SI及NLR对急性ST段抬高型心肌梗死短期预后的评估能力

Evaluation of SI and NLR for Short-Term Prognosis in Acute ST-Segment Elevation Myocardial Infarction

目的:探讨中性粒细胞/淋巴细胞比值(NLR)及休克指数(SI)对急诊急性ST段抬高型心肌梗死(STEMI)病患短期预后的预测价值。方法:选取首诊急诊科STEMI患者280例,记录所有入组患者人口学资料和临床资料。动态检测病人收缩压(SBP)、舒张压(DBP)、心率(HR)等指标,通过急诊绿色通道检测血常规,记录并计算SI及NLR数值,统计14天内主要不良心脏事件(MACE)的发生例数,分为MACE组与非MACE组。采用受试者工作特征曲线(ROC曲线)分析比较SI与NLR对STEMI患者的不良预后评估能力。结果:纳入280例STEMI患者,52例发生心血管不良事件,发生率为18.57%,其中恶性心律失常24例、心源性休克18例和全因死亡者10例,228例未发生不良心血管事件。MACE组患者的SI、白细胞计数、中性粒细胞计数、NLR、心功能Ⅲ、Ⅳ级均显著高于非MACE组(P<0.05),MACE组患者的DBP、SBP、淋巴细胞计数均明显低于非MACE组,差异有统计学意义(P<0.05)。SI、NLR与SI联合NLR的ROC曲线下面积分别为0.684、0.769和0.801。结论:NLR与SI对急诊STEMI短期发生不良事件的发生均有较高的评估价值,二者联合预测价值更高。

Objective:To investigate the predictive value of neutrophil/lymphocyte ratio(NLR)and shock index(SI)in short-term prognosis of emergency St-segment elevation myocardial infarction(STEMI)patients.Methods:A total of 280 first-visit emergency department patients with STEMI were included in this study.Demographic and clinical data of all patients were recorded.Key vital signs including systolic blood pressure(SBP),diastolic blood pressure(DBP),and heart rate(HR)were monitored dynamically.Blood routine tests were conducted using the emergency green channel,and SI and NLR values were calculated.The occurrence of major adverse cardiac events(MACE)within 14 days was recorded,and the patients were categorized into the MACE and non-MACE groups.Receiver operating characteristic curve(ROC curve)analysis was employed to compare the ability of SI and NLR to assess adverse outcomes in STEMI patients.Results:Among the 280 STEMI patients,52 experienced adverse cardiovascular events,resulting in an incidence of 18.57%.These events included 24 cases of malignant arrhythmias,18 cases of cardiogenic shock,and 10 all-cause deaths,while the remaining 228 patients did not experience adverse cardiovascular events.In the MACE group,SI,white blood cell count,neutrophil count,NLR,and cardiac function gradeⅢandⅣwere significantly higher compared to the non-MACE group(P<0.05).Additionally,the MACE group exhibited significantly lower DBP,SBP,and lymphocyte counts compared to the non-MACE group,and these differences were statistically significant(P<0.05).The areas under the ROC curves for SI,NLR,and the combined SI and NLR were 0.684,0.769,and 0.801,respectively.Conclusion:Both NLR and SI demonstrate substantial value in evaluating short-term adverse events in emergency STEMI patients.When used in combination,they offer even higher predictive value.