NLR、MVP检测在STEMI病人临床结局与预后评估中的价值

目的探讨中性粒细胞和淋巴细胞比值(NLR)、平均血小板体积(MPV)检测在急性ST段抬高型心肌梗死(STEMI)病人临床结局与预后评估中的价值。方法将220例STEMI病人按照NLR的不同将病人分为高NLR组(144例)和低NLR组(76例),按照MPV的不同分为高MPV组(70例)和低MPV组(150例),比较不同NLR和不同MPV病人之间临床资料,并比较不同NLR和不同MPV病人之间院内、院外主要不良心血管事件(MACE)的发生率;二分类Logistic回归分析高NLR、高MPV对院内、院外MACE的预测价值。结果高NLR组吸烟率、血B型利钠肽(BNP)、血D-二聚体含量均高于低NLR组(P<0.05),高MPV组血小板计数低于低MPV组(P<0.05),血BNP、血D-二聚体含量均高于低MPV组(P<0.05)。高NLR组院外MACE发生率高于低NLR组(P<0.05),院内MACE发生率与低NLR组差异无统计学意义(P>0.05);高MPV组院内、院外MACE发生率均与低MPV组差异无统计学意义(P>0.05)。二分类Logistic回归分析显示,在调整高血压、吸烟等传统促进心血管疾病发生的危险因素后,高NLR是STEMI病人出院后发生MACE的独立危险因素。结论高NLR是STEMI病人院外MACE发生的独立危险因素,在STEMI病人预后评估中有一定临床价值。     

STEMI患者入院后急性期内NLR数值与院内MACE发生率的相关性

目的分析ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者院内主要不良心血管事件(major adverse cardiovascular events,MACE)发生率与入院后急性期内中性粒细胞淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)的相关性,为STEMI患者院内MACE发生的预测及防治提供参考依据。方法选取徐州市中心医院2010年9月至2015年9月收治的550例STEMI患者,进行回顾性分析。按照患者院内MACE发生情况分为发生组及未发生组,计算其院内MACE发生率,并比较两组患者临床资料间差异,应用多因素Logistic回归分析,明确STEMI患者院内MACE发生的危险因素,并绘制NLR预测MACE发生的受试者工作特征曲线(receiver operator characteristic curve,ROC)。结果 550例患者中,共有62例发生院内MACE,发生率11.3%。多因素Logistic回归分析显示,年龄、并发冠状动脉粥样硬化性心脏病(冠心病)、Killip分级Ⅲ~Ⅳ级、肾小球滤过率(glomerular filtration rate,GFR)60%、高NLR、多支病变或左主干病变、低左心室射血分数(left ventricular ejection fraction,LVEF)、高肌酸激酶同工酶(creatine kinase isoenzyme MB,CKMB)峰值、高收缩压是导致STEMI患者院内MACE发生率增加的独立危险因素(P0.05)。ROC示,以NLR=5.0为界值,判断患者MACE发生的敏感度为76.9%,特异性为66.7%。结论入院时NLR水平对STEMI患者经皮冠状动脉介入治疗后院内MACE的发生具有一定的预测价值,NLR水平的升高预示着患者MACE发生率上升、预后不良风险增加。     

急性ST段抬高型心肌梗死患者入院早期中性粒细胞/淋巴细胞比值与院内主要不良心血管事件的相关性

目的:探讨急性ST段抬高型心肌梗死(STEMI)患者入院早期中性粒细胞/淋巴细胞比值(NLR)与院内主要不良心血管事件(MACE)的相关性。方法:回顾分析2010-01至2014-12我院接受急诊经皮冠状动脉介入治疗(PCI)的STEMI患者420例,分为发生院内MACE组(n=47)和正常出院组(n=273)。应用单因素及多因素Logistic回归分析评价NLR是否可以作为STEMI患者发生院内MACE的独立危险因素。结果:单因素Logistic回归分析提示:高NLR患者院内MACE发生率明显高于低NLR患者(比值比=3.19,95%可信区间:1.55~2.65,P=0.012)。多因素Logistic回归分析提示:高NLR是STEMI患者发生院内MACE的独立危险因素(比值比=3.05,95%可信区间:1.59~10.54,P=0.015)。结论:入院早期高NLR与STEMI患者发生院内MACE相关,是STEMI患者发生院内MACE的独立危险因素。     

