术前血清学炎症指标对急性心肌梗死患者PCI术后生存时间的评价及炎症标志物构建

The evaluation of preoperative serological inflammatory markers on survival time after PCI in patients with acute myocardial infarction and the construction of inflammatory markers

目的 探究术前血清学炎症指标对急性心肌梗死(AMI)患者经皮冠状动脉介入(PCI)术后生存时间的评价及炎症标志物构建。方法 回顾性选取208例经PCI治疗的AMI患者,收集并分析术前临床资料和实验室检查结果,根据受试者工作特征(ROC)曲线分析中性粒细胞与淋巴细胞比值(NLR)及血小板与淋巴细胞比值(PLR)评估PCI术后生存时间的最佳截断值来构建预测AMI患者PCI术后生存时间的系统炎症标志物评分(SIMS);绘制Kaplan-Meier生存曲线比较不同评价指标患者的全因病死率,采用单因素与多因素Cox风险回归分析影响AMI患者预后的危险因素。结果 患者均得到有效随访1~48个月,平均(45.39±8.74)个月,全因死亡19例(9.1%)。ROC曲线分析结果显示,PLR和NLR评估AMI术后死亡风险的曲线下面积(AUC)为0.883和0.765,最佳截断值分别为155.93和3.55。Kaplan-Meier生存曲线分析结果显示,PLR>155.93组、NLR>3.55组AMI患者PCI术后的死亡率显著高于PLR≤155.93组、NLR≤3.55组(χ^(2)=72.000、71.920,均P=0.001)。不同PLR及NLR组间生存率差异显著(P<0.05)。单因素Cox风险回归结果显示,高密度脂蛋白胆固醇(HDL-C)(HR=3.191,95%CI:1.059~9.616)、PLR(HR=42.427,95%CI:9.789~183.878)、NLR(HR=14.997,95%CI:6.012~37.407)及SIMS(HR=9.234,95%CI:4.909~17.370)是AMI患者PCI术后全因死亡的影响因素(P<0.05);多因素Cox风险回归结果显示,SIMS(HR=3.826,95%CI:1.410~10.380)是AMI患者PCI术后全因死亡的独立影响因素(P<0.05)。结论 成功构建SIMS且证实术前SIMS是AMI患者PCI术后预后指标,其不仅简单经济,而且还可以作为术前评估AMI患者PCI术后的生存时间的标志物。

Objective To investigate the evaluation of preoperative serological inflammatory markers on survival time after percutaneous coronary intervention(PCI) in patients with acute myocardial infarction(AMI) and the construction of inflammatory markers.Methods 208 cases of AMI patients treated by PCI were retrospectively selected to collect and analyze the preoperative clinical datas and laboratory test results, according to the analysis of the receiver-operating characteristic(ROC) curve of the ratio of neutrophils and lymphocytes(NLR) and platelet and lymphocyte ratio(PLR) assessment of PCI postoperative survival time best cutoff value to build prediction AMI patients system inflammatory markers rating of PCI postoperative survival time(SIMS);Kaplan-Meier survival curves were drawn to compare the all-cause fatality rates of patients with different evaluation indexes, and univariate and multivariate Cox risk regression were used to analyze the risk factors affecting the prognosis of AMI patients.Results All patients were followed up effectively for 1 to 48 months, with an average follow-up time of(45.39±8.74) months, there were 19 cases of all-cause death(9.1%).ROC curve analysis showed that the area under the curve(AUC) for PLR and NLR to assess the risk of death after AMI was 0.883 and 0.765, and the optimal cutoff values were 155.93 and 3.55, respectively.Kaplan-Meier survival curve analysis showed that the mortality of AMI patients after PCI in PLR > 155.93 group and NLR >3.55 group were significantly higher than those in PLR≤155.93 group and NLR≤3.55 group(χ^(2)=72.000, 71.920, all P=0.001).There were significant differences in survival rate among PLR and NLR groups(P<0.05).Univariate Cox risk regression results showed that high density lipoprotein cholesterol(HDL-C)(HR: 3.191, 95%CI: 1.059~9.616), PLR(HR: 42.427, 95%CI: 9.789~183.878), NLR(HR: 14.997, 95%CI: 6.012~37.407) and SIMS(HR: 9.234, 95%CI: 4.909~17.370) were the influential factors of all-cause mortality after PCI in AMI patients(P<0.05).Multivariate Cox risk regression results showed that SIMS(HR:3.826,95%CI: 1.410~10.380) was an independent influencing factor for all-cause mortality after PCI in AMI patients(P<0.05).Conclusions SIMS was successfully constructed and it could prove that preoperative SIMS is a prognostic index for patients with AMI after PCI, which is not only simple and economical, but also could be used as a marker for preoperative evaluation of the survival time of patients with AMI after PCI.