中性粒细胞、淋巴细胞及血小板相关参数对ST段抬高型心肌梗死患者PCI术后不良事件发生的影响

Effects of Neutrophil, Lymphocyte and Platelet Related Parameters on the Incidence of Adverse Events in Patients with ST-segment Elevation Myocardial Infarction after PCI

目的:研究中性粒细胞、淋巴细胞及血小板相关参数对ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入(PCI)术后不良事件发生的影响。方法:选择2019年1月-2021年10月于上海交通大学医学院附属苏州九龙医院就诊并行PCI治疗的STEMI患者80例,收集整理患者临床资料、PCI术前实验室及超声检查指标,包括性别、年龄、既往病史、病变血管、发病至PCI时间、药物治疗情况、中性粒细胞计数、淋巴细胞计数、中性粒细胞与淋巴细胞比值(NLR)、血小板计数、平均血小板体积(MPV)、平均血小板体积与淋巴细胞比值(MPVLR)、血小板计数与淋巴细胞比值(PLR)及左心室射血分数(LVEF)。截止随访结束以发生不良事件患者为不良组,未发生不良事件患者为良好组,采用多因素logistic回归分析对影响STEMI患者PCI术后不良事件发生的因素进行分析。结果:共20例(25.00%)患者发生不良事件,其中再发心肌梗死2例(10.00%),复发心绞痛4例(20.00%),死亡5例(25.00%),恶性心律失常2例(10.00%),急性心力衰竭6例(30.00%),卒中1例(5.00%)。不良组年龄大于良好组(P<0.05),而两组间性别、既往病史、病变血管、药物治疗情况比较,差异均无统计学意义(P>0.05)。两组中性粒细胞计数、淋巴细胞计数、NLR、MPV、MPVLR、PLR及LVEF比较,差异均有统计学意义(P<0.05),而血小板计数比较,差异无统计学意义(P>0.05)。多因素logistic回归分析结果显示,中性粒细胞计数、淋巴细胞计数、NLR、MPV、MPVLR、PLR及LVEF均为STEMI患者PCI术后不良事件发生的独立影响因素(P<0.05)。结论:除LVEF外,PCI术前中性粒细胞计数、淋巴细胞计数、NLR、MPV、MPVLR及PLR亦为STEMI患者PCI术后不良事件发生的独立影响因素,对存在危险因素的患者应加强随访监测及干预。

Objective: To investigate the effects of neutrophil, lymphocyte and platelet-related parameters on adverse events after percutaneous coronary intervention(PCI) in patients with ST-segment elevation myocardial infarction(STEMI). Method: A total of 80 STEMI patients treated with PCI in Suzhou Kowloon Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2019 to October 2021 were selected. The clinical data, laboratory and ultrasound indexes before PCI were collected and collated. Including gender, age,previous medical history, pathological vessels, time from onset to PCI, drug treatment, neutrophil count, lymphocyte count, neutrophil lymphocyte ratio(NLR), platelet count, mean platelet volume(MPV), mean platelet volume and lymphocyte ratio(MPVLR), platelet count and lymphocyte ratio(PLR) and left ventricular ejection fraction(LVEF).By the end of follow-up, patients with adverse events were selected as the adverse group, and those without adverse events were selected as the good group. Multivariate logistic regression analysis was used to analyze the factors affecting adverse events after PCI in STEMI patients. Result: A total of 20 patients(25.00%) had adverse events,including 2 cases(10.00%) of recurrent myocardial infarction, 4 cases(20.00%) of recurrent angina pectoris, 5 cases(25.00%) of death, 2 cases(10.00%) of malignant arrhythmia, 6 cases(30.00%) of acute heart failure, and 1 case(5.00%) of stroke. The age of the adverse group was higher than that of the good group(P<0.05), but there were no significant differences in gender, previous medical history, pathological vessels and drug treatment between the two groups(P>0.05). There were statistically significant differences in neutrophil count, lymphocyte count, NLR, MPV,MPVLR, PLR and LVEF between the two groups(P<0.05), while there was no statistically significant differences in platelet count(P>0.05). Multivariate logistic regression analysis showed that neutrophil count, lymphocyte count,NLR, MPV, MPVLR, PLR and LVEF were independent influencing factors for adverse events after PCI in STEMI patients(P<0.05). Conclusion: In addition to LVEF, neutrophil count, lymphocyte count, NLR, MPV, MPVLR and PLR before PCI are also independent influencing factors of adverse events after PCI in STEMI patients, follow up monitoring and intervention should be strengthened for patients with risk factors.