中性粒细胞/淋巴细胞比值及平均血小板体积与STEMI患者临床结局及预后的关系

目的:探讨入院时中性粒细胞/淋巴细胞比值(NLR)、平均血小板体积(MPV)与ST段抬高型急性心肌梗死(STEMI)患者临床结局及预后的关系。方法:选取2016-09-2018-04入住扬州苏北人民医院心内科并诊断为STEMI的患者共208例,记录中性粒细胞计数、淋巴细胞计数及MPV,计算NLR。以NLR三分位数上限值为分割点,将所有患者分为高NLR组(NLR≥7.5)和低NLR组(NLR7.53)。以MPV三分位数上限值为分割点,将所有患者分为高MPV组(MPV≥11.93fl)和低MPV组(MPV11.93fl)。比较各组院内临床结局和院外主要心血管不良事件(MACE)发生率,依次采用单因素分析及Logistic回归分析评估NLR与MPV对院内临床结局和院外MACE发生的预测作用,并采用Spearman相关分析对NLR与MPV进行相关性检验。结果:高NLR组患者院外MACE发生风险显著高于低NLR组(RR=1.83,95%CI:1.08～3.12,P=0.03),且在调整吸烟及高血压等传统心血管病危险因素后,高NLR仍是STEMI患者院外MACE发生的独立预测因子(RR=2.24,95%CI:1.10～4.58,P=0.03)。未发现MPV与患者临床结局及预后相关。结论:高NLR是STEMI患者院外MACE事件发生的独立预测因子,可作为判断不良预后的一个指标。     

不同缺血时间对急性ST段抬高型心肌梗死患者介入血栓抽吸获益程度的影响

目的 探讨不同缺血时间对急性ST段抬高型心肌梗死(STEMI)患者介入血栓抽吸(TA)获益程度的影响。方法 纳入STEMI且接受经皮冠状动脉介入治疗（PCI）患者198例,其中109例接受TA治疗患者作为TA组,89例未接受TA治疗患者作为对照组。根据心肌总缺血时间（TTT）将患者分为早期PCI组（TTT≤4h）72例和非早期PCI组（TTT＞4h）126例。采用心肌梗死溶栓试验(TIMI)血流分级评价患者心外膜冠脉血流情况,并分析TA和TTT对STEMI患者PCI预后的影响。结果 PCI术前TA组TIMI血流分级0级患者比例高于对照组（P＜0.05）。早期PCI组接受TA患者比例高于非早期PCI组,而发生主要不良心血管事件(MACE)患者比例低于非早期PCI组（P＜0.05）。STEMI患者接受TA治疗与MACE的发生呈负相关（P＜0.001）,而TTT与PCI术后全因死亡和MACE的发生均呈正相关（P＜0.001）。Logistic回归分析结果显示,对于所有STEMI患者,TTT＞4h明显增加MACE的发生风险,接受TA治疗降低MACE的发生风险（P＜0.05）。对于TA组患者,TTT＞4h增加全因死亡和MACE的发生风险（P＜0.05）。结论 对于接受PCI时行TA治疗的STEMI患者,TTT＞4h增加其全因死亡和MACE的发生风险。     

