不同性别心肌梗死患者急诊PCI术后炎性标志物及NT-proBNP水平比较分析

Gender related differences of inflammatory markers and NT-pro BNP after emergency PCI in patients with AMI

目的比较不同性别急性心肌梗死(AMI)患者外周血白细胞(WBC)、中性粒细胞(NE)、淋巴细胞(LY)、中性粒/淋巴细胞比值(NLR)、超敏C反应蛋白(hs-CRP)和N端脑钠肽前体(NT-pro BNP)水平差异,评估其对主要心血管事件(MACEs)的影响,为不同性别AMI患者提供个体化治疗。方法选取2016年12月—2018年7月本院初次诊治的AMI患者142例,均经急诊PCI治疗,分男性组93例与女性组49例,搜集患者基本资料,比较术前、术后1天和5天WBC、NE、LY、NLR、hs-CRP、NT-pro BNP表达水平,分析其对不同性别AMI患者MACEs的影响。结果 (1)女性AMI患者平均住院时间和花费均高于男性,PCI术后1天及5天WBC水平高于男性(P<0.05),其中男性组WBC在术后逐渐下降(P<0.05),女性组PCI术后5天WBC较前有所下降(P<0.05);两组患者术前后NE和NLR水平无明显差异。(2)女性组hs-CRP在术前及术后均高于男性组(P<0.05),两组患者在术后1天hs-CRP均达最高水平(P<0.05),并在术后5天再次下降(P<0.05)。(3)女性患者NT-pro BNP水平在术前及术后均高于男性(P<0.05),且两组NT-pro BNP在入院时最高,在术后逐渐下降(P<0.05)。(4)住院期间,男性组患者MACEs发生率为16.13%,女性组为28.57%(P<0.05)。(5)多元Logistic分析发现:男性组和女性组高血压、糖尿病、低密度脂蛋白、NLR是发生不良心血管事件预测因子;对于不同性别AMI患者NLR在预测PCI术后不良心血管事件方面价值更高。结论 (1)与男性相比,女性术后白细胞、hs-CRP、NT-pro BNP表达水平更高,体内炎性负荷更重、心功能更差。(2)女性AMI患者比男性有更高的MACEs发生率,NLR在预测术后MACEs方面有更高价值。

Objective To explore levels of WBC,NE,LY,NLR,hs-CRP and NT-pro BNP in patients with AMI between different genders and assess their impact on MACEs,and to provide references for individualized therapy for patients with AMI. Methods From December 2016 to July 2018,142 patients( 93 males and 49 females) those who were primarily diagnosed AMI in our hospital were enrolled in this study. All of the patients received emergency PCI for treatment. Collect baseline data of the patients,the express levels of WBC,NE,LY,NLR,hs-CRP and NT-pro BNP between different genders were compared at the following time points: preoperative,the first and the fifth day postoperative. We analyzed its effect on MACEs in different genders.Results Average hospital stay and cost of female AMI patients were higher than those of the male patients,WBC levels were higher in females than in males on the first day and fifth day postoperative( P<0.05). WBC gradually decreased in males after surgery,while it is decreased on the 5 th day after surgery in the females( P<0.05). There was no significant difference in NE and NLR levels between the two groups. The hsCRP in female group was higher than that in male group before and after the operation( P<0.05). The levels of hs-CRP reached the peak on the first day after the operation in both group,and start to decrease on the fifth day after operation( P<0.05). NT-pro BNP levels in female patients were higher than those in males before and after operation( P < 0. 05). The NT-pro BNP levels was the highest before surgery,and decrease gradually after operation( P<0.05). The incidence of MACEs in male group was lower than that in female group( 16.13% VS28.57%,P<0.05). Multivariate logistic analysis showed that hypertension,diabetes,low density lipoprotein and NLR were predictors of adverse cardiovascular events in male and female groups,and NLR was more valuable in predicting adverse cardiovascular events after PCI in AMI patients of different genders. Conclusions Compared with the male group,WBC,hs-CRP,and NT-pro BNP expression levels are higher in the female group,the inflammation load is higher and the heart function was worse in female. Female patients with acute myocardial infarction have a higher incidence of MACEs than that in male. NLR is more valuable in predicting MACEs after PCI.