循环单核细胞亚群联合左心室射血分数对急性ST段抬高型心肌梗死患者预后危险分层的评估

发布时间：2018-06-17 10:33

本文选题：心肌梗死 + 单细胞分析　；参考：《中国循环杂志》2017年09期

【摘要】：目的:探讨循环单核细胞亚群联合左心室射血分数(LVEF)对急性ST段抬高型心肌梗死(STEMI)患者预后危险分层的评估价值。方法:入选发病后24小时内就诊于武警后勤学院附属医院心脏中心并接受经皮冠状动脉介入(PCI)治疗的STEMI患者,采用流式细胞术检测外周血单核细胞3个亚群:经典型单核细胞(CD14~(++)CD16~-)、中间型单核细胞(CD14~(++)CD16~+)和非经典型单核细胞(CD14~+CD16~(++))。随访患者3年内主要不良心血管事件(MACE)的发生情况;采用COX比例风险模型分析单核细胞亚群及LVEF与MACE的关系;采用受试者工作特征(ROC)曲线结合多元Logistic回归分析建立相关MACE预测模型。结果:3年的随访中221例患者共50例发生MACE。与非MACE患者相比,MACE患者年龄更大[(63.82±11.88)岁vs(58.84±11.40)岁,P=0.009]、糖尿病病史更多(28.0%vs18.7%,P0.001)、LDL-C(2.77 mmol/L vs 2.41 mmol/L,P=0.003)、CD14~(++)CD16~+单核细胞值(47.17 cells/μl vs 21.47 cells/μl,P0.001)更高;LVEF值(52%vs 46%,P0.001)更低。多变量COX回归分析显示,CD14~(++)CD16~+(HR=2.211,95%CI:1.211~3.635,P=0.016)、LVEF(HR=2.014,95%CI:1.038~2.933,P=0.022)是STEMI患者发生MACE的独立危险因素。多元Logistic回归分析联合ROC曲线结果显示,CD14~(++)CD16~+单核细胞联合LVEF对MACE的预测价值(AUC=0.744,95%CI:0.664~0.823,P0.001)高于单指标CD14~(++)CD16~+单核细胞(AUC=0.683,95%CI:0.598~0.768,P0.001)及LVEF(AUC=0.640,95%CI:0.552~0.729,P=0.003)。结论:循环CD14~(++)CD16~+单核细胞联合LVEF能够预测STEMI患者3年内MACE的发生,具有潜在临床应用价值。
[Abstract]:Objective: to evaluate the value of circulating monocyte subsets combined with left ventricular ejection fraction (LVEF) in evaluating prognostic risk stratification in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods: STEMI patients who had been treated by percutaneous coronary intervention (PCI) at the heart center of the affiliated Hospital of Armed Police Logistics College within 24 hours after the onset of the disease were enrolled. Three subsets of peripheral blood mononuclear cells (PBMC) were detected by flow cytometry: classical monocytes (CD16), intermediate monocytes (CD14) and nonclassical monocytes (CD14 ~ CD16). The incidence of major adverse cardiovascular events (MACEE) and the relationship between monocyte subsets, LVEF and Mace were analyzed by Cox proportional risk model. The correlation Mace prediction model was established by using the ROC- curve and multivariate logistic regression analysis. Results: in the 3-year follow-up, there were 50 cases of MACEE in 221 patients. Compared with non-Mace patients, the patients with Mace were older [63.82 卤11.88 years old vs(58.84 卤11.40] years old P0.009], and the diabetic history was 28.010 and 18.7m / L P 0.001mol / L vs 2.41 mmol / L P0.003 / L / L / 2.41 mmol / L / L P0.003 / CD14 (CD16 ~ 11.88 cells/ 渭 l vs 21.47 cells/ 渭 L P _ (0.001), and the higher the LVEF value was 52.02 vs 460.71 mmol / L (P 0.001). Multivariate Cox regression analysis showed that CD14 was an independent risk factor for Mace in patients with STEMI. The results of multivariate logistic regression analysis and ROC curve showed that the predictive value of CD14T (CD16- monocytes combined with LVEF) for Mace was higher than that of single marker CD14C (AUC0.68395CIV0.5980.76868P0.001) and LVEFUC0.64095CIU 0.64095CI0.55202929PU 0.003. Conclusion: circulating CD14 monocytes combined with LVEF can predict the occurrence of Mace in STEMI patients within 3 years.
【作者单位】：天津医科大学研究生院;天津市心血管重塑与靶器官损伤重点实验室武警后勤学院附属医院心脏中心心血管病研究所;天津市心血管重塑与靶器官损伤重点实验室武警后勤学院附属医院心脏中心呼吸与重症医学科;
【基金】：国家自然科学基金(81570335) 天津市心血管重塑与靶器官损伤重点实验室开放基金(TJC1404,TJC1408)
【分类号】：R542.22

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