NHR和MHR联合检测与STEMI患者院内心衰的相关性

NHR and MHR combined test studies associated with hospital heart failure in patients with STEMI

目的 探讨中性粒细胞与高密度脂蛋白胆固醇比值(NHR)和单核细胞与高密度脂蛋白胆固醇比值(MHR)联合检测与急性ST段抬高型心肌梗死(STEMI)患者住院期间并发心衰的相关性。方法 选取2020年6月—2021年12月本院收治的STEMI患者274例。根据患者住院期间是否发生心力衰竭分为心力衰竭组(n=98)和非心力衰竭组(n=176)。收集患者临床资料,分别于入院后即刻及24 h后,测定血细胞计数、随机血糖(GLU)、肌酸激酶同工酶(CK-MB)、肌钙蛋白I(TnI)、血脂、N末端脑钠肽前体(NT-proBNP)、可溶性肿瘤因子2抑制剂(sST2)。计算NHR、MHR。入院后24 h及出院前测定左心室射血分数(LVEF)。结果 两组患者性别、体重、GLU、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL)及基础疾病之间比较,差异无统计学差异(P>0.05)。心力衰竭组年龄、血细胞计数、入院时GRACE评分、发病到首次就诊时间高于非心力衰竭组,高密度脂蛋白(HDL)低于非心力衰竭组(P<0.01)。入院后及入院后24 h,心力衰竭组NHR、MHR、TnI、CK-MB高于非心力衰竭组,且入院后与入院后24 h比较,差异有统计学意义(P<0.05)。入院后,两组NT-proBNP、sST2水平比较,差异无统计学意义(P>0.05)。入院后24 h,心力衰竭组NT-proBNP、sST2高于非心力衰竭组(P<0.01)。入院后24 h,两组LVEF比较,差异无统计学意义(P>0.05),心力衰竭组出院前LVEF低于非心力衰竭组,且出院前LVEF低于入院后24 h(P<0.01)。KillipⅣ级组患者,NHR、MHR、TnI、CK-MB、NT-proBNP、sST2高于KillipⅡ级组及KillipⅢ级组,KillipⅢ级组高于KillipⅡ级组(P<0.05)。Pearson相关性分析:STEMI患者NHR、MHR与LVEF之间呈负相关(r=-0.696,P=0.001;r=-0.715,P=0.01)。Logistic回归分析显示,入院后24 h,NHR、MHR、NT-proBNP、sST2及冠状动脉多支病变的STEMI患者,住院期间并发心衰的危险性增加。ROC结果显示,入院后24 h,NHR、MHR联合检测曲线下面积为0.765,对STEMI住院期间并发心衰预测价值更大。结论 NHR、MHR联合检测与STEMI住院期间并发心衰具有相关性,对预后有预测价值,有助于对STEMI住院期间并发心衰的高危患者进行识别和判断。

Objective To investigate the correlation of neutrophil to high density lipoprotein cholesterol ratio(NHR)and monocyte to high density lipoprotein cholesterol ratio(MHR)for concurrent heart failure during hospitalization in patients with acute ST-segment elevation myocardial infarction.Methods We selected 274 patients with acute ST segment elevation myocardial infarction(STEMI)admitted from June 2020 to December 2021.It was divided into 98 cases in the heart failure group and 176 cases in the nonheart failure groups.Patient clinical data were collected,After admission and at 24 hours of admission,blood cell counts,random blood glucose(GLU),creatine kinase isoenzyme(CK-MB),troponin I(TnI),blood lipid,N-terminal brain sodium peptide precursor(NT-proBNP),and soluble tumor factor 2 inhibitor(sST2)were measured.Calculate the NHR,MHR.Left ventricular ejection fraction(LVEF)was determined after admission and before discharge.Results There were no statistical differences between sex,weight,random blood sugar,total cholesterol(TC),trionyglycerol(TG),low density lipoprotein(LDL),and underlying disease(P>0.05).Significant differences in the heart failure group age,blood cell count,GRACE score at admission,onset to first visit were higher than the non-heart failure group,and high-density lipoprotein(HDL)were lower than the non-heart failure group(P<0.01).NHR,MHR,TnI,CK-MB were higher than in the 24h,and post-admission to heart failure group,and was statistically different when compared to 24h after admission(P<0.05).After admission,the two groups of NT-proBNP,sST2 levels were compared,and the differences were not statistically significant(P>0.05).The 24h,heart failure group was higher than non-heart failure and was statistically significant(P<0.01).At 24h after admission,the LVEF was not different(P>0.05),LVEF was lower before discharge than non-heart failure,and LVEF was lower than 24h after admission,which showed a significant difference(P<0.01).In the grade KillipⅣgroup,the comparison between NHR,MHR,TnI,CK-MB,NT-proBNP,and sST2 higher than grade KillipⅡand grade KillipⅢgroups,The KillipⅢgroup was higher than the KillipⅡgroup,which was statistically significant(P<0.05).Correlation analysis:A negative correlation between NHR,MHR and LVEF in STEMI patients.(r=0.696,P=0.001;r=0.715,P=0.01).Logistic regression analysis:At 24h after admission,patients with STEMI with NHR,MHR,NT-proBNP,sST2 and multiple branches of coronary artery had an increased risk of complicated heart failure during hospitalization.ROC results showed that the area under the 24h,NHR,MHR joint detection curve after admission was 0.765 after admission,which had a greater predictive value for concurrent HF during the STEMI hospital.Conclusion The joint detection of NHR and MHR is associated with concurrent heart failure during STEMI hospitalization,being of predictive value for prognosis,and facilitated the identification and judgment of high-risk patients with concurrent heart failure during STEMI hospitalization.