WMR、RDW、NLR水平与急性心肌梗死患者PCI术后发生主要不良心血管事件的关系

Relationship between WMR,RDW and NLR levels and MACE after percutaneous coronary intervention in AMI patients

目的分析白细胞计数与平均血小板体积比值(WMR)、红细胞分布宽度(RDW)、中性粒/淋巴细胞比值(NLR)水平与急性心肌梗死(AMI)发病人群经皮冠状动脉介入治疗(PCI)术后主要不良心血管事件(MACE)发生的关系。方法选取2018年1月—2019年12月海南省人民医院收治的262例AMI患者,均行PCI术,根据术后30 d内是否发生MACE分为MACE组和非MACE组。收集患者病历资料,应用全自动血细胞分析仪检查血常规,计算WMR、NLR,比较两组患者术前WMR、RDW、NLR水平。绘制受试者工作特征(ROC)曲线,分析WMR、RDW、NLR预测AMI患者PCI术后发生MACE的效能。采用多因素Logistic回归模型分析AMI患者PCI术后发生MACE的独立危险因素。结果MACE组术前WMR、RDW、NLR水平高于非MACE组(P<0.05)。WMR预测术后发生MACE的截断值为1404.25×10^(-6)/L^(2),AUC为0.916,特异性为88.69%(95%CI:0.832,0.927),敏感性为91.11%(95%CI:0.871,0.943);RDW预测术后发生MACE的截断值为13.81%,AUC为0.808,特异性为83.93%(95%CI:0.782,0.883),敏感性为82.22%(95%CI:0.776,0.875);NLR预测术后发生MACE的截断值为5.66,AUC为0.832,特异性为91.71%(95%CI:0.886,0.944),敏感性为86.67%(95%CI:0.822,0.904)。多因素Logistic回归分析结果显示,WMR[■=2.818(95%CI:1.493,5.318)]、RDW[■=1.613(95%CI:1.098,2.368)]、NLR[■=2.643(95%CI:1.344,5.198)]是AMI患者PCI术后发生MACE的独立危险因素(P<0.05)。结论AMI患者术前WMR、RDW、NLR处于高水平状态,均可作为PCI术后发生MACE的危险因素,对于MACE的早期预测有一定临床价值。

Objective To analyze the relationship between white blood cell count to mean platelet volume ratio(WMR),red cell distribution width(RDW),and neutrophil to lymphocyte ratio(NLR)levels and major adverse cardiovascular events(MACE)after percutaneous coronary intervention(PCI)in acute myocardial infarction(AMI)patients.Methods A total of 262 AMI patients who were admitted to our hospital from January 2018 to December2019 and treated with PCI were enrolled.According to whether MACE occurred within 30 days after operation,they were divided into MACE group and non-MACE group.The medical records of these patients were collected,and the automatic blood cell analyzer was applied for blood routine examination to measure RDW and to calculate WMR and NLR.Preoperative WMR,RDW,and NLR levels were compared between the two groups.Receiver operating characteristic(ROC)curve was plotted to analyze the efficacy of WMR,RDW and NLR in predicting MACE in AMI patients after PCI.Multivariate Logistic regression analysis was performed to determine the independent risk factors for MACE after PCI.Results The preoperative levels of WMR,RDW,and NLR in the MACE group were higher than those in the non-MACE group(P<0.05).The optimal cut-off value of WMR for predicting MACE after PCI was 1,404.25×10^(-6)/L^(2),where the area under the ROC curve(AUC)was 0.916,the specificity was 88.69%(95%CI:0.832,0.927),and the sensitivity was 91.11%(95%CI:0.871,0.943).The optimal cut-off value of RDW for predicting MACE after PCI was 13.81%,where the AUC was 0.808,the specificity was 83.93%(95%CI:0.782,0.883),and the sensitivity was 82.22%(95%CI:0.776,0.875).In addition,the optimal cut-off value of NLR for predicting the MACE after PCI was 5.66,where the AUC was 0.832,the specificity was 91.71%(95%CI:0.886,0.944),and the sensitivity was 86.67%(95%CI:0.822,0.904).Multivariate Logistic regression analysis showed that WMR[■=2.818(95%CI:1.493,5.318)],RDW[■=1.613(95%CI:1.098,2.368)],and NLR[■=2.643(95%CI:1.344,5.198)]were risk factors for MACE after PCI in AMI patients(P<0.05).Conclusions High levels of preoperative WMR,RDW and NLR are risk factors and of predictive value for MACE after PCI in AMI patients.