白细胞与红细胞比容比值对急性ST段抬高型心肌梗死再灌注治疗后院内主要不良心血管事件的预测价值

Predictive value of white blood cell-to-hematocrit ratio for in-hospital major adverse cardiovascular events after reperfusion therapy in patients with acute ST-segment elevation myocardial infarction

目的探讨白细胞与红细胞比容比值(WBCHR)对急性ST段抬高型心肌梗死(STEMI)患者再灌注治疗后发生院内主要不良心血管事件(MACE)的预测价值。方法采用病例-对照研究方法,回顾性选取首次确诊STEMI并接受经皮冠状动脉介入治疗(PCI)的319例患者作为研究对象,按照住院期间是否发生MACE分为MACE组69例和非MACE组250例。比较2组患者的临床资料,包括一般资料、实验室检验指标、超声心动图和冠状动脉造影结果。采用单因素与多因素Logistic回归分析探讨STEMI患者再灌注治疗后发生院内MACE的危险因素,绘制受试者工作特征(ROC)曲线分析WBCHR对STEMI患者再灌注治疗后发生院内MACE的预测价值。结果MACE组空腹血糖、尿酸、肌酐、白细胞计数、中性粒细胞计数、超敏C反应蛋白(hs-CRP)、D-二聚体、WBCHR水平均高于非MACE组,红细胞计数、血红蛋白、红细胞比容、左室射血分数均低于非MACE组,差异有统计学意义(P<0.05);2组患者年龄、性别、吸烟史、高血压史、糖尿病史、入院首次接触导丝至通过病变血管(D2W)时间、总胆固醇、甘油三酯和病变血管数目比较,差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,尿酸水平升高(OR=1.005,95%CI:1.002~1.009,P=0.004)、血红蛋白浓度降低(OR=0.964,95%CI:0.941~0.988,P=0.003),hs-CRP水平升高(OR=1.032,95%CI:1.009~1.056,P=0.007)、WBCHR水平升高(OR=1.455,95%CI:1.295~1.635,P<0.001)均为STEMI患者再灌注治疗后发生院内MACE的独立危险因素。ROC曲线分析结果显示,WBCHR预测STEMI患者再灌注治疗后发生院内MACE的曲线下面积为0.855(95%CI:0.796~0.914,P<0.001),灵敏度为63.8%,特异度为99.6%。结论WBCHR是STEMI患者再灌注治疗后发生院内MACE的独立影响因素,对STEMI患者再灌注治疗后发生院内MACE具有较高的预测价值。

Objective To investigate the predictive value of white blood cell-to-hematocrit ratio(WBCHR)for in-hospital major adverse cardiovascular events(MACE)after reperfusion therapy in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A case-control study was conducted to retrospectively select 319 patients with first-time diagnosis of STEMI who underwent percutaneous coronary intervention(PCI).Patients were divided into MACE group(69 cases)and non-MACE group(250 cases)based on the occurrence of MACE during hospitalization.Clinical data,including general information,laboratory test indicators,echocardiography,and coronary angiography results,were compared between the two groups.Univariate and multivariate Logistic regression analyses were performed to explore the risk factors for in-hospital MACE after reperfusion therapy in STEMI patients.Receiver operating characteristic(ROC)curve analysis was conducted to evaluate the predictive value of WBCHR for in-hospital MACE after reperfusion therapy in STEMI patients.Results The levels of fasting blood glucose,uric acid,creatinine,white blood cell count,neutrophil count,high-sensitivity C-reactive protein(hs-CRP),D-dimer,and WBCHR were significantly higher in the MACE group than in the non-MACE group,while red blood cell count,hemoglobin,hematocrit,and left ventricular ejection fraction were lower(P<0.05).No significant differences were observed in age,gender,smoking history,hypertension history,diabetes history,door-to-wire(D2W)time,total cholesterol,triglycerides,and the number of diseased vessels between the two groups(P>0.05).Multivariate Logistic regression analysis revealed that elevated uric acid levels(OR=1.005;95%CI,1.002 to 1.009;P=0.004),decreased hemoglobin concentration(OR=0.964;95%CI,0.941 to 0.988;P=0.003),increased hs-CRP levels(OR=1.032;95%CI,1.009 to 1.056;P=0.007),and increased WBCHR(OR=1.455;95%CI,1.295 to 1.635;P<0.001)were independent risk factors for in-hospital MACE after reperfusion therapy in STEMI patients.ROC curve analysis showed that the area under the curve of WBCHR for predicting in-hospital MACE after reperfusion therapy in STEMI patients was 0.855(95%CI,0.796 to 0.914,P<0.001),with a sensitivity of 63.8%and a specificity of 99.6%.Conclusion WBCHR is an independent influencing factors of in-hospital MACE after reperfusion therapy in STEMI patients and has a high predictive value for in-hospital MACE in these patients.