CHA2DS2-VASc 评分联合中性粒细胞与淋巴细胞比值对急性STEMI患者直接PCI 后无复流的关系研究

目的：探讨CHA2DS2-VASc 评分联合中性粒细胞与淋巴细胞比值（neutrophil to lymphocyte ratio，NLR）与急性ST 段抬高型心肌梗死（ST-segment elevation myocardial infarction，STEMI）患者直接经皮冠状动脉介入（percutaneous coronary intervention，PCI）术后无复流现象的关系。方法：以2018 年09 月01 日~2019 年12月31 日就诊于河北省人民医院心血管内科行直接PCI 治疗的急性STEMI 患者275 例为研究对象，收集患者各项临床资料及检查指标。根据患者PCI 术后是否出现无复流将其分为无复流组（47 例，17.1%）和复流组（228例，82.9%）。分析STEMI 患者PCI 术后发生无复流的独立影响因素，绘制受试者工作特征（receiver operating characteristic， ROC）曲线以分析CHA2DS2-VASc 评分、NLR 及二者联合因子对急性STEMI 患者PCI 术后发生无复流的预测价值。结果：无复流组患者CHA2DS2-VASc 评分、NLR 及术中预扩张例数均高于复流组（P<0.05）。二元Logistic 回归分析结果显示，CHA2DS2-VASc 评分、NLR 是急性STEMI 患者PCI 术后无复流现象的独立影 响因素（P<0.05）。ROC 曲线结果显示：CHA2DS2-VASc 评分（AUC：0.640，95%CI 0.562~0.719，P=0.002）、NLR（AUC：0.631，95%CI 0.541~0.721，P=0.005）对无复流现象有一定预测能力，但两者联合预测因子（AUC：0.675，95%CI 0.589~0.762，P<0.001）的AUC 更高，可更好的预测STEMI 患者直接PCI 术后无复流现象的发生，分别比较联合预测因子与单独CHA2DS2-VASc 评分和单独NLR 的预测能力，均无统计学差异（P>0.05）。结论：CHA2DS2-VASc 评分、NLR 是无复流现象的独立预测因子，两者联合对急性STEMI 患者PCI 术后无复流现象的发生具有较好的预测价值，但并未体现出优于单一使用CHA2DS2-VASc 评分或NLR 的预测价值。

Correlation between CHA2DS2-VASc Score Combined with Neutrophil to Lymphocyte Ratio and No Reflow after Direct PCI in Patients with Acute STEMI

Objective：To investigate the relationship between CHA2DS2-VASc score combined with neutrophil to lymphocyte ratio （NLR） and no-reflow phenomenon after direct percutaneous coronary intervention （PCI） in patients with acute ST-segment elevation myocardial infarction （STEMI）. Methods：A total of 275 patients with acute STEMI who received direct PCI in the Department of Cardiology，Hebei General Hospital from September 1，2018 to December 31，2019 were selected as the study subjects. All clinical data and examination indicators of patients were collected. According to the results of angiography，they were divided into two groups：the reflow group （n=228） and no-reflow group （n=47）.The independent influencing factors of no-reflow after PCI in STEMI patients were analyzed，and receiver operating characteristic （ROC） curve was drawn to analyze the predictive value of CHA2DS2-VASc score，NLR and their combined factors for no-reflow after PCI in acute STEMI patients. Results：CHA2DS2-VASc score，NLR and intraoperative predilation in patients no-reflow were higher than those in reflow group （P<0.05）. Binary Logistic regression analysis showed that CHA2DS2-VASc score and NLR were independent influencing factors of no-reflow after PCI in acute STEMI patients （P<0.05）. ROC curve results showed that：CHA2DS2-VASc score （AUC：0.640，95%CI0.562~0.719，P=0.002），NLR （AUC：0.631，95%CI0.541~0.721，P=0.005） had certain predictive power for no-reflow phenomenon，but the combined predictive factor（AUC：0.675，95%CI0.589~0.762，P<0.001）were higher in AUC，which could better predict the occurrence of no-reflow after direct PCI in STEMI patients. The predictive power of combined predictors was compared with CHA2DS2-VASc score alone and NLR alone. There were no statistical differences（P>0.05）. Conclusion：CHA2DS2-VASc score and NLR are independent predictors of no-reflow.The combination of the two has a good predictive value for the occurrence of no-reflow after PCI in acute STEMI patients，but does not show a better predictive value than CHA2DS2-VASc score or NLR alone.