中国医科大学学报

中国医科大学学报
  • 中文核心期刊
  • 中国科技核心期刊
  • 中国高校百佳科技期刊
  • BA、CA收录

中国医科大学学报 ›› 2019, Vol. 48 ›› Issue (8): 719-725.doi: 10.12007/j.issn.0258-4646.2019.08.010

• 论著 • 上一篇    下一篇

血小板淋巴细胞比值与老年急性冠状动脉综合征患者冠状动脉介入治疗围术期心肌梗死的相关分析及其预测价值

徐健, 赵世杰, 牛一蒙, 齐国先, 田文   

  1. 中国医科大学附属第一医院老年心血管病房, 沈阳 110001
  • 收稿日期:2018-08-28 出版日期:2019-08-30 发布日期:2019-07-16
  • 通讯作者: 田文 E-mail:dr_wentian@163.com
  • 作者简介:徐健(1990-),男,医师,硕士研究生.
  • 基金资助:
    辽宁省科学技术计划(2015225027)

Association of Platelet-to-Lymphocyte Ratio with Periprocedural Myocardial Infarction and Its Predictive Value in Elderly Patients Who Underwent Percutaneous Coronary Intervention for Acute Coronary Syndrome

XU Jian, ZHAO Shijie, NIU Yimeng, QI Guoxian, TIAN Wen   

  1. Department of Geriatric Cardiology, The First Hospital, China Medical University, Shenyang 110001, China
  • Received:2018-08-28 Online:2019-08-30 Published:2019-07-16

摘要: 目的 分析经皮冠状动脉介入治疗(PCI)的老年非ST段抬高型急性冠状动脉综合征(NSTE-ACS)患者入院时的炎症标志物水平对围术期心肌梗死(PMI)的预测价值。方法 回顾性收集连续入选2014年1月至2017年12月我院老年心血管病房接受PCI治疗的206例老年NSTE-ACS患者的临床数据,包括危险因素、临床表现、术前肌钙蛋白、炎症相关标志物以及PCI术后的肌钙蛋白水平(cTnI)。依据术后cTnI水平将患者分为PMI组(n=28)和对照组(n=178)。对样本进行倾向评分匹配,使2组患者具有可比性。最终,2组分别纳入26例和90例患者,分析影响PMI的危险因素及预测因子。结果 与对照组相比,PMI组血小板淋巴细胞比值(PLR)明显升高[159.43(105.81,196.13)vs 123.86(92.46,149.60),P=0.021];多因素分析比较PLR四分位极值发现,PLR(OR=13.11,95% CI:2.42,70.92,P=0.003)、非ST段抬高型心肌梗死(OR=4.56,95% CI:1.24,16.78,P=0.022)、支架植入数(OR=2.83,95% CI:1.52,5.25,P=0.001)、高密度脂蛋白胆固醇(OR=0.07,95% CI:0.01,0.66,P=0.020)均是PMI的独立影响因素;趋势分析发现PLR越高,则PMI的发生风险也越高(OR=13.11,95% CI:2.42,70.92,P-trend=0.017);PLR>149.92预测PMI发生的敏感度和特异度分别为57.70%和75.60%。结论 老年NSTE-ACS患者PCI术前PLR升高是PMI发生的独立危险因素,能够较特异地预测老年NSTE-ACS患者的PMI风险。

关键词: 老年, 非ST段抬高型急性冠状动脉综合征, 血小板淋巴细胞比值, 围术期心肌梗死, 经皮冠状动脉介入治疗

Abstract: Objective To analyze the predictive value of inflammatory markers for periprocedural myocardial infarction (PMI) in elderly patients who underwent percutaneous coronary intervention (PCI) for non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Methods This retrospective study enrolled 206 consecutive elderly patients with NSTE-ACS who underwent PCI in the department of geriatric cardiology of the First Hospital of China Medical University between January 2014 and December 2017. The clinical data of the patients,including risk factors,clinical presentation,lipid profiles,inflammatory markers,and troponin I level (before and after PCI),were collected. The patients were divided into PMI group (n=28) and control group (n=178) according to serum troponin I level. Finally,26 and 90 patients were matched according to propensity scores to make them comparable,and the risk factors and predictors of PMI were analyzed. Results Compared with the control group,the PMI group had significantly increased platelet-to-lymphocyte ratio[PLR:159.43 (105.81-196.13) vs 123.86 (92.46-149.60),P=0.021]. In the multivariable analyses,PLR[odds ratio (OR)=13.11; 95% confidence interval (CI):2.42,70.92; P=0.003],non-ST-segment elevation myocardial infarction (OR=4.56,95% CI:1.24,16.78; P=0.022),number of stents used (OR=2.83; 95% CI:1.52,5.25; P=0.001),and low high-density lipoprotein cholesterol level (OR=0.07; 95% CI:0.01,0.66; P=0.020) were revealed as the independent risk factors of PMI. The trend analysis revealed that the risk of PMI was increasing,accompanied by increasing PLR (OR=13.11; 95% CI:2.42,70.92; P-trend=0.017). A PLR of >149.92 had a sensitivity of 57.70% and a specificity of 75.60% in predicting PMI. Conclusion Increased PLR is an independent risk factor of PMI and might predict PMI risk in elderly patients with NSTE-ACS who are undergoing PCI.

