新型炎症标志物对急性心肌梗死院内死亡的预测价值

Predictive value of novel inflammatory indexes for in-hospital death of patients with acute myocardial infarction

目的探究入院新型炎症标志物全身炎症反应指数(SIRI)和中性粒细胞/淋巴细胞比值(NLR)对急性心肌梗死(AMI)患者院内死亡的预测价值。方法回顾性分析2017年1月至2022年12月于首都医科大学宣武医院心内科接受住院治疗的AMI患者2694例。通过分析ROC曲线确定本研究入院SIRI、NLR预测AMI患者院内死亡的最佳界值分别为2.93和5.56。分别以上述最佳界值将纳入患者分组:按SIRI分为低值组(<2.93,n=1960)和高值组(≥2.93,n=734),按NLR分为低值组(<5.56,n=1886)和高值组(≥5.56,n=808)。比较两组患者主要不良心血管事件(MACEs)的发生情况,并采用logistic回归确定SIRI及NLR对MACEs的预测价值。结果SIRI和NLR分组中,低值组院内死亡率均为0.7%,高值组院内死亡率分别为5.4%和4.8%,均显著高于低值组水平,差异具有统计学意义(P<0.05)。此外,SIRI和NLR分组中高值组院内室速/室颤、心房颤动、心脏骤停、心脏破裂和出血事件发生率亦均显著高于低值组,差异具有统计学意义(P<0.05)。多因素logistic回归分析显示,除入院Killip分级、GRACE评分、空腹血糖水平和N末端B型利钠肽原(NT-proBNP)以外,SIRI也是AMI患者发生院内MACEs中死亡的独立危险因素(OR=2.780,95%CI 1.067~7.243,P=0.036)。结论SIRI可以独立预测AMI患者院内死亡的发生风险。

Objective To explore the predictive value of systemic inflammatory response index(SIRI)and neutrophil/lymphocyte ratio(NLR)for in-hospital death in patients with acute myocardial infarction(AMI).Methods The retrospective study included 2694 patients with AMI who were admitted to the cardiology unit of Xuanwu Hospital of Capital Medical University in January 2017 to December 2022.By the ROC curve analyzing,the optimal cut-off values for the in-hospital death of patients with AMI predicted by SIRI and NLR were obtained,which were 2.93 and 5.56 respectively.The patients were divided into groups according to the above optimal threshold values:the low value group(<2.93,n=1960)and the high value group(≥2.93,n=734)according to SIRI,and the low value group(<5.56,n=1886)and the high value group(≥5.56,n=808)according to NLR.The clinical baseline characteristics and the occurrence of major adverse cardiovascular events(MACEs)were compared between the two groups;and logistic regression was used to determine the predictive value of SIRI and NLR for the occurrence of MACEs in AMI patients.Results The in-hospital mortality of the low value groups both were 0.7%,and the mortality of high value groups was 5.4%in the high value group of SIRI and 4.8%in the high value group of NLR,which were significantly higher than those in the low value group(P<0.05).In addition,the incidences of in-hospital death,ventricular tachycardia/ventricular fibrillation,atrial fibrillation,cardiac arrest,cardiac rupture and bleeding events in the high value groups of SIRI and NLR were significantly higher than in the low value groups(P<0.05).Multivariate logistic regression analysis showed that SIRI(≥2.93 vs.<2.93)(OR=2.780,95%CI 1.067-7.243,P=0.036)was also an independent risk factor for the in-hospital death of MACEs in AMI patients besides Killip grade,GRACE score,fasting blood glucose level and NT-proBNP(N-terminal-pro B-type Natriuretic Peptide).Conclusion SIRI can independently predict the risk of the in-hospital death in AMI patients.