炎症参数与非ST段抬高型急性冠状动脉综合征患者行择期经皮冠状动脉介入术预后相关性研究

Correlation between inflammatory parameters and prognosis of patients with non-ST-segment elevation acute coronary syndrome undergoing selective percutaneous coronary intervention

目的探讨系统性免疫炎症指数(SII)、中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)与非ST段抬高型急性冠状动脉综合征(NSTE-ACS)患者行择期经皮冠状动脉介入术(PCI)1年内预后关系的研究。方法回顾性分析2016年1月至2019年6月于常熟市第一人民医院心内科住院诊断为NSTE-ACS并成功行择期PCI的230例患者的临床资料。统计患者主要心脑血管不良事件(MACE)事件发生情况,采用单因素及多因素Logistic回归分析NSTE-ACS患者MACE发生的影响因素,绘制ROC曲线,计算AUC评估术前NLR及SII对MACE发生的预测价值。结果成功随访208例,失访及退出22例,随访成功率为90.43%,其中男142例(68.27%),女66例(31.73%),平均年龄(66.25±8.17)岁。随访患者中发生MACE事件34例(16.34%),未发生MACE事件174例(83.66%)。MACE患者与非MACE患者年龄、LVEF、低密度脂蛋白胆固醇(LDL-C)水平、NLR、PLR、SII、冠状动脉三支病变占比比较差异有统计学意义(P<0.05);多因素Logistic回归分析结果显示,SII升高、NLR升高及高龄、LVEF降低、是否冠状动脉三支病变是NSTE-ACS患者行择期PCI术后1年内MACE事件发生的独立危险因素(P<0.05)。ROC曲线结果显示,NLR对MACE预测的AUC为0.749,PLR预测MACE的AUC为0.760,SII对MACE预测的AUC为0.781。结论NLR升高、SII升高、高龄、LVEF降低值、冠状动脉三支病变是NSTE-ACS患者行择期PCI术后发生MACE的独立危险因素,与NLR、PLR相比,SII对NSTE-ACS患者行择期PCI术后1年内发生MACE可能有更好的预测价值。

Objective To explore the relationship between systemic immune inflammation(SII),neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),and the prognosis of patients with non-ST-segment elevation acute coronary syndrome(NSTE-ACS)undergoing elective percutaneous coronary intervention(PCI)within 1 year.Methods The clinical data of 230 patients who were diagnosed with NSTE-ACS and suc-cessfully underwent elective PCI in the department of Cardiology of Changshu No.1 People's Hospital from January 2016 to June 2019 were retro-spectively analyzed.The occurrence of major adverse cardiac events(MACE)in patients was counted,the univariate and multivariate Logistic regres-sion were used to analyze the influencing factors of MACE in patients with NSTE-ACS,the ROC curve was drawn and AUC was calculated to evalu-ate the predictive value of preoperative NLR and SII for MACE.Results Among them,208 successfully completed the clinical follow-up,and 22 cases were lost or dropped out,translating to a follow-up rate of 90.43%,of which 142 were males(68.27%)and 66 were females(31.73%),the mean age was(66.25±8.17)years.In the follow-up patients,34 cases(16.34%)had MACE events and 174 cases(83.66%)had no MACE events.There were significant differences in age,LVEF,low density lipoprotein cholesterol(LDL-C)level,NLR,PLR,SII and the proportion of three-vessel coronary artery disease between MACE patients and non-MACE patients(P<0.05);multivariate Logistic regression analysis showed that elevated SII,elevated NLR,advanced age,decreased LVEF,and triple-vessel coronary artery disease were independent risk factors for MACE events within 1 year after elective PCI in patients with NSTE-ACS(P<0.05).The ROC curve results showed that the AUC predicted by NLR for MACE was 0.749,the AUC predicted by PLR for MACE was 0.760,and the AUC predicted by SII for MACE was 0.781.Conclusion Elevated NLR,elevated SII,ad-vanced age,decreased LVEF,and three-vessel coronary artery disease are independent risk factors for MACE after elective PCI in NSTE-ACS pa-tients,compared with NLR and PLR,SII may have a better predictive value for MACE within 1 year after elective PCI in NSTE-ACS patients.