作者：任浩进，王丽岳，黄莉芳

单位：

430080 湖北省武汉市普仁医院；通信作者：王丽岳，E-mail：ren951463@163.com

Units：

Puren Hospital of Wuhan，Wuhan 430080，China；Corresponding author：WANG Liyue，E-mail：ren951463@163.com

关键词：

心肌梗死；经皮冠状动脉介入治疗；炎症；心肌梗死面积；心脏磁共振

Keywords：

Myocardial infarction；Percutaneous coronary intervention；Inflammation；Myocardial infarctionarea；Cardiac magnetic resonance

CLC：

R 542.22

DOI：

DOI：10.3969/j.issn.1008-5971.2020.03.008

Funds：

基金项目：武汉市临床医学科研项目（WX14C67）

摘要：

背景　经皮冠状动脉介入治疗（PCI）是目前 ST 段抬高型心肌梗死（STEMI）患者发病 12 h 内最有效的治疗手段，可有效缩小心肌梗死面积（IS），但炎性标志物与 STEMI 患者 PCI 后 IS 的关系尚不完全明确。目的探讨炎性标志物与 STEMI 患者 PCI 后 IS 的相关性并尝试构建预测模型。方法　选取 2016 年 1 月—2019 年 4 月武汉市普仁医院收治的 STEMI 患者 104 例，根据 PCI 后 3 d IS 分为 IS>19% 组（n=60）和 IS ≤ 19% 组（n=44）。比较两组患者年龄、性别、体质指数（BMI）、心率、血压〔包括收缩压（SBP）、舒张压（DBP）〕、Killip 分级、合并症（包括高血压、高脂血症、糖尿病）、ST 段抬高幅度、心肌缺血时间、生化指标〔包括高敏心肌肌钙蛋白 T（Hs-cTnT），N 末端 B 型利钠肽原（NT-proBNP）、肌酸激酶（CK）、纤维蛋白原（FIB）〕及炎性标志物〔包括中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、淋巴细胞与单核细胞比值（LMR）〕；炎性标志物与 STEMI患者PCI后IS的相关性分析采用Pearson相关分析；STEMI患者PCI后IS的影响因素分析采用多因素Logistic回归分析；构建预测模型并绘制 ROC 曲线以分析其对 STEMI 患者 PCI 后 IS 的预测价值。结果　（1）IS>19% 组患者年龄、ST 段抬高幅度大于 IS ≤ 19% 组，心率、Killip Ⅱ级者所占比例，Hs-cTnT、NT-proBNP、CK 水平及 NLR、PLR、LMR 高于 IS ≤ 19% 组，心肌缺血时间长于 IS ≤ 19% 组（P<0.05）；两组患者男性比例、BMI、SBP、DBP、高血压发生率、高脂血症发生率、糖尿病发生率及 FIB 水平比较，差异无统计学意义（P>0.05）。（2）Pearson 相关分析结果显示，NLR（r=0.292）、PLR（r=0.272）、LMR（r=0.212）均与 STEMI 患者 PCI 后 IS 呈正相关（P<0.05）。（3）多因素Logistic回归分析结果显示，ST段抬高幅度〔OR=1.997，95%CI（1.144，3.484）〕、Hs-cTnT〔OR=1.914，95%CI（1.163，3.148）〕、NT-proBNP〔OR=1.820，95%CI（1.009，3.281）〕、NLR〔OR=2.500，95%CI（1.566，3.992）〕、PLR〔OR=2.362，95%CI（1.466，3.804）〕是 STEMI 患者 PCI 后 IS 的独立影响因素（P<0.05）。（4）构建预测模型：（模型 1：ST 段抬高幅度 +Hs-cTnT+NT-proBNP，模型 2：ST 段抬高幅度 +Hs-cTnT+NT-proBNP+NLR，模型 3：ST 段抬高幅度 +Hs-cTnT+NT-proBNP+PLR，模型 4：ST 段抬高幅度 +Hs-cTnT+NT-proBNP+NLR+PLR），ROC 曲线显示，模型 1、模型 2、模型 3、模型 4 预测 STEMI 患者 PCI 后 IS 的曲线下面积（AUC）分别为 0.707〔95%CI（0.653，0.757）〕、0.720〔95%CI（0.667，0.769）〕、0.744〔95%CI（0.692，0.791）〕、0.884〔95%CI（0.843，0.917）〕，Youden 指数分别为 0.441、0.358、0.421、0.678。结论　NLR、PLR、LMR 均与 STEMI 患者 PCI 后 IS 呈正相关，ST 段抬高幅度、Hs-cTnT、NT-proBNP、NLR、PLR 是 STEMI 患者 PCI 后 IS 的独立影响因素，且 NLR、PLR 参与构建的预测模型对STEMI 患者 PCI 后 IS 具有较高的预测价值。

