炎性标志物与ST段抬高型心肌梗死患者经皮冠状动脉介入治疗后心肌梗死面积的相关性及预测模型的构建研究

背景经皮冠状动脉介入治疗(PCI)是目前ST段抬高型心肌梗死(STEMI)患者发病12 h内最有效的治疗手段,可有效缩小心肌梗死面积(IS),但炎性标志物与STEMI患者PCI后IS的关系尚不完全明确。目的探讨炎性标志物与STEMI患者PCI后IS的相关性并尝试构建预测模型。方法选取2016年1月-2019年4月武汉市普仁医院收治的STEMI患者104例,根据PCI后3 d IS分为IS>19%组(n=60)和IS≤19%组(n=44)。比较两组患者年龄、性别、体质指数(BMI)、心率、血压包括收缩压(SBP)、舒张压(DBP)]、Killip分级、合并症(包括高血压、高脂血症、糖尿病)、ST段抬高幅度、心肌缺血时间、生化指标包括高敏心肌肌钙蛋白T(Hs-cTnT),N末端B型利钠肽原(NT-proBNP)、肌酸激酶(CK)、纤维蛋白原(FIB)]及炎性标志物包括中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、淋巴细胞与单核细胞比值(LMR)];炎性标志物与STEMI患者PCI后IS的相关性分析采用Pearson相关分析;STEMI患者PCI后IS的影响因素分析采用多因素Logistic回归分析;构建预测模型并绘制ROC曲线以分析其对STEMI患者PCI后IS的预测价值。结果 (1) IS>19%组患者年龄、ST段抬高幅度大于IS≤19%组,心率、KillipⅡ级者所占比例,Hs-cTnT、NT-proBNP、CK水平及NLR、PLR、LMR高于IS≤19%组,心肌缺血时间长于IS≤19%组(P<0.05);两组患者男性比例、BMI、SBP、DBP、高血压发生率、高脂血症发生率、糖尿病发生率及FIB水平比较,差异无统计学意义(P>0.05)。(2) Pearson相关分析结果显示,NLR (r=0.292)、PLR (r=0.272)、LMR (r=0.212)均与STEMI患者PCI后IS呈正相关(P<0.05)。(3)多因素Logistic回归分析结果显示,ST段抬高幅度OR=1.997,95%CI(1.144,3.484)]、Hs-cTnTOR=1.914,95%CI(1.163,3.148)]、NT-proBNPOR=1.820,95%CI(1.009,3.281)]、NLROR=2.500,95%CI(1.566,3.992)]、PLROR=2.362,95%CI(1.466,3.804)]是STEMI患者PCI后IS的独立影响因素(P<0.05)。(4)构建预测模型:(模型1:ST段抬高幅度+Hs-cTnT+NT-proBNP,模型2:ST段抬高幅度+Hs-cTnT+NT-proBNP+NLR,模型3:ST段抬高幅度+Hs-cTnT+NT-proBNP+PLR,模型4:ST段抬高幅度+Hs-cTnT+NT-proBNP+NLR+PLR),ROC曲线显示,模型1、模型2、模型3、模型4预测STEMI患者PCI后IS的曲线下面积(AUC)分别为0.70795%CI(0.653,0.757)]、0.720 95%CI(0.667,0.769)]、0.744 95%CI(0.692,0.791)]、0.884 95%CI(0.843,0.917)],Youden指数分别为0.441、0.358、0.421、0.678。结论 NLR、PLR、LMR均与STEMI患者PCI后IS呈正相关,ST段抬高幅度、Hs-cTnT、NT-proBNP、NLR、PLR是STEMI患者PCI后IS的独立影响因素,且NLR、PLR参与构建的预测模型对STEMI患者PCI后IS具有较高的预测价值。

Correlations between Inflammatory Markers and Infarction Size in Postoperative STEMI Patients Treated by PCI and Construction of Prediction Model

