白细胞衍生炎症指标对再灌注损伤的预测价值

The predictive value of leukocyte-associated inflammatory markers for reperfusion injury

目的探讨中性粒细胞淋巴细胞比值等细胞衍生炎症指标对急性ST段抬高型心肌梗死(STEMI)再灌注损伤(IRI)的预测价值,及IRI对STEMI患者短期预后的相关性。方法连续收集2017年1月至2020年6月在该院住院并接受急诊PCI治疗的STEMI患者758例,依据介入治疗中是否发生IRI分为两组:IRI组285例,非IRI组473例。分析不同组别患者年龄、性别、身高、体质量、既往史、个人史及患者入院后24 h实验室检查结果,探讨其对STMEI介入治疗术中IRI的预测价值。所有患者出院后对其进行电话或门诊随访,记录主要心血管不良事件,分析IRI对STEMI患者短期预后的相关性。结果与非IRI相比,发生IRI组患者CRP、WBC、NEUT、PLT、NLR水平明显高于非IRI组,差异有统计学意义(P<0.05)。多因素Logistic逐步回归分析,结果示CRP、NLR、MLR是影响IRI发生的独立危险因素。术后第1、3、6、12个月对患者进行电话或者门诊随访,记录各患者发生的主要心血管不良事件,经LOG rank检验分析两组患者Kaplan-Meier生存曲线结果,比较差异无统计学意义(χ^(2)=0.269,P=0.604)。结论CRP、NLR、MLR是影响IRI发生的独立危险因素,可作为STEMI术前评估、术中预防IRI的参考指标。术中是否发生IRI对近期心功能及预后无显著影响。

Objective To explore the predictive value of leukocyte-associated inflammatory markers such as neu-trophil to lymphocyte ratio in acute ST-segment elevation myocardial infarction(STEMI)reperfusion injury(IRI),and the correlation of IRI to the STEMI patients.Methods A continuous collection of 758 STMEI patients who were hospitalized in the hospital from January 2017 to June 2020 and were divided into two groups based on whether IRI occurred during interventional therapy:285 cases in the IRI group and 473 cases in the non-IRI group.Analyze the age,gender,height,weight,past history personal historyof patients in different groups,and the laboratory test results,to explore their prediction of reperfusion injury during STMEI interventional therapy value.All patients were followed up by telephone and outpatient clinics after the operation.To analyze the correlation between reperfusion injury and the short-term prognosis of STEMI patients.Results Comparing the inflammatory indexes between the two groups,the levels of CRP,WBC,NEUT,PLT and NLR in the IRI group were significantly higher than those in the non-IRI group(P<0.05),and the difference was statistically signifcant.Multivariate logistic regression analysis showed that CRP,NLR and MLR were independent risk factors affecting the occurrence of IRI.At 1,3,6,and 12 months after surgery,the patients were followed up by telephone or outpatient,and cardiovascular adverse events were recorded;Kaplan-Meier survival curves of the two groups were obtained by the LOG rank test The analysis results showed that the difference was not statistically significant(χ^(2)=0.269,P=0.604).Conclusion CRP,NLR and MLR are independent risk factors affecting the occurrence of IRI.Whether reperfusion injury occurs during the operation has no significant effect on the short-term cardiac function and prognosis.