Key words: the elderly, non-ST segment elevation acute coronary syndrome, platelet-to-lymphocyte ratio, periprocedural myocardial infarction, percutaneous coronary intervention

中图分类号: 

  • R541.4
[1] CAVALLINI C,SAVONITTO S,VIOLINI R,et al. Impact of the elevation of biochemical markers of myocardial damage on long-term mortality after percutaneous coronary intervention:results of the CK-MB and PCI study[J]. Eur Heart J,2005,26(15):1494-1498. DOI:10.1093/eurheartj/ehi173.
[2] PATTI G,PASCERI V,COLONNA G,et al. Atorvastatin pretreatment improves outcomes in patients with acute coronary syndromes undergoing early percutaneous coronary intervention:results of the ARMYDA-ACS randomized trial[J]. J Am Coll Cardiol,2007,49(12):1272-1278. DOI:10.1016/j.jacc.2007.02.025.
[3] DI SCIASCIO G,PATTI G,PASCERI V,et al. Efficacy of atorvastatin reload in patients on chronic statin therapy undergoing percutaneous coronary intervention:results of the ARMYDA-RECAPTURE (Atorvastatin for Reduction of Myocardial Damage During Angioplasty) Randomized Trial[J]. J Am Coll Cardiol,2009,54(6):558-565. DOI:10.1016/j.jacc.2009.05.028.
[4] HERRMANN J. Peri-procedural myocardial injury:2005 update[J]. Eur Heart J,2005,26(23):2493-2519. DOI:10.1093/eurheartj/ehj455.
[5] LEE DW,CAVENDER MA. Periprocedural myocardial infarction in contemporary practice[J]. Interv Cardiol Clin,2019,8(2):209-223. DOI:10.1016/j.iccl.2018.12.001.
[6] LIBBY P. Mechanisms of acute coronary syndromes and their implications for therapy[J]. N Engl J Med,2013,368(21):2004-2013. DOI:10.1056/NEJMra1216063.
[7] FRACASSI F,NICCOLI G,VETRUGNO V,et al. Optical coherence tomography and C-reactive protein in risk stratification of acute coronary syndromes[J]. Int J Cardiol,2019,pii:S0167-5273(18) 36900-6. DOI:10.1016/j.jcard.2019.01.058.
[8] TAJFARD M,TAVAKOLY SANY SB,AVAN A,et al. Relationship between serum high sensitivity C-reactive protein with angiographic severity of coronary artery disease and traditional cardiovascular risk factors[J]. J Cell Physiol,2019,234(7):10289-10299. DOI:10.1002/jcp.27945.
[9] HELD C,WHITE HD,STEWART RAH,et al. Inflammatory biomarkers interleukin-6 and c-reactive protein and outcomes in stable coronary heart disease:experiences from the stability (stabilization of atherosclerotic plaque by initiation of darapladib therapy) trial[J]. J Am Heart Assoc,2017,6(10):e005077. DOI:10.1161/jaha.116.005077.
[10] KURTUL A,MURAT SN,YARLIOGLUES M,et al. Association of platelet-to-lymphocyte ratio with severity and complexity of coronary artery disease in patients with acute coronary syndromes[J]. Am J Cardiol,2014,114(7):972-978. DOI:10.1016/j.amjcard.2019.01.058.
[11] MOUSSA ID,KLEIN LW,SHAH B,et al. Consideration of a new definition of clinically relevant myocardial infarction after coronary revascularization:an expert consensus document from the Society for Cardiovascular Angiography and Interventions (SCAI)[J]. J Am Coll Cardiol,2013,62(17):1563-1570. DOI:10.1016/j.jacc.2013.08.720.
