急性ST段抬高型心肌梗死患者近期预后的影响因素

Influencing factors of short-term prognosis in patients with acute ST segment elevation myocardial infarction

  • 摘要: 目的 探讨中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)及心脏超声相关参数在评价急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入术(PCI)后近期预后中的价值。 方法 选取在本院行PCI治疗的200例STEMI患者,按照主要不良心血管事件(MACE)发生情况分为非MACE组(n=143)和MACE组(n=57)。比较2组术后1、3、5 d的NLR、PLR水平。比较2组术后3 d的心脏超声相关参数[左室壁厚度(LVPW), 左房容积(LAV), 心输出量(CO), 左室射血分数(LVEF), 二尖瓣口舒张早期最大血流速度(E), E峰血流减速时间(DT), 室壁运动指数(WMSI)]。采用COX回归模型分析STEMI患者PCI后再发MACE的相关影响因素。 结果 MACE组术后1、3、5 d的NLR、PLR水平均高于非MACE组,差异有统计学意义(P<0.05)。MACE组术后3 d的LVPW、E、WMSI高于非MACE组,LAV、CO、LVEF、DT低于非MACE组,差异均有统计学意义(P<0.05)。多因素COX回归分析显示, NLR、PLR及各心脏超声参数与STEMI患者PCI后MACE发生风险具有相关性(P<0.05)。结论 NLR、PLR及心脏超声相关参数与STEMI患者PCI后近期MACE发生风险增高具有相关性,能够较好地预测MACE的发生,对改善患者近期预后具有积极的意义。

     

    Abstract: Objective To explore the value of neutrophil to lymphocyte ratio(NLR), platelet to lymphocyte ratio(PLR)and echocardiography related parameters in evaluating the short-term prognosis of patients with acute ST segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI). Methods Totally 200 STEMI patients with PCI were selected. According to the occurrence of major adverse cardiovascular events(MACE), the patients were divided into non-MACE group(n=143)and MACE group(n=57). The levels of NLR and PLR were compared between the two groups at 1 day, 3 and 5 days after operation. Echocardiographic parameters[left ventricular wall thickness(LVPW), left atrial volume(LAV), cardiac output(CO), left ventricular ejection fraction(LVEF), maximum flow velocity of mitral orifice in early diastolic phase(E), deceleration time of E peak blood flow(DT)and wall motion score index(WMSI)]were compared between the two groups at 3 days after operation. COX regression model was used to analyze the related factors of recurrence of MACE in STEMI patients after PCI. Results The levels of NLR and PLR in the MACE group were significantly higher than those in the non-MACE group at 1 day, 3 and 5 days after operation(P<0.05). At 3 days after operation, the LVPW, E and WMSI of the MACE group were significantly higher than those of the non-MACE group, while the LAV, CO, LVEF and DT were significantly lower than those of the non-MACE group(P<0.05). Multivariate COX regression analysis showed that NLR, PLR and echocardiographic parameters were correlated with risk of MACE in STEMI patients after PCI(P<0.05). Conclusion NLR, PLR and echocardiographic parameters - are correlated with the increased risk of MACE in STEMI patients after PCI, which can better predict the occurrence of MACE and have a positive significance for improving the short-term prognosis of STEMI patients.

     

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