外周血NLR、PLR、MLR联合血清sST2对急性冠脉综合征患者的预后评价价值

Appraisal Value of Prognosis of Peripheral Blood NLR,PLR,MLR Combined with Serum sST2 in Patients with Acute Coronary Syndrome

目的探讨外周血中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、血小板/淋巴细胞比值(platelets to lymphocytes ratio,PLR)、单核细胞/淋巴细胞比值(monocytes to lymphocytes ratio,MLR)联合血清可溶性生长刺激表达基因2(soluble growth ST imulation expressed gene 2,sST2)对急性冠脉综合征(acute coronary syndrome,ACS)患者的预后评价价值。方法纳入2018-12/2020-06月医院收治的156例ACS患者,均行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI),并在术后24 h检测外周血NLR、PLR、MLR、B型尿钠肽(B-type natriuretic peptide,BNP)及血清sST2水平。术后随访至2021-01月,根据患者随访期间是否发生主要心脏不良事件(major adverse cardiac events,MACE)分为预后不良组和预后良好组。采用单因素和多因素Logistic回归分析影响ACS患者预后的相关因素,绘制受试者工作特征(receiver operating characteristic,ROC)曲线分析NLR、PLR、MLR及血清sST2对ACS患者预后的评价价值。结果截至随访时间,156例患者中4例失访,113例预后良好,39例预后不良。预后不良组外周血NLR、PLR、MLR、BNP水平、血清sST2水平、全球急性冠状动脉事件(global register of acute coronary events,GRACE)评分、Killip分级Ⅳ级占比均较预后良好组升高,预后不良组左心室射血分数(left ventricular ejection fraction,LVEF)较预后良好组降低(P<0.05)。Logsitic回归分析显示,外周血NLR、PLR、MLR、血清sST2及GRACE评分均是影响ACS患者预后的危险因素(P<0.05)。ROC曲线分析显示,NLR、PLR、MLR及sST2联合检测对ACS患者预后的灵敏性为90.27%、特异性为64.10%、准确度为87.63%、曲线下面积(area under the curve,AUC)为0.871,4项指标联合检测的灵敏性、准确度均高于单独检测。结论外周血NLR、PLR、MLR及血清sST2均是影响ACS患者预后的危险因素,且4项联合检测对ACS患者预后具有较高的评价价值。

Objective To explore the evaluation value of prognosis of peripheral blood neutrophil to lymphocyte ratio(NLR),platelets to lymphocytes ratio(PLR),monocytes to lymphocytes ratio(MLR)combined with serum soluble growth ST imulation expressed gene 2(sST2)in patients with acute coronary syndrome(ACS).Methods A total of 156 patients with ACS admitted to author′s hospital from December 2018 to June 2020 were enrolled.All patients underwent percutaneous coronary intervention(PCI),and the levels of peripheral blood NLR,PLR,MLR,B-type natriuretic peptide(BNP)and serum sST2 were detected 24 hours after surgery.The patients were followed up to January 2021,and the patients were divided into poor prognosis group and good prognosis group according to whether major adverse cardiac events(MACE)occurred during the follow-up period.The related factors affecting the prognosis of ACS patients were analyzed by univariate and multivariate Logistic regression,and the evaluation values of NLR,PLR,MLR and serum sST2 on the prognosis of ACS patients were analyzed by the receiver operating characteristic(ROC)curve.Results As of the follow-up time,4 of the 156 patients were lost to follow-up,113 had good prognoses,while 39 had poor prognoses.The levels of peripheral blood NLR,PLR,MLR,BNP,serum sST2,global register of acute coronary events(GRACE)score and the proportion of Killip grade IV in the poor prognosis group were higher than those in good prognosis group,and the left ventricular ejection fraction(LVEF)in the poor prognosis group was lower than that in the good prognosis group(P<0.05).Logsitic regression analysis showed that peripheral blood NLR,PLR,MLR,serum sST2 and GRACE scores were all risk factors affecting the prognosis of ACS patients(P<0.05).ROC curve analysis showed that the sensitivity,specificity,accuracy and area under the curve(AUC)of combined detection of NLR,PLR,MLR and sST2 for the prognosis of ACS patients were 90.27%,64.10%,87.63% and 0.871 respectively.The sensitivity and accuracy of combined detection of 4 indicators were higher than that of single detection.Conclusion Peripheral blood NLR,PLR,MLR and serum sST2 are all risk factors affecting the prognosis of ACS patients,and the combined detection of 4 indicators has a high evaluation value for the prognosis of ACS patients.