NT-proBNP联合NLR对高危非ST段抬高型心肌梗死患者早期PCI后近期预后的预测价值

目的探讨N端脑钠肽前体(NT-proBNP)联合中性粒细胞/淋巴细胞比率(NLR)对高危非ST段抬高心肌梗死(NSTEMI)患者早期经皮冠状动脉介入术(PCI)后近期预后的预测价值。方法选择2015年8月～2016年9月于衡水哈励逊国际和平医院行早期PCI的高危急性非ST段抬高心肌梗死患者114例为研究对象,记录患者年龄、性别、吸烟以及高血压、糖尿病、血脂异常等一般资料。PCI术前采集血标本,检测血清NT-proBNP及全血NLR水平。对其随访1年,分别记录院内7 d、术后30 d及1年主要不良心脏事件(MACE)发生情况,根据是否发生MACE将患者分为MACE组和非MACE组,比较两组NT-proBNP、NLR水平差异。Pearson相关分析研究NT-proBNP、NLR水平与Gensini积分相关性。Logistic回归分析NSTEMI患者早期PCI后1年内MACE发生的危险因素。运用受试者工作特征曲线(ROC)分析NT-proBNP、NLR单独及联合检测对高危NSTEMI患者早期PCI后近期预后的预测价值。结果 MACE组患者院内7 d、术后30 d和1年的术前NT-proBNP、NLR水平均显著高于非MACE组(P0.05)。多变量Logistic回归分析显示,糖尿病史,冠状动脉多支病变,首次医疗接触--球囊扩张(FMC-to-Balloon)时间延长,NT-proBNP和NLR水平升高是术后心血管事件发生的独立危险因素。经Pearson分析显示,NT-proBNP、NLR水平与GRACE评分均呈正相关(P0.05)。ROC分析显示,NT-proBNP、NLR、NTproBNP联合NLR预测心血管事件的曲线下面积(AUC)分别为:0.789(95%CI:0.762～0.815)、0.776(95%CI:0.758～0.832)、0.902(95%CI:0.813～0.932),敏感度分别为82.8%、81.9%、87.4%,特异度分别为83.6%、82.5%、88.3%。结论高危NSTEMI患者早期PCI前NT-proBNP、NLR水平与冠状动脉病变程度呈正相关,对术后近期预后均有一定的预测价值,两者联合检测的预测价值高于单独检测。     

微小RNA-150对急性ST段抬高型心肌梗死患者经皮冠状动脉介入术后6月内主要不良心血管事件的预测价值

目的探究微小RNA-150(miR-150)对急性ST段抬高型心肌梗死(STEMI)患者行经皮冠状动脉介入术(PCI)后主要不良心血管事件(MACE)的预测价值。方法选取我院2016年1月至2019年1月收治的130例确诊为STEMI并行急诊PCI治疗患者,依照患者PCI术后6月是否发生MACE分为MACE组(n=36)和非MACE组(n=94)。比较2组患者miR-150表达水平及临床一般资料。Logistic回归分析急性STEMI患者PCI术后6月发生MACE的危险因素。Spearman相关性分析miR-150与各危险因素的相关性。受试者工作特征曲线(ROC)分析miR-150对急性STEMI患者PCI术后6月内MACE的预测价值。结果 2组患者在性别、年龄、合并症(糖尿病、高血压、冠心病、高脂血症)、梗死部位、术后用药、急诊PCI时间、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、总胆固醇、甘油三酯、血红蛋白比较差异无统计学意义(P0.05)。MACE组心率(HR)、收缩压、舒张压、血小板、C反应蛋白(CRP)、肌酸激酶同工酶(CK-MB)、中性粒细胞/淋巴细胞比值(NLR)显著高于非MACE组,左心室射血分数(LVEF)、miR-150水平显著低于非MACE组,差异具有统计学意义(P=0.000)。多因素Logistic回归分析结果显示,年龄、高血压史、HR、LVEF、CRP、CK-MB、NLR、miR-150均为急性STEMI患者PCI术后6月发生MACE的独立危险因素。相关性分析结果显示,miR-150与高血压史、HR、CRP、CK-MB、NLR水平呈明显负相关性,与年龄、LVEF呈明显正相关性(P=0.000)。ROC曲线表明,miR-150诊断急性STEMI患者PCI术后6月内发生MACE的切点为0.23,曲线下面积为0.905(95%CI 0.871～0.939)。结论低水平miR-150为急性STEMI患者PCI术后6月内发生MACE的独立危险因素,检测miR-150水平可帮助评估急性STEMI患者预后。     

