SII的动态变化与PPCI术后NSTEMI患者不良临床预后的关系

Relationship Between Dynamic Changes of SII and Adverse Clinical Outcomes in NSTEMI Patients after PPCI

目的探讨急性非ST段抬高型心肌梗死(non-ST-segment elevation myocardial infarction,NSTEMI)患者行急诊经皮冠状动脉介入治疗术(primary percutaneous coronary intervention,PPCI)前后全身免疫炎症指数(systemic immune inflammation index,SII)的动态变化及其与术后6个月内发生主要心血管不良事件(major cardiovascular adverse events,MACE)的关系。方法选取2020年1月~2021年8月徐州医科大学附属医院收治的因急性NSTEMI行PPCI的患者193例,术前24h内、术后12h内、术后1天、术后2天、出院前最后1次、术后1个月分别采集血样,行血常规检查并计算SII,根据术后随访6个月内是否发生MACE,分为MACE组(n=22)和非MACE组(n=171)。采用多因素Logistic回归分析筛选急性NSTEMI患者PPCI术后6个月随访期内发生MACE的独立预测因子。采用受试者操作特征(receiver operator characteristic,ROC)曲线计算SII下降幅度比率的最佳截断值,及其评判术后6个月随访期内发生MACE的特异性和敏感度。结果与非MACE组比较,年龄≥65岁、男性、Killip分级>2级、冠状动脉造影显示多支病变、低密度脂蛋白胆固醇(low density lipoprotein-cholesterol,LDL-C)>1.8mmol/L、SII≥819.09×10^(9)/L、术后SII升高组(术后12h内、术后1天、术后2天)与患者术后随访6个月内发生MACE相关。多因素Logistic回归分析结果显示,LDL-C>1.8mmol/L、术后SII升高亦为影响急性NSTEMI患者术后发生MACE的独立危险因素(OR=4.085,95%CI:1.201~13.901,P<0.05;OR=3.645,95%CI:1.094~12.148,P<0.05)。ROC曲线分析结果显示,当SII下降幅度比率截断值为0.655时,曲线下面积(area under the curve,AUC)为0.679,敏感度为77.30%,特异性为61.40%。结论术后SII升高、LDL-C>1.8mmol/L是急性NSTEMI患者PPCI术后6个月内发生MACE的独立预测因子。SII下降幅度比率的最佳截断值为0.655,患者经过药物抗炎治疗,将SII降低至截断值以上水平,可以减少术后MACE的发生。

Objective To investigate the dynamic changes of systemic immune inflammation index(SII)before and after primary percutaneous coronary intervention(PPCI)in patients with acute non-ST-segment elevation myocardial infarction(NSTEMI)and its relationship with major cardiovascular events(MACE)within 6months of post-operative follow-up.Methods A total of 193 patients who received PPCI due to acute NSTEMI admitted to the Affiliated Hospital of Xuzhou Medical University from January 2020 to August 2021 were selected.Blood samples were collected within 24hours before surgery,12hours after surgery,1day after surgery,2days after surgery,the last time before discharge,and 1month after surgery,for routine blood examination and SII calculation.Patients were divided into MACE group(n=22)and non-MACE group(n=171)according to whether MACE occurred at 6months of post-operative follow-up.Multivariate Logistic regression analysis was used to screen for independent predictors of MACE in patients with acute NSTEMI during 6-month follow-up after PPCI.The receiver operator characteristic(ROC)curve was used to evaluate the optimal cut-off value for the ratio of the decline in SII,and to evaluate the specificity and sensitivity of MACE during the 6-month follow-up period.ResultsCompared with the non-MACE group,age≥65 years,male,Killip grade>2,coronary angiography showing multiple vessel lesions,LDL-C>1.8mmol/L,SII≥819.09×10^(9)/L,and elevated post-operative SII(within 12h,1day,2days after surgery)were associated with MACE within 6months of post-operative follow-up.Multivariate Logistic analysis showed that LDL-C>1.8mmol/L and increased post-operative SII were also independent risk factors for MACE in NSTEMI patients(OR=4.085,95%CI:1.201-13.901,P<0.05;OR=3.645,95%CI:1.094-12.148,P<0.05).ROC curve showed that the area under the curve(AUC)was 0.679,the sensitivity was 77.30%,and the specificity was 61.40%when the cut-off value of SII decline amplitude ratio was 0.655.ConclusionThe elevated post-operative SII and LDL-C>1.8mmol/L were independent predictors of MACE within 6months of post-operative follow-up after PPCI in NSTEMI patients.The optimal cut-off value of SII decline amplitude ratio was 0.655.The incidence of post-operative MACE can be reduced by reducing SII above the cut-off value after anti-inflammatory treatment with drugs.