经皮冠状动脉介入治疗术后炎症指标对急性冠脉综合征患者预后影响

目的 前瞻性观察接受经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）的急性冠脉综合征患者PCI术后中性粒细胞/淋巴细胞比值（neutrophil to lymphocyte ratio，NLR）、血小板/淋巴细胞比值（platelet to lymphocyte ratio，PLR）、C反应蛋白（ C-reactive protein?，CRP）、降钙素原（procalcitonin，PCT）、白细胞介素-6（interleukin-6，IL-6）等炎症指标水平对近期预后的影响。方法　214例急性冠脉综合征患者行PCI治疗手术后次日清晨，抽取外周肘静脉血行全血细胞测定（计算NLR和PLR）和 CRP、PCT、IL-6等炎症因子检测。应用二分类Logistic 多因素回归模型分析急性冠脉综合征PCI术后主要心脏不良事件 (?major adverse cardiac events，MACE)?发生的影响因素；ROC曲线评估上述炎症指标对急性冠脉综合征患者PCI术后MACE发生的预测价值。结果　214例急性冠脉综合征患者，平均随访12月（中位数），共累计33例患者（15.4%）出现MACE事件。应用二分类Logistic 多因素回归模型分析，发现NLR（odds ratio,OR值）2.98,P<0.001]和急性冠脉综合征类型（OR=0.29,P=0.048）是PCI术后MACE发生的独立影响因素。ROC曲线评估分析发现，NLR、PLR、CRP、PCT、IL-6均有预测PCI术后MACE发生的价值（P<0.01），但是NLR预测MACE发生的ROC曲线下面积最大（0.898），NLR预测PCI术后MACE事件发生最佳切点为3.94。结论 PCI术后NLR、PLR、CRP、PCT、IL-6等炎症指标均具有预测PCI术后MACE发生的价值，而NLR的预测价值最高。PCI术后过高的NLR和急性ST段抬高型心肌梗死是急性冠脉综合症患者PCI术后MACE发生的独立影响因素。

Effect of inflammatory markers on prognoses of patients with acute coronary syndrome after percutaneous coronary intervention

Objective The aim of this study was to prospectively observe these effects of inflammatory markers postoperation ,including neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and C-reactive protein (CRP) ,procalcitonin (PCT), interleukin-6 (IL-6) ,on short-term prognoses in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) . Methods A total of 214 patients with ACS included in this study.Peripheral elbow venous blood were collected in the morning of the next day after PCI,and tested obtaining the following results: total blood cell assay ( used to compute NLR and PLR ),CRP,PCT,IL-6. A binary Logistic multivariate regression model was used to analyze the influencing factors of major adverse cardiac events (MACE) in these patients .The Receiver operating characteristic (ROC) curves was used to evaluate the influencing?factor for MACE events of these inflammatory markers after PCI . Results A total of 214 patients with ACS were followed up for a median of 12 months, and 33 patients (15.4%) had MACE. Using binary Logistic multivariate regression model , it was found that NLR(odds ratio(OR ) 2.98,P<0.001) and the type of ACS (OR=0.29,P=0.048) were independent influencing?factor for the occurrence of MACE after PCI. These inflammatory markers included NLR, PLR, CRP, PCT and IL-6,have been found to have predictive value for the occurrence of MACE in these patients by ROC curve evaluation (P < 0.01) .Furthermore, the area under the ROC curve of NLR was the biggest among these areas under the ROC curve of inflammatory markers . The best tangent point on the ROC curve of NLR predicting MACE after PCI was 3.94. Conclusion These inflammatory markers included NLR, PLR, CRP, PCT and IL-6 had predictive values for the occurrence of MACE after PCI in patients with ACS, and NLR had the best predictive value. High NLR and acute ST-segment elevation myocardial infarction were independent influencing factors for the occurrence of MACE in patients with ACS after PCI.