中性粒细胞与淋巴细胞比值和血小板平均体积对急性冠脉综合征患者PCI术后近期及远期不良事件的预测价值

Predictive value of NLR and MPV for short-term and long-term adverse events after PCI in patients with acute coronary syndrome

目的探讨中性粒细胞与淋巴细胞比值(NLR)和血小板平均体积(MPV)对急性冠脉综合征(ACS)患者接受介入治疗(PCI)后短期及远期主要不良心血管事件(MACE)的预测价值。方法选择GRAND研究和GRANDEXTENDED研究中接受PCI治疗的ACS患者2225例,分别按照NLR和MPV的第75百分位数分为高NLR组(n=557)、低NLR组(n=1668)和高MPV组(n=577)、低MPV组(n=1635)。比较不同NLR或MPV水平患者无复流/慢血流、住院期间MACE和术后1年MACE的发生情况。采用多因素logistic回归分析评估不良事件发生的独立影响因素。采用ROC曲线分析NLR和(或)MPV对不良事件的预测价值。结果高NLR组术中无复流/慢血流、住院期间MACE和术后1年MACE的发生率均高于低NLR组(11.7%vs 5.1%,13.5%vs 8.5%和35.0%vs 10.8%;P<0.05);高MPV组术中无复流/慢血流、住院期间MACE事件和术后1年MACE的发生率均高于低MPV组(12.1%vs 4.8%,17.3%vs 7.0%和29.6%vs12.2%;P<0.05)。校正混杂因素后,NLR仍是无复流/慢血流(OR=1.04,95%CI 1.01~1.06)和术后1年MACE事件(OR=1.01,95%CI 1.00~1.07)的独立影响因素(P<0.05);MPV是术后1年MACE的独立影响因素(OR=1.02,95%CI 1.00~1.05;P<0.05)。NLR与MPV两者联合预测无复流/慢血流、住院期间MACE和1年MACE的AUC分别为0.701、0.698、0.766,高于单一指标(P<0.05)。结论NLR、MPV升高的ACS患者PCI术后短期和长期MACE的发生率升高,两者联合预测的价值较高。

Objective To explore the predictive value of neutrophil to lymphocyte ratio(NLR)and mean platelet volume(MPV)for short-and long-term adverse events in patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI).Methods A total of 2225 ACS patients treated with PCI from GRAND and GRAND-EXTENDED studies were included.The patients were grouped into high-NLR(n=557),low-NLR(n=1668),groups and high-MPV(n=577),low-MPV(n=1635),groups according to the 75th percentile of NLR or MPV.The incidences of intraoperative no-reflow/slow-flow,in-hospital major adverse cardiac events(MACE)and 1-year MACE after surgery were analyzed in the different NLR or MPV groups.Multiple logisti regression was used to analyze the independent influencing factors of adverse events.ROC was used to analyze predict values of NLR and/or MPV for adverse events.Results Compared with low-NLR group the incidences of intraoperative no-reflow/sloflow,in-hospital MACE and 1-year MACE after surgery were significantly higher than those in high-NLR group(11.7%vs 5.1%,13.5%vs 8.5%and 35.0%vs 10.8%,respectively;P<0.05).The incidences of intraoperative no-reflow/slow-flow,in-hospital MACE,and 1-year MACE after surgery in high-MPV group were also significantly higher than those in low-MPV group(12.1%vs 4.8%,17.3%vs 7.0%,and 29.6%vs 12.2%,respectively;P<0.05).After adjustment for confounding factors,NLR still was the an independent influence for no reflow/slow-flow(OR=1.04,95%CI 1.01-1.06)and 1-year MACE after surgery(OR=1.01,95%CI 1.00-1.07,P<0.05).MPV was an independent influence for 1-year MACE after surgery(OR=1.02,95%CI 1.00-1.05,P<0.05).The AUC of combination of NLR and MPV in predicting short-term and long-term adverse events was 0.701,0.698 and 0.766,respectively,which were higher than the single index(P<0.05).Conclusions ACS patients with high NLR or MPV may have higher rates of short-term and long-term adverse events,and combination of NLR and MPV has higher predictive value.