年龄对急性ST段抬高型心肌梗死患者左室射血分数的影响

目的:分析年龄对急性ST段抬高型心肌梗死患者(STEMI)左室射血分数(LVEF)的影响.方法:收集急性STEMI患者245例,根据年龄分为5组:≤50岁组(49例)、51～60岁组(70例)、61～70岁组(62例)、71～ 79岁组(50例)、≥80岁组(14例);对临床基线资料(包括年龄、性别、高血压、糖尿病、高血脂、吸烟史、超急性期及急性期ST段抬高导联数、入院时及入院12～72 h肌钙蛋白、Killip分级、LVEF、是否接受冠状动脉介入治疗(PCI)和住院期间死亡等)进行比较分析.结果:多元线性回归分析显示,LVEF与年龄(P＜0 05)和肌钙蛋白(P＜0.05)呈负相关,随着年龄增长,LVEF降低;随着肌钙蛋白的增加,LVEF降低.在≤50岁组LVEF显著高于其余各年龄组(均P＜ 0.05),而≥80岁组LVEF则显著低于其余各组(均P＜0.05).≥80岁组KilliP分级≥Ⅱ级者显著高于其余各组(均P＜0.05).≥80岁组患者的住院期间病死率显著高于≤50岁组、51～60岁组、61～ 70岁组(均P＜0.05).结论:年龄可作为影响急性STEMI患者心功能的独立危险因素.     

白细胞水平对接受急诊冠状动脉介入治疗的急性心肌梗死患者预后的影响

目的探讨接受急诊冠状动脉介入治疗(PCI)的急性心肌梗死患者即刻白细胞计数(WBC)水平对院内事件和长期预后的影响.方法行急诊PCI的AMI患者352例,按急诊PCI前WBC水平分为3组≤10×109/L为A组,＞10×109～≤15×109/L为B组,＞15×109/L为C组.结果B组和C组的年龄明显低于、高血压史例数及病变支数明显少于A组(P＜0.05或P＜0.01),高敏C反应蛋白(hs-CRP)、肌酸激酶(CK)水平明显高于A组(P＜0.05或P＜0.01);B组吸烟史的比例高于A组(P＜0.05);C组的CK和CK-同工酶(CK-MB)水平、Killip分级水平、院内病死率和长期病死率显著高于A组、B组(P＜0.05或P＜0.01).多元逐步回归分析显示WBC与年龄、高血压、TG、hs-CRP、CK、CK-MB、Killip分级、TIMI血流、院内病死率、随访期病死率等因素有明显的相关性.结论急性心肌梗死时WBC水平的升高与院内病死率和随访期病死率的升高明显相关,因此是预测院内和随访期生存率有价值的指标.     

不同年龄段STEMI患者PCI治疗后住院期间短期预后效果与MACE发生率的差异性分析

目的探讨不同年龄段ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后住院期间短期预后效果与主要不良心血管事件(major adverse cardiovascular events,MACE)发生率的差异性分析。方法选取2015年10月至2016年10月在解放军八五医院住院治疗的STEMI患者178例,根据年龄的差异分为老年组(114例,年龄≥60岁)和非老年组(64例,年龄60岁),比较两组的一般临床资料、心功能参数[左心室射血分数(left ventricular ejection fraction,LVEF)、左心室缩短分数(left ventricular fractional shortening,LVFS)和每搏输出量(stroke volume,SV)]及MACE发生率,并应用Logistic回归模型分析影响STEMI患者MACE发生率的因素。结果两组在病变血管支数和年龄上相比,差异具有统计学意义(P0.05);治疗前,两组LVEF、LVFS和SV相比,差异无统计学意义(P0.05)。治疗后,老年组LVEF、LVFS和SV均显著低于非老年组,差异具有统计学意义(P0.05);老年组MACE发生率高于非老年组,差异具有统计学意义[26.32%(30/114)vs.12.50%(8/64),P0.05]。Logistic回归模型结果显示,年龄(OR=3.387,95%CI:2.329~7.024)和病变血管支数(OR=2.436,95%CI:2.610~5.168)是影响STE-MI患者发生MACE的因素(P0.05)。结论老年STEMI患者PCI治疗后住院期间的短期预后效果较差、MACE发生率较高。年龄是STEMI患者发生MACE的主要危险因素之一。     

