两指标联合对急性中重度一氧化碳中毒心肌损伤患者发生院内心血管不良事件的预测价值

目的探讨可溶性生长刺激表达基因2蛋白(soluble growth stimulating expression gene 2 protein,sST2)联合中性粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)对预测急性中重度一氧化碳中毒(acute carbon monoxide poisoning,ACOP)心肌损伤患者发生院内心血管不良事件的临床意义。方法纳入2017年1月至2019年12月于河北医科大学哈励逊国际和平医院急诊病房及EICU收治的ACOP合并心肌损伤的患者,收集患者基线资料,入院时查血常规计算NLR,入院时、入院3 d酶联免疫吸附法(ELISA)检测sST2(T0sST2、T3dsST2)。根据是否发生心血管不良事件,分为事件组和无事件组,二元logistics回归分析院内心血管不良事件危险因素,受试者工作曲线分析sST2、NLR、sST2联合NLR对预测ACOP心肌损伤患者发生院内心血管不良事件的价值。结果 255例ACOP心肌损伤患者纳入最终分析,事件组29例,发生率11.37%。事件组NLR为(13.38±4.33),无事件组NLR为(9.57±4.22),事件组T3dsST2(61.59±22.67)ng/mL,无事件组T3dsST2(40.52±13.14)ng/mL,差异有统计学意义(均P<0.001);事件组T0sST2(265.34±89.95)ng/mL,无事件组T0sST2(242.43±93.09)ng/mL,差异无统计学意义(P=0.333)。二元logistics回归分析显示,NLR(OR=1.270,95%CI:1.125~1.434,P<0.01)、T3dsST2(OR=1.082,95%CI:1.052~1.114,P<0.01)是ACOP心肌损伤患者发生院内心血管不良事件的独立危险因素。T3dsST2的最佳截断值为44.5 ng/mL,NLR的最佳截断值为12.08,联合应用T3dsST2和NLR预测ACOP心肌损伤患者发生院内心血管不良事件的敏感度为79.3%,特异度为82.7%,曲线下面积为0.857,约登指数为0.620。结论 T3dsST2和NLR是ACOP心肌损伤患者发生院内心血管不良事件的独立危险因素,联合应用T3dsST2和NLR对ACOP心肌损伤患者发生院内心血管不良事件具有较好的预测价值。以T3dsST2为44.5 ng/mL、NLR为12.08为界值,可以作为临床预测ACOP心肌损伤患者发生院内心血管不良事件的早期预测指标。

The value of sST2 combined with NLR for prediction of the occurrence of nosocomial cardiovascular adverse events in patients with myocardial injury from acute moderate to severe carbon monoxide poisoning

Objective:To investigate the clinical significance of soluble growth stimulating expression gene 2 protein (sST2) combined with neutrophil/lymphocyte ratio (NLR) in the prediction of nosocomial cardiovascular adverse events in patients with acute carbon monoxide poisoning (ACOP) myocardial injury.Methods:Patients with ACOP myocardial injury from January 2017 to December 2019 in Emergency Ward and EICU of Harrson International Peace Hospital, Hebei Medical University were enrolled. NLR was calculated by routine blood examination on admission, and sST2 (T 0sST2, T 3dsST2) was detected by ELISA on admission and at 3 days after admission. According to the occurrence of cardiovascular adverse events, the patients were divided into the event group and the non-event group. Logistic regression was used to analyze the risk factors of in-hospital cardiovascular adverse events. ROC curve was used to analyze the value of sST2, NLR, sST2 and NLR combined in predicting the occurrence of in-hospital cardiovascular adverse events in patients with ACOP myocardial injury. Results:Totally 255 patients with ACOP myocardial injury were included in the final analysis. NLR was (13.38±4.33) in the event group and (9.57±4.22) in the non-event group, T 3dsST2 was (61.59±22.67) ng/mL in the event group and (40.52±13.14) ng/mL in the non-event group, with statistically significant differences (all P<0.01). T 0sST2 was (265.34±89.95) ng/mL in the event group and (242.43±93.09) ng/mL in the non-event group, with no statistically significant difference ( P=0.333). Logistic regression analysis showed that NLR ( OR=1.270, 95% CI: 1.125-1.434, P<0.01) and T 3dsST2 ( OR=1.082, 95% CI: 1.052-1.114, P<0.01) were independent risk factors for nosocomial cardiovascular adverse events in patients with ACOP myocardial injury. The optimal cutoff value of T 3dsST2 was 44.5 ng/mL, and of NLR was 12.08. The sensitivity and specificity of dual T 3dsST2 and NLR in predicting nosocomial cardiovascular adverse events was 79.3% and 82.7%, respectively (AUC 0.857, Youden index 0.620). Conclusions:T 3dsST2 and NLR are independent risk factors for the nosocomial cardiovascular adverse events in patients with ACOP myocardial injury. The predictive cutoff values are 44.5 ng/mL for T 3dsST2 and 12.08 for NLR. Combination of T 3dsST2 and NLR has a practical predictive value for nosocomial cardiovascular adverse events in patients with ACOP myocardial injury.