[12] MOREIRA DM,DA SILVA RL,VIEIRA JL,et al. Role of vascular inflammation in coronary artery disease:potential of anti-inflammatory drugs in the prevention of atherothrombosis. Inflammation and anti-inflammatory drugs in coronary artery disease[J]. Am J Cardiovasc Drugs,2015,15(1):1-11. DOI:10.1007/s40256-014-0094-z.
[13] CREA F,LIUZZO G. Pathogenesis of acute coronary syndromes[J]. J Am Coll Cardiol,2013,61(1):1-11. DOI:10.1016/j.jacc.2012.07.064.
[14] CREA F,LIBBY P. Acute coronary syndromes:the way forward from mechanisms to precision treatment[J]. Circulation,2017,136(12):1155-1166. DOI:10.1161/circulationaha.117.029870.
[15] RIDKER PM,EVERETT BM,THUREN T,et al. Antiinflammatory therapy with canakinumab for atherosclerotic disease[J]. N Engl J Med,2017,377(12):1119-1131. DOI:10.1056/NEJMoa1707914.
[16] NISSEN SE,TUZCU EM,SCHOENHAGEN P,et al. Statin therapy,LDL cholesterol,C-reactive protein,and coronary artery disease[J]. N Engl J Med,2005,352(1):29-38. DOI:10.1056/NEJMoa042000.
[17] BRIGUORI C,VISCONTI G,FOCACCIO A,et al. Novel approaches for preventing or limiting events (Naples)Ⅱtrial:impact of a single high loading dose of atorvastatin on periprocedural myocardial infarction[J]. J Am Coll Cardiol,2009,54(23):2157-2163. DOI:10.1010/j.jacc.2009.07.005.
[18] RIDKER PM,DANIELSON E,FONSECA FA,et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein[J]. N Engl J Med,2008,359(21):2195-2207. DOI:10.1056/NEJMoa0807646.
[19] TUNON J,BADIMON L,BOCHATON-PIALLAT ML,et al. Identifying the anti-inflammatory response to lipid lowering therapy:a position paper from the working group on atherosclerosis and vascular biology of the European Society of Cardiology[J]. Cardiovasc Res,2019,115(1):10-19. DOI:10.1093/cvr/cvy293.
[20] AZAB B,SHAH N,AKERMAN M,et al. Value of platelet/lymphocyte ratio as a predictor of all-cause mortality after non-ST-elevation myocardial infarction[J]. J Thromb Thrombolysis,2012,34(3):326-334. DOI:10.1007/s11239-012-0718-6.
[21] TEMIZ A,GAZI E,GUNGOR O,et al. Platelet/lymphocyte ratio and risk of in-hospital mortality in patients with ST-elevated myocardial infarction[J]. Med Sci Monit,2014,20:660-665. DOI:10.12659/msm.890152.
[22] LEE Y SG,BARADI A,Peverelle M,et al. Usefulness of platelet-to-lymphocyte ratio to predict long-term all-cause mortality in patients at high risk of coronary artery disease who underwent coronary angiography[J]. Am J Cardiol,2018,121(9):1021-1026. DOI:10.1016/j.amjcard.2018.01.018.
[23] KURTUL A,YARLIOGLUES M,MURAT S N,et al. Usefulness of the platelet-to-lymphocyte ratio in predicting angiographic reflow after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction[J]. Am J Cardiol,2014,114(3):342-347. DOI:10.1016/j.amjcard.2014.04.045.
