急性ST段抬高型心肌梗死患者淋巴细胞/单核细胞比值与PCI术后左心室重构和心血管事件的相关性研究

Association of lymphocyte/monocyte ratio with left ventricular remodelling and cardiovascular events after PCI in patients with acute ST-segment elevation myocardial infarction

目的探讨急性ST段抬高型心肌梗死(ASTEMI)患者淋巴细胞/单核细胞比值(LMR)与经皮冠状动脉介入治疗(PCI)后左心室重构(LVR)和主要心脏不良事件(MACE)的相关性。方法选取2017年1月至2019年1月于葫芦岛市中心医院收治的急性ST段抬高型心肌梗死行PCI的患者280例作为研究对象。收集并对比所有患者PCI术前、出院时及出院后第6个月时LMR、左心室舒张末期容积指数(LVEDVI)差异,并用Pearson法分析LMR与LVEDVI的关系;根据出院后第6个月行心脏超声结果(第6个月LVEDVI较出院时LVEDVI增加≥20%作为LVR评判标准)将患者分为LVR组(n=56)和无LVR组(n=224),绘制受试者工作特征曲线(ROC)评估出院时LMR对LVR的预测价值;收集2020年6月止所有患者的主要心脏不良事件(MACE)发生情况,绘制ROC曲线探讨出院时LMR对MACE的预测价值,以该阈值为界点分为LMR高值组(n=120)和LMR低值组(n=160),绘制KaplanMeier生存曲线并以Log-rank检验对比两组生存率。结果ASTEMI患者PCI术前、出院时和出院后第6个月时LMR和LVEDVI比较,差异均有统计学意义(P<0.001)。经Pearson相关分析得知,ASTEMI患者PCI术前、出院时和出院后第6个月均LMR与LVEDVI均呈明显负相关(r=-0.382、-0.351、-0.377,P<0.001)。绘制ROC曲线分析发现,出院时LMR可预测ASTEMI患者PCI术后LVR发生情况(P=0.027),在最佳截断值3.35时其灵敏度和特异度分别为82.5%和41.3%;出院时LMR可预测ASTEMI患者PCI术后MACE发生情况(P=0.016),在最佳截断值3.94时,其灵敏度和特异度分别为84.2%和38.5%。绘制Kaplan-Meier生存曲线分析得知,LMR高值组MACE总发生率(5.00%)低于LMR低值组(16.25%),差异有统计学意义(P=0.003)。结论ASTEMI患者不同时间点LMR与LVEDVI密切相关,有望成为预测PCI术后LVR和MACE发生的重要指标,且LMR越低,MACE发生率越高。

Objective To investigate the relationship between lymphocyte/monocyte ratio(LMR),left ventricular remodeling(LVR)and major adverse cardiac events(MACE)in patients with acute ST segment elevation myocardial infarction(ASTEMI).Methods 280 patients with acute ST-segment elevation myocardial infarction who underwent PCI from January 2017 to January 2019 in huludao central hospital were selected as the research objects.The differences between LMR and LVEDVI before PCI,at discharge and 6 months after discharge were collected and compared,and the relationship between LMR and LVEDVI was analyzed by the Pearson method.The patients were divided into LVR(n=56)and non-LVR(n=224)according to the results of echocardiography at 6 months after discharge(the LVEDVI increased by more than 20%at the 6th month compared with that at the time of discharge was taken as the LVR criterion).As of June 2020,the occurrence of major adverse cardiac events(MACE)in all patients was collected,ROC curve was drawn to explore the predictive value of LMR on mace at discharge,and the high LMR group(n=120)and low LMR group(n=160)were divided into two groups,Kaplan Meier survival curve was drawn,and the survival rates of the two groups were compared by log-rank test.Results There were significant differences in LMR and LVEDVI among ASTEMI patients before PCI,at discharge and 6 months after discharge(P<0.001).Pearson correlation analysis showed that LMR was negatively correlated with LVEDVI before PCI,after PCI and at discharge(r=-0.382/-0.351/-0.377,P<0.001).The ROC curve analysis showed that LMR could predict the incidence of LVR in ASTEMI patients after PCI(P=0.027),and the sensitivity and specificity were 82.5%and 41.3%respectively at the best cutoff value of 3.35;the sensitivity and specificity of LMR were 84.2%and 38.5%respectively when the optimal cutoff value was 3.94.Kaplan Meier survival curve analysis showed that the total incidence of mace in the high LMR group(5.00%)was lower than that in the low LMR group(16.25%)(P=0.003).Conclusion LMR is closely related to LVEDVI in ASTEMI patients at different time points,which is expected to be an important indicator to predict the occurrence of LVR and mace after PCI,and the lower the LMR,the higher the incidence of MACE.