Background PCI is the most effective treatment strategy for STEMI patients within 12 hours after attack at present,which can effectively shrink the infarction size(IS),however relationship between inflammatory markers and IS in postoperative STEMI patients treated by PCI is not yet clear. Objective To investigate the correlations between inflammatory markers and IS in postoperative STEMI patients treated by PCI and try to construct the prediction model. Methods A total of 104 patients with STEMI were selected in Puren Hospital of Wuhan from January 2016 to April 2019,and they were divided into IS>19% group(n=60)and IS ≤ 19% group(n=44)according to the IS 3 days after PCI. Age,gender,BMI,heart rate,blood pressure(including SBP and DBP),Killip classification,merged disease(including hypertension,hyperlipidemia and diabetes mellitus),elevated range of ST-segment,duration of myocardial ischemia,biochemical indicators(including Hs-cTnT,NT-proBNP,CK and FIB)and inflammatory markers(including NLR,PLR and LMR)were compared between the two groups;correlations between inflammatory markers and IS in postoperative STEMI patients treated by PCI were analyzed by Pearson correlation analysis;multivariate Logistic regression analysis was used to analyze the influencing factors of IS in postoperative STEMI patients treated by PCI;ROC curve was drawn to analyze the predictive value of the constructed prediction models on IS in postoperative STEMI patients treated by PCI. Results(1)Age in IS>19% group was statistically significantly older than that in IS ≤ 19% group,elevated range of ST-segment in IS>19% group was statistically significantly greater than that in IS ≤ 19% group,heart rate,proportion of patients with Ⅱ-Killip classification,Hs-cTnT,NT-proBNP,CK,NLR,PLR and LMR in IS>19% group were statistically significantly higher than those in IS ≤ 19% group,duration of myocardial ischemia in IS>19% group was statistically significantly longer than that in IS ≤ 19% group(P<0.05);there was no statistically significant difference in male ratio,BMI,SBP,DBP,incidence of hypertension,hyperlipidemia or diabetes mellitus,or FIB between the two groups(P>0.05).(2)Pearson correlation analysis results showed that,NLR(r=0.292),PLR(r=0.272)and LMR(r=0.212)was positively correlated with IS in postoperative STEMI patients treated by PCI,respectively(P<0.05).(3)Multivariate Logistic regression analysis showed that,elevated range of ST-segment OR=1.997,95%CI(1.144,3.484)],Hs-cTnTOR=1.914,95%CI(1.163,3.148)],NT-proBNP OR=1.820,95%CI(1.009,3.281)],NLROR=2.500,95%CI(1.566,3.992)]and PLROR=2.362,95%CI(1.466,3.804)]were independent influencing factors of IS in postoperative STEMI patients treated by PCI(P<0.05).(4)We construscted the prediction models,including Model 1(involving ST-segment elevation,Hs-cTnT and NT-proBNP),Model 2(involving ST-segment elevation,Hs-cTnT,NT-proBNP and NLR),Model 3(involving ST-segment elevation,Hs-cTnT,NT-proBNP and PLR),Model 4(involving ST-segment elevation,Hs-cTnT,NT-proBNP,NLR and PLR).ROC curve showed that,AUC of Model 1,Model 2,Model 3 and Model 4 in predicting IS in postoperative STEMI patients treated by PCI was 0.70795%CI(0.653,0.757)],0.72095%CI(0.667,0.769)],0.74495%CI(0.692,0.791)] and 0.88495%CI(0.843,0.917)],respectively, moreover Youden index of the above four modes was 0.441,0.358,0.421 and 0.678,respectively. Conclusion NLR,PLR and LMR are all significantly correlated with IS in postoperative STEMI patients treated by PCI,elevated range of ST-segment,Hs-cTnT,NT-proBNP,NLR and PLR are independent influencing factors of IS in postoperative STEMI patients treated by PCI,moreover prediction model involving NLR and PLR has relative high predictive value on IS in postoperative STEMI patients treated by PCI.