Abstract：

Background　PCI is the most effective treatment strategy for STEMI patients within 12 hours after attackat present，which can effectively shrink the infarction size（IS），however relationship between inflammatory markers and ISin postoperative STEMI patients treated by PCI is not yet clear. Objective　To investigate the correlations between inflammatorymarkers and IS in postoperative STEMI patients treated by PCI and try to construct the prediction model. Methods　A total of104 patients with STEMI were selected in Puren Hospital of Wuhan from January 2016 to April 2019，and they were divided intoIS>19% group（n=60）and IS ≤ 19% group（n=44）according to the IS 3 days after PCI. Age，gender，BMI，heart rate，blood pressure（including SBP and DBP），Killip classification，merged disease（including hypertension，hyperlipidemiaand diabetes mellitus），elevated range of ST-segment，duration of myocardial ischemia，biochemical indicators（includingHs-cTnT，NT-proBNP，CK and FIB）and inflammatory markers（including NLR，PLR and LMR）were compared betweenthe two groups；correlations between inflammatory markers and IS in postoperative STEMI patients treated by PCI were analyzedby Pearson correlation analysis；multivariate Logistic regression analysis was used to analyze the influencing factors of IS inpostoperative STEMI patients treated by PCI；ROC curve was drawn to analyze the predictive value of the constructed predictionmodels on IS in postoperative STEMI patients treated by PCI. Results　（1）Age in IS>19% group was statistically significantlyolder than that in IS ≤ 19% group，elevated range of ST-segment in IS>19% group was statistically significantly greaterthan that in IS ≤ 19% group，heart rate，proportion of patients with Ⅱ -Killip classification，Hs-cTnT，NT-proBNP，CK，NLR，PLR and LMR in IS>19% group were statistically significantly higher than those in IS ≤ 19% group，durationof myocardial ischemia in IS>19% group was statistically significantly longer than that in IS ≤ 19% group（P<0.05）；therewas no statistically significant difference in male ratio，BMI，SBP，DBP，incidence of hypertension，hyperlipidemia ordiabetes mellitus，or FIB between the two groups（P>0.05）.（2）Pearson correlation analysis results showed that，NLR（r=0.292），PLR（r=0.272）and LMR（r=0.212）was positively correlated with IS in postoperative STEMI patients treatedby PCI，respectively（P<0.05）.（3）Multivariate Logistic regression analysis showed that，elevated range of ST-segment〔OR=1.997，95%CI（1.144，3.484）〕，Hs-cTnT〔OR=1.914，95%CI（1.163，3.148）〕，NT-proBNP〔OR=1.820，95%CI（1.009，3.281）〕，NLR〔OR=2.500，95%CI（1.566，3.992）〕and PLR〔OR=2.362，95%CI（1.466，3.804）〕were independent influencing factors of IS in postoperative STEMI patients treated by PCI（P<0.05）.（4）We construscted the prediction models，including Model 1（involving ST-segment elevation，Hs-cTnT and NT-proBNP），Model 2（involving ST-segment elevation，Hs-cTnT，NT-proBNP and NLR），Model 3（involving ST-segment elevation，Hs-cTnT，NT-proBNP and PLR），Model 4（involving ST-segment elevation，Hs-cTnT，NT-proBNP，NLR and PLR）.ROC curve showed that，AUC of Model 1，Model 2，Model 3 and Model 4 in predicting IS in postoperative STEMI patientstreated by PCI was 0.707〔95%CI（0.653，0.757）〕，0.720〔95%CI（0.667，0.769）〕，0.744〔95%CI（0.692，0.791）〕and 0.884〔95%CI（0.843，0.917）〕，respectively， moreover Youden index of the above four modes was 0.441，0.358，0.421and 0.678，respectively. Conclusion　NLR，PLR and LMR are all significantly correlated with IS in postoperative STEMIpatients treated by PCI，elevated range of ST-segment，Hs-cTnT，NT-proBNP，NLR and PLR are independent influencingfactors of IS in postoperative STEMI patients treated by PCI，moreover prediction model involving NLR and PLR has relative highpredictive value on IS in postoperative STEMI patients treated by PCI.

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