[24] YILDIZ A,YUKSEL M,OYLUMLU M,et al. The utility of the platelet-lymphocyte ratio for predicting no reflow in patients with ST-segment elevation myocardial infarction[J]. Clin Appl Thromb Hemost,2015,21(3):223-228. DOI:10.1177/1076029613519851.
[25] CHAN W,STUB D,CLARK DJ,et al. Usefulness of transient and persistent no reflow to predict adverse clinical outcomes following percutaneous coronary intervention[J]. Am J Cardiol,2012,109(4):478-485. DOI:10.1016/j.amjcard.2011.09.037.
[26] HOTCHKISS RS,KARL IE. The pathophysiology and treatment of sepsis[J]. N Engl J Med,2003,348(2):138-150. DOI:10.1056/NEJMra021333.
[1] 范蒙蒙, 马晶茹. 急性冠状动脉综合征患者经皮冠状动脉介入治疗术后谵妄的回顾性分析[J]. 中国医科大学学报, 2019, 48(6): 519-524.
[2] 张燕平, 赵平. 褪黑素对老年女性患者术后早期认知功能障碍的影响[J]. 中国医科大学学报, 2019, 48(5): 437-441.
[3] 武佳科, 田春阳, 何东旭, 宋佳, 于彤彤, 孙志军, 孙兆青. 休克指数对行经皮冠状动脉介入治疗的急性心肌梗死患者长期预后的预测价值[J]. 中国医科大学学报, 2018, 47(6): 522-526.
[4] 桑阿明, 柴军, 谭媚月, 陶倩云, 陈丽娜. 行择期结直肠手术的老年患者术后肺部并发症的相关因素[J]. 中国医科大学学报, 2018, 47(5): 426-430.
[5] 穆晓云, 许立薇, 丁艳萍. 基于新媒体平台的延续护理对老年糖尿病患者自我效能水平的影响[J]. 中国医科大学学报, 2018, 47(4): 373-375.
[6] 范蒙蒙, 马晶茹. 非ST段抬高型心肌梗死患者经皮冠状动脉介入治疗术中应用替罗非班致极重度血小板减少1例[J]. 中国医科大学学报, 2018, 47(11): 1047-1049.
[7] 金波,刘云鹏. 老年小细胞肺癌的治疗进展[J]. 中国医科大学学报, 2017, 46(8): 750-753.
[8] 刘艳 ,付强 ,贾兴亚 ,安欣. Er,Cr:YSGG 激光对老年人不同牙本质粘接强度的影响[J]. 中国医科大学学报, 2017, 46(8): 754-757.
[9] 王慧,杨洋,徐萍,王万粮,杜秋红,宋文玲,段秋艳. 稳定型心绞痛患者经皮冠状动脉介入治疗后血浆 OX40L 水平与预后的关系[J]. 中国医科大学学报, 2017, 46(7): 649-652.
[10] 李斌 ,黄承 ,张丛笑 ,王广斌. 老年衰弱和髋部骨折术后短期预后的相关研究[J]. 中国医科大学学报, 2017, 46(5): 457-459.
[11] 朱家赫,于彤彤,孙兆青. 完全血运重建策略对老年急性 ST 段抬高型心肌梗死合并多支 血管病变患者预后的影响[J]. 中国医科大学学报, 2017, 46(3): 227-231.
[12] 孙婧菡,刘志. 无创心排量监测在老年脓毒性休克患者早期液体复苏中的应用[J]. 中国医科大学学报, 2017, 46(10): 942-945.
[13] 陈思敏,毛杰. 快速通道外科在老年结肠癌患者围手术期的应用[J]. 中国医科大学学报, 2016, 45(7): 631-634.
[14] 张添甜 ,张潇怡 ,赵紫薇 ,孙光 ,牛一蒙 ,林杰. 原发高血压老年患者低舒张压对心脏舒张功能的影响[J]. 中国医科大学学报, 2016, 45(6): 514-517.
[15] 吴宝刚,万小旭,刘丹,白雪,王佳贺. 重症监护病房老年患者鲍曼不动杆菌感染的临床特点及药敏分析[J]. 中国医科大学学报, 2016, 45(5): 406-408.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 贺雪梅, 熊欣, 邹建中, 李发琪, 龚晓波. 超声消融剂量与生物学焦域特征[J]. 中国医科大学学报, 2009, 38(9): 654 .
[2] 尹玉, 赵卫华, 胡健. 替米沙坦与非诺贝特对高脂饮食大鼠血清脂联素水平的影响[J]. 中国医科大学学报, 2009, 38(9): 674 .
[3] 孔静, 吴硕东, 范莹, 金俊哲, 石刚. 腹腔镜胰体尾切除及胰腺假性囊肿内引流手术体会[J]. 中国医科大学学报, 2009, 38(9): 690 .
[4] 宋辉. 缺氧诱导因子-1α在喉鳞状细胞癌中的表达及与微血管密度的关系[J]. 中国医科大学学报, 2009, 38(9): 700 .
[5] 夏永辉, 徐克. 对吻式支架置入术治疗Leriche综合征15例体会[J]. 中国医科大学学报, 2009, 38(9): 714 .
[6] 林书坡, 林杰, 史今. 替米沙坦对胰岛素抵抗大鼠肾脏脂联素表达的影响[J]. 中国医科大学学报, 2009, 38(10): 741 .
[7] 张丽, 齐瑞群, 孙艳, 陈国红, 任宏伟, 陈洪铎, 高兴华. 卡介菌多糖核酸对特应性皮炎外周血CLA~+T细胞表达不同细胞因子的影响[J]. 中国医科大学学报, 2009, 38(10): 764 .
[8] 戴宇, 焦伊胜, 王永来. 骨桥蛋白和基质金属蛋白酶9在上皮性卵巢癌中的表达及二者相关性[J]. 中国医科大学学报, 2009, 38(10): 775 .
[9] 蔡鑫泽, 顾卉, 刘彤, 李丰. hLMO1编码基因重组质粒的构建及蛋白的表达和定位[J]. 中国医科大学学报, 2009, 38(11): 816 .
[10] 贾兰玲, 陈相, 庹航行, 贾心善, 陈颖, 李继光. 大鼠海马神经细胞原代培养及塑料孔板原位鉴定[J]. 中国医科大学学报, 2009, 38(11): 843 .

中国医科大学学报版权所有©2018

未经允许,严禁擅自转载本站图文资料

地址:中国 沈阳市沈北新区蒲河路77号 110122

辽ICP备05014850

JOURNAL OF CHINA MEDICAL UNIVERSITY