NLR与MSI对急性NSTEMI短期预后判断价值

Prognostic potentials of the modified shock index and neutrophil/lymphocyte ratio in predicting short-term poor prognosis in patients with acute non-ST elevation myocardial infarction

目的本研究旨在探讨校正休克指数(MSI)和中性粒细胞/淋巴细胞比值(NLR)在判断急性非ST段抬高型心肌梗死(NSTEMI)患者短期内可能出现不良预后的预测能力。方法研究组选择2020年3月到2021年9月期间,首次就诊急诊科明确诊断为急性非ST段抬高型心肌梗死的276例患者。通过快速急诊绿道监测血压与心率,并于急诊科10 min内抽取血常规、床旁心脏彩超等相关化验检查,依据监测及化验结果,研究小组计算了校正休克指数(MSI)和中性粒细胞/淋巴细胞比值(NLR),然后根据统计结果将患者分为2组:NLR≥5.0组(n=75)与NLR﹤5.0组(n=201);(2)MSI≥1.2组(n=57)与MSI<1.2组(n=219)。比较2组一般资料情况,发生不良心血管事件的比例,采用受试者ROC曲线下面积来评估NLR值和MSI值对NSTEMI院内不良心血管事件的预测能力。结果连续入选的276例NSTEMI患者中,发生不良心血管事件52例,占18.8%,心源性休克患者15例,占5.4%,恶性心律失常患者24例,占8.7%,死亡13例,占4.7%。NLR≥5.0与MSI≥1.2值组的心功能、收缩压(SBP)、舒张压(DBP)及心率(HR)分别与NLR<5.0与MSI<1.2组比较,差异有统计学意义(P<0.05);NLR≥5.0与MSI≥1.2组MACE发生率分别高于NLR<5.0组与MSI<1.2组(P<0.05)。此外,NLR和MSI的ROC曲线下面积分别为0.734和0.703,提示NLR和MSI均具有评价急性非ST段抬高型心肌梗死患者短期不良心血管事件发生能力。结论MSI与NLR是评估NSTEMI短期不良预后的两个简单的重要的易获得指标。

Objective To investigate the prognostic potentials of the modified shock index(MSI)and neutrophil/lymphocyte ratio(NLR)in predicting short-term poor prognosis in patients with acute non-ST elevation myocardial infarction(NSTEMI).Methods A total of 276 patients with initially diagnosed NSTEMI in the Emergency Department between March 2020 and September 2021 were recruited.Blood pressure(BP)and heart rate(HR)were monitored through the rapid emergency greenway.The complete blood count and bedside color Doppler ultrasound were performed within 10 minutes in the emergency department.According to the monitoring and laboratory testing results of NLR and MSI,patients were divided into NLR≥5.0 group(n=75)and NLR<5.0 group(n=201),and MSI≥1.2 group(n=57)and MSI<1.2 group(n=219).Baseline characteristics and the incidence of adverse cardiovascular events were compared between groups.The receiver operating characteristic(ROC)curves and the area under the curve(AUC)were used to evaluate the potential of NLR and MSI in predicting in-hospital adverse cardiovascular events in NSTEMI patients.Results Among 276 NSTEMI patients,there were 52(18.8%)cases of adverse cardiovascular events,15(5.4%)of cardiogenic shock,24(8.7%)of malignant arrhythmia and 13(4.7%)of deaths.There were significant differences in the cardiac function,systolic blood pressure(SBP),diastolic blood pressure(DBP)and heart rate(HR)in NSTEMI patients of NLR≥5.0 group versus NLR<5.0 group,as well as those of MSI≥1.2 group versus MSI<1.2 group(P<0.05).The incidence of major adverse cardiovascular events(MACEs)in NSTEMI patients of NLR≥5.0 group was significantly higher than that of NLR<5.0 group,which was significantly higher in MSI≥1.2 group than that of MSI<1.2 group(P<0.05).The AUC of NLR and MSI in predicting NSTEMI was 0.734 and 0.703,respectively,suggesting that both NLR and MSI exerted the potential in predicting short-term adverse cardiovascular events in NSTEMI patients.Conclusion MSI and NLR are simply detected,important,highly available indicators to predict the short-term poor prognosis of NSTEMI.