rate, Killip grade(≥grade Ⅲ), neutrophil count, serum creatinine, left ventricular ejection fraction and MACEs(all P<0.05).(4) On admission, Killip ≥ Grade Ⅲ(OR=4.788, 95%CI: 1.165-19.683, P=0.030), EOS%≥0.2%(OR=0.231, 95%CI: 0.057-0.939, P=0.041), hsCRP ≥10.52 mg/L(OR=4.625, 95%CI: 1.196-17.881, P=0.026), EOS%-hsCRP 1 group(OR=6.692, 95%CI: 1.013-44.192, P=0.048), EOS%-hsCRP 2 group(OR=7.632, 95%CI: 1.367-42.607, P=0.021) was an independent risk factor for MACEs in STEMI patients after PCI. Conclusion: EOS%-hsCRP can predict the occurrence of MACEs in STEMI patients.