血小板/总胆红素与欧洲心脏手术风险评估系统Ⅱ评分对冠心病患者经皮冠状动脉介入治疗术后主要不良心脑血管事件发生的预测效能

Predictive efficacy of PLT/TBIL and Euro SCORE Ⅱ score for major adverse cardiovascularand cerebrovascular events in patients with coronary heart disease after PCI

目的:评价血小板/总胆红素(PLT/TBIL)与欧洲心脏手术风险评估系统Ⅱ(Euro SCOREⅡ)评分对冠心病患者经皮冠状动脉介入治疗(PCI)术后主要不良心脑血管事件(MACCE)发生的预测效能。方法:回顾性分析接受PCI术治疗的94例冠心病患者的临床资料,根据术后是否发生MACCE分为MACCE组和非MACCE组。比较两组术前PLT/TBIL与Euro SCOREⅡ评分。采用受试者工作特征(ROC)曲线评价PLT/TBIL与Euro SCOREⅡ评分对冠心病患者PCI术后MACCE的预测效能。结果:94例患者术后随访6~36个月,共43例(45.74%)患者发生MACCE。MACCE组和非MACCE组患者罪犯血管、病变血管支数、植入支架数、支架总长度、支架直径和球囊数量比较差异无统计学意义(均P>0.05)。MACCE组术前TBIL水平低于非MACCE组,PLT/TBIL和Euro SCOREⅡ评分高于非MACCE组(均P<0.05)。ROC曲线分析表明,术前PLT/TBIL预测PCI术后发生MACCE的曲线下面积(AUC)为0.763,敏感度为62.80%,特异度为80.39%,约登指数为0.432,阳性预测值为72.97%,阴性预测值为71.93%;术前Euro SCOREⅡ评分预测PCI术后发生MACCE的AUC为0.864,敏感度为81.40%,特异度为82.35%,约登指数为0.638,阳性预测值为79.55%,阴性预测值为84.00%。结论:术前PLT/TBIL和Euro SCOREⅡ评分都能有效预测冠心病患者PCI术后MACCE发生风险,后者预测效能更高,前者操作更加简单,临床应根据实际情况进行灵活选择。

Objective:To evaluate the predictive efficacy of platelet/total bilirubin ratio(PLT/TBIL)and European system for cardiac operative risk evaluationⅡ(Euro SCOREⅡ)score for major adverse cardiovascular and cerebrovascular events(MACCE)in patients with coronary heart disease after percutaneous coronary intervention(PCI).Methods:The clinical data of 94 patients with coronary heart disease who received PCI were retrospectively analyzed.They were divided into MACCE group and non-MACCE group according to whether MACCE occurred after operation.PLT/TBIL and Euro SCOREⅡscore before operation were compared between two groups.ROC curve was used to evaluate the predictive efficacy of PLT/TBIL and Euro SCOREⅡfor MACCE in patients with coronary heart disease after PCI.Results:A total of 94 patients were followed up foR6 to 36 months,and MACCE occurred in 43 patients(45.74%).There were no significant differences in culprit vessels,number of diseased vessels,number of implanted stents,total length of stents,diameter of stents and number of balloons between MACCE group and non-MACCE group(all P>0.05).The preoperative TBIL level in MACCE group was lower than that in non-MACCE group,and the PLT/TBIL and Euro SCOREⅡscore were higher than those in non-MACCE group(all P<0.05).ROC curve analysis showed that the AUC of preoperative PLT/TBIL for predicting MACCE after PCI was 0.763,the sensitivity,specificity,Youden index,positive and negative predictive value was 62.80%,80.39%,0.432,72.97%and 71.93%,respectively;the AUC of preoperative Euro SCOREⅡscore for predicting MACCE after PCI was 0.864,the sensitivity,specificity,Youden index,positive and negative predictive value was 81.40%,82.35%,0.638,79.55%and 84.00%,respectively.Conclusion:Both PLT/TBIL and Euro SCOREⅡscore can effectively predict the risk of MACCE in patients with coronary heart disease after PCI,the latter has a higher predictive efficiency,and the former is simpler to operate,so the choice should be flexible according to the actual situation in clinical practice.