急性STEMI患者梗死相关动脉血流异常的预测因素和长期预后情况

发布时间：2018-05-26 13:19

本文选题：梗死相关动脉 + 中性粒细胞计数/淋巴细胞计数比值　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:探索行急诊PCI治疗的急性STEMI患者术前梗死相关动脉血流异常的预测因素及其预后情况。方法:回顾性分析2014年01月至2014年12月,因急性ST段抬高型心肌梗死发病12 h就诊于吉林大学第一医院心血管疾病诊治中心并接受急诊经皮冠状动脉介入治疗(PCI)的患者561例,根据入选及排除标准最终506例患者(男性354例,女性152例,平均年龄61.19岁±10.07岁)符合此次临床研究。根据PCI前梗死相关动脉心肌梗死溶栓治疗(TIMI)分级情况将患者分为血流正常组(TIMI血流3级,69例)和血流异常组(TIMI血流≤2级,437例)。记录研究对象的基本临床特征、冠状动脉造影情况、治疗情况、实验室检查情况、Grace评分及随访18个月的预后情况,并计算入院时中性粒细胞计数与淋巴细胞计数的比值。应用多元Logistic回归分析法分析影响PCI前梗死相关动脉血流的因素,采用受试者工作特征(ROC)曲线评估NLR预测PCI前梗死相关动脉血流异常的敏感性、特异性及预测价值,应用Kaplan-Meier生存分析法比较两组随访18个月的生存状况。结果:1.与血流正常组相比血流异常组白细胞计数[(12.04±3.53)×109/L vs(10.84±2.79)×109/L,P0.05]、中性粒细胞计数[(9.99±3.48)×109/L vs(8.23±2.69)×109/L,P0.001]、空腹血糖水平[(7.84±4.00)mmmol/L vs(6.23±1.83)mmol/L,P0.001]及NLR[8.03(4.54,10.92)vs 5.14(2.97,7.02),P0.001]水平高于血流正常组,差异有统计学意义;血流异常组淋巴细胞计数、LVEF值和吸烟比例低于血流正常组,差异有统计学意义(P0.05)。2.将空腹血糖、NLR、吸烟、白细胞计数、中性粒细胞计数、淋巴细胞计数、LVEF进行多元Logistic回归分析,提示空腹血糖和NLR是PCI前梗死相关动脉血流异常的独立危险因素。3.应用受试者工作特征(ROC)曲线分析显示NLR预测血流异常的曲线下面积(AUC)为0.685(95%CI:0.624~0.745),最佳截点值为7.22时,此时预测的敏感度、特异度分别为47.6%和81.2%。当NLR联合空腹血糖时预测PCI前梗死相关动脉血流异常的曲线下面积(AUC)为0.743(95%CI:0.689~0.794)。4.与血流正常组相比,血流异常组有更高在院呼吸机使用率及心力衰竭发生率(8.2%vs 0%,P0.05;18.5%vs 8.7%,P0.05),差异有统计学意义。虽然两组患者住院天数及在院死亡率间的比较无统计学差异,但血流异常组患者随访6个月MACEs发生率(13%vs 2.9%,P0.05)、随访12个月MACEs发生率(16.2%vs 5.8%,P0.05)、随访18个月MACEs发生率及全因死亡率(19%vs7.2%,P0.05;6.2%vs 0%,P0.05)较血流正常组显著增高。5.应用Kaplan-Meier生存分析比较急性STEMI患者随访18个月的预后情况,血流异常组患者无全因死亡及无MACEs生存概率下降趋势较血流正常组快,两组间生存结局比较差异有统计学意义(Log-Rank,P0.05)。结论:1.空腹血糖、NLR是PCI前梗死相关动脉血流异常的独立危险因素。2.NLR联合空腹血糖可以显著提高对PCI前梗死相关动脉血流异常的预测价值。3.PCI前梗死相关动脉血流异常患者较血流正常患者预后差(随访18个月)。
[Abstract]:Objective: to explore the prognostic factors and prognosis of infarct related artery blood flow abnormality in acute STEMI patients treated with emergency PCI. Methods: from January 2014 to December 2014, 561 patients with acute ST-segment elevation myocardial infarction who were admitted to the Cardiovascular Disease diagnosis and treatment Center of the first Hospital of Jilin University and received emergency percutaneous coronary intervention (PCI) for 12 hours were analyzed retrospectively. According to the inclusion and exclusion criteria, 506 patients (354 males and 152 females, mean age 61.19 卤10.07 years) were eligible for this clinical study. According to the classification of thrombolytic therapy in infarct-related artery myocardial infarction before PCI, the patients were divided into normal group (69 cases) and abnormal group (437 cases). The basic clinical features, coronary arteriography, treatment, laboratory examination, Grace score and prognosis of 18 months follow-up were recorded, and the ratio of neutrophil count to lymphocyte count at admission was calculated. Multivariate Logistic regression analysis was used to analyze the factors affecting the blood flow of infarct-related artery before PCI. The sensitivity, specificity and predictive value of NLR in predicting the abnormal blood flow of infarct-related artery before PCI were evaluated by using the operating characteristics