The traditional and modifiable risk factors of coronary artery disease – a community-based cross-sectional study among 2 populations

A community-based cross-sectional study was undertaken by the Cardiology Society of India (Kerala Chapter) to determine the prevalence of coronary artery disease (CAD) and its risk factors. The periodontal health status of the rural and urban participants in the Thiruvananthapuram district of Kerala was evaluated to document any association between periodontal disease (PD) and CAD and to describe any shared risk factors.The participants were selected using a multistage cluster random sampling method. Socio-demographic data and personal histories were collected using a structured interview schedule and validated tools. Body mass index, blood pressure, electrocardiogram, and biochemical investigations were recorded and analyzed using standard protocols. A modification of the Ramfjord periodontal disease index was used to assess periodontal health.PD was more frequent among rural (61.4%) than in the urban population (35.5%). The frequencies of CAD associated with PD in the rural and urban populations were 82.6% and 40.5%, respectively. PD was not found to be a significant risk factor for CAD in the univariate regression analysis of urban populations. In the rural population, the odds of PD as a risk factor for CAD were found to be 3.08 (95% CI [1.38–8.38]) and significant (P = .043) in univariate regression analysis and 1.54 (95% CI: 0.44–5.4) and non-significant (P = .503) in the multivariate regression analysis.In rural areas, male sex and dyslipidemia demonstrated borderline significance as risk factors for CAD. PD was not found to be an independent risk factor after adjusting for age, sex, tobacco use, hypertension, sedentary lifestyle, and dyslipidemia. Male sex and dyslipidemia were identified as shared risk factors between PD and CAD, which could have confounded the significant association between the latter. In urban areas, age, male sex, and dyslipidemia demonstrated an independent association with CAD. This study could not establish an independent association between PD and CAD in either community. Future epidemiological studies should identify and recruit novel environmental factors to understand the interrelationships between PD and CAD and focus on the role of effect modifiers that may have a protective role against PD colluding with CAD.     

Higher relative, but lower absolute risks of myocardial infarction in women than in men: analysis of some major risk factors in the S heep study

OBJECTIVES: Middle-aged men have often been the subjects of multifactorial studies of myocardial infarction (MI) risk factors. One major objective of the SHEEP study was to compare the effects of different MI risk factors in women and men. DESIGN: SHEEP (Stockholm Heart Epidemiology Program) is a population-based case-referent study of causes of MI (first event) in Swedish women and men aged 45-70 years. During the period 1992-94, 2246 cases of MI were identified; 34% of the cases were women and 27% of the cases were fatal. One referent per case was chosen randomly from the Stockholm County population after stratification for the case's sex and age. Logistic regression was used to estimate the relative risks associated with risk factors of primary interest (diabetes, hypercholesterolaemia, hypertriglyceridaemia, hypertension, overweight, physical inactivity, smoking and job strain). RESULTS: The relative risk estimates ranged from 1.5 to 4.4 in women and from 1.3 to 2.9 in men (results for nonfatal cases and their referents). None of the 95% confidence intervals included 1.0. The relative risks were higher in the women than in the men (101-180%). The absolute risks, however, were all lower in the women than in the men. Estimates of Rothman's synergy index for gender ranged from 1.0 (hypertension) to 1.8 (current smoking). CONCLUSIONS: The indications of some effect modification due to sex (stronger risks in men for certain exposures) invoke the question of possible mechanisms.     

