急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗术后炎性因子的变化对院内主要不良心血管事件的预测价值

目的 探讨急性ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入（PCI）术后炎性因子的变化对院内主要不良心血管事件（MACE）的预测价值。 方法 选取2015年6月～2019年6月于邢台市第三医院院就诊的500例STEMI患者为研究对象，收集患者临床资料，于PCI手术次日抽取空腹静脉血进行炎性因子检测，根据院内是否发生MACE分为MACE组（85例）和无MACE组（415例）。采用单因素分析和多因素Logistic回归分析STEMI患者PCI术后发生院内MACE的独立影响因素，采用ROC曲线评价炎症指标对STEMI患者院内MACE的预测价值，构建STEMI患者行PCI术后院内发生MACE的列线图预测模型，采用受试者工作特征（ROC）曲线、Hosmer-Lemeshow goodness-of-fit检验、Calibration曲线评价模型的区分度、准确度和一致性。 结果 MACE组年龄、糖尿病患病率、D-二聚体（DD）指标明显高于无MACE组（均P<0.05），LVEF指标明显低于无MACE组（P<0.05），吸烟率、血清肌酐（Scr）、肌酸激酶同工酶（CK-MB）、心肌钙蛋白I（cTnI）、白细胞计数（WBC）、超敏C反应蛋白（hs-CRP）、中性粒细胞淋巴细胞比值（NLR）、血小板淋巴细胞比值（PLR）、降钙素原（PCT）、白介素-6（IL-6）指标显著高于无MACE组（均P<0.01）。多因素回归分析结果显示年龄（P<0.05）、糖尿病（P<0.05）、Scr（P<0.05）、CK-MB（P<0.05）以及炎性因子hs-CRP、NLR、PLR、PCT和IL-6（均P<0.01）是STEMI患者PCI术后院内发生MACE的独立危险因素，LVEF（P<0.05）是院内发生MACE的保护因素。炎症因子hs-CRP、NLR、PLR、PCT、IL-6均具有一定的预测价值。基于预后独立影响因素构建的列线图模型拟合效果良好，ROC曲线下面积为0.761（95% CI为0.680～0.839），表明模型预测能力较好。 结论 炎性因子hs-CRP、NLR、PLR、PCT、IL-6均为STEMI患者PCI术后发生院内MACE的独立危险因素，对患者近期预后具有较好的预测价值，该研究构建的列线图模型可作为预测STEMI患者PCI术后院内MACE风险的量化工具，有助于为STEMI患者制定术后护理，帮助患者降低并发症风险。

Predictive value of inflammatory factors for in-hospital major adverse cardiovascular events in patients with acute ST-segment elevation myocardial infarction after percutaneous coronary intervention

AIM To investigate the prognostic value of inflammatory factors for in-hospital major adverse cardiac events (MACE) in patients with acute ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI). METHODS A total of 500 STEMI patients admitted to our hospital from June 2015 to June 2019 were selected as the study subjects, and clinical data of the patients were collected. Fasting venous blood was taken for inflammatory factor detection on the next day after PCI, and patients were divided into MACE group (85 cases) and non-MACE group (415 cases) according to the occurrence of MACE in hospital. Univariate analysis and multivariate logistic regression were used to analyze the independent influencing factors of nosocomial MACE after PCI in STEMI patients. ROC curve was used to evaluate the predictive value of inflammatory indicators on nosocomial MACE in STEMI patients and a nomogram prediction model for nosocomial MACE in STEMI patients after PCI was constructed. The receiver operating characteristic (ROC) curve, Hosmer-Lemeshow goodness-of-fit test and Calibration curve were used to evaluate the differentiation, accuracy and consistency of the model. RESULTS Age, prevalence of diabetes mellitus and D-dimer (DD) index in MACE group were significantly higher than those in MACE group (all P<0.05), LVEF index was significantly lower than those in MACE group (P<0.05). Smoking rate, serum creatinine (Scr), creatine kinase isoenzyme (CK-MB), cardiac calcium protein I (cTnI), white blood cell count (WBC), hypersensitive C-reactive protein (hs-CRP), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), procalcitonin (PCT) and interleukin-6 (IL-6) were significantly higher than those in MACE group (ALL P<0.01). Multivariate regression analysis showed that age (P<0.05), diabetes mellitus (P<0.05), Scr (P<0.05), CK-MB (P<0.05), inflammatory factors hs-CRP, NLR, PLR, PCT and IL-6 (all P<0.01) were the only factors of MACE in STEMI patients after PCI LVEF (P<0.05) was a protective factor for nosocomial MACE. Inflammatory factors hs-CRP, NLR, PLR, PCT and IL-6 all had certain predictive value. The fitting effect of the line graph model based on independent prognostic factors was good, and the area under ROC curve was 0.761 (95% CI was 0.680～0.839), indicating that the model had good predictive ability. CONCLUSION Inflammatory factors hs-CRP, NLR, PLR, PCT and IL-6 are independent risk factors for nosocomial MACE after PCI in STEMI patients and they have good predictive value for the short-term prognosis of patients. The nomogram model constructed in this study can be used as a quantitative tool to predict the risk of in-hospital MACE for STEMI patients after PCI, which can help formulate postoperative care for STEMI patients and reduce the risk of complications.