of subjects. Kaplan-Meier survival analysis was used to compare the survival status of the two groups during a follow-up period of 18 months. The result is 1: 1. Compared with normal blood flow group, the white blood cell count (WBC), neutrophil count (9.99 卤3.48) 脳 10 9 vs(8.23 卤2.69 脳 10 9 / L P0.001, fasting blood glucose level (7.84 卤1.83 mmol / L) and NLR (8.03 卤4.544.410.92 vs 5.14 卤4.97.77.02P 0.001) were significantly higher in abnormal group than those in normal group. The Lymphocyte count and smoking ratio in abnormal blood flow group were lower than those in normal blood flow group, and the difference was statistically significant. Multivariate Logistic regression analysis showed that fasting blood glucose (FBG), smoking, leukocyte count, neutrophil count and lymphocyte count were independent risk factors of infarct-related arterial blood flow abnormality before PCI. The area under the curve of NLR for predicting abnormal blood flow was 0.68595% CI0.6240.745, and the best cut-off point was 7.22. The predicted sensitivity and specificity were 47.6% and 81.2%, respectively. When NLR combined with fasting blood glucose, the area under the curve of predicting the abnormal blood flow of infarct-related artery before PCI was 0.74395% CI: 0.689 + 0.794n.4. Compared with normal blood flow group, the rate of ventilator utilization and heart failure in abnormal blood flow group was higher than that in normal group. The incidence of heart failure was 8.2% vs 0. 05%, 18. 5% vs 8. 7% P 0. 05. The difference was statistically significant. Although there was no statistical difference between the two groups in terms of the length of stay in hospital and the mortality rate in hospital, However, the incidence of MACEs in patients with abnormal blood flow was 13g vs 2.9 P0.05, the incidence of MACEs was 16.2vs 5.8 and P0.05in the 12 months follow-up. The incidence of MACEs and the total mortality rate of 19vs7.2VS7.2vs P0.05 were significantly higher than that of the normal blood flow group (P 0.05, P 0.05, P 0.05) in the group with abnormal blood flow at the follow up period of 6 months (P < 0.05), and the incidence of MACEs was significantly higher than that in the group with normal blood flow (P 0.05). Kaplan-Meier survival analysis was used to compare the prognosis of the patients with acute STEMI for 18 months. The survival probability of the patients with abnormal blood flow was decreased faster than that of the normal blood flow group. The difference of survival outcome between the two groups was statistically significant. Conclusion 1. FBG NLR is an independent risk factor for abnormal blood flow of infarct-related artery before PCI. 2. NLR combined with fasting blood glucose can significantly increase the predictive value of abnormal blood flow of infarct-related artery before PCI. 3. Patients with abnormal blood flow of infarct-associated artery before PCI The prognosis was worse than that in patients with normal blood flow (follow-up for 18 months).
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R542.22

【相似文献】