Two-minute heart rate recovery after cycle ergometer exercise and all-cause mortality in middle-aged men

Abstract. Savonen KP, Kiviniemi V, Laaksonen DE, Lakka TA, Laukkanen JA, Tuomainen T‐P, Rauramaa R (Kuopio Research Institute of Exercise Medicine, Kuopio, Finland; Kuopio University Hospital, Kuopio; Information Technology Center, University of Eastern Finland, Kuopio Campus, Kuopio; Kuopio University Hospital, Kuopio; Institute of Biomedicine/Physiology, University of Eastern Finland, Kuopio Campus; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio Campus; and Lapland Central Hospital, Rovaniemi, Finland). Two‐minute heart rate recovery after cycle ergometer exercise and all‐cause mortality in middle‐aged men. J Intern Med 2011; doi: 10.1111/j.1365‐2796.2011.02434.x Background. A slow heart rate recovery (HRR) after an exercise test is associated with an increased risk of all‐cause mortality in asymptomatic individuals, but the data regarding additional prognostic information provided by HRR beyond other exercise test variables are inconsistent. We investigated the prognostic significance of HRR for premature death, particularly in relation to other exercise test variables. Methods. The study subjects were a representative population‐based sample of 1102 men (42–61 years of age) without cardiovascular disease, cancer or diabetes. HRR was defined as the difference between maximal HR and HR 2 min after a maximal symptom‐limited exercise test using a cycle ergometer. The association between HRR and premature mortality was examined with Cox regression models. Results. During an average follow‐up of 18 years, 238 deaths occurred. HRR was an independent predictor of death [for a decrease of 12 beats min^?1, relative risk (RR) 1.16, 95% CI 1.02–1.33, P = 0.02] after adjustment for age and established risk factors. When added in a Cox model with chronotropic response (decrease of 12 beats min^?1, RR 1.09, 95% CI 0.93–1.27, P = 0.26) or cardiorespiratory fitness (decrease of 12 beats min^?1, RR 1.12, 95% CI 0.98–1.30, P = 0.08), the association between a slow HRR and an increased risk of death was clearly weaker. Conclusion. A slow 2‐min HRR after a cycle ergometer exercise test was an independent predictor of death in healthy middle‐aged men after accounting for demographic and clinical characteristics. However, it was no longer predictive after accounting for chronotropic response and exercise capacity.     

Risk factors for acute hepatitis B: a case-control study

Over the period 1989–1991 a case-control study was carried out in the area of Naples comparing 162 subjects with acute hepatitis B and 788 hospitalized control subjects. The results of multivariate analysis showed that surgical intervention (odds ratio 3.8; 95% CI 1.2–11.7), household contact with an hepatitis B surface antigen (HBsAg) positive carrier (odds ratio 2.7; 95% CI 1.1–6.7) and intravenous drug use (odds ratio 13.0; 95% CI 3.2–52.7) were risk factors independently associated with hepatitis B. No association was found with the other risk factors considered, such as blood transfusion, hospitalization, other percutaneous exposures, dental therapy, contact with an icteric case, barber shop shaving and two or more sexual partners. As a significant proportion of the general population undergoes surgical intervention, efficient procedures for sterilization of instruments should be implemented, together with the use of disposable materials, to control the spread of HBV infection in surgical settings.     

Risk factors for acute hepatitis B: a case-control study

Over the period 1989–1991 a case-control study was carried out in the area of Naples comparing 162 subjects with acute hepatitis B and 788 hospitalized control subjects. The results of multivariate analysis showed that surgical intervention (odds ratio 3.8; 95% CI 1.2–11.7), household contact with an hepatitis B surface antigen (HBsAg) positive carrier (odds ratio 2.7; 95% CI 1.1–6.7) and intravenous drug use (odds ratio 13.0; 95% CI 3.2–52.7) were risk factors independently associated with hepatitis B. No association was found with the other risk factors considered, such as blood transfusion, hospitalization, other percutaneous exposures, dental therapy, contact with an icteric case, barber shop shaving and two or more sexual partners. As a significant proportion of the general population undergoes surgical intervention, efficient procedures for sterilization of instruments should be implemented, together with the use of disposable materials, to control the spread of HBV infection in surgical settings.     

The Cardiac Risk Factors of Coronary Artery Disease and its relationship with Cardiopulmonary resuscitation: A retrospective study

Background

Cardiovascular diseases are considered as the most prevalent serious disease in developed countries, and act as the number one cause of death among men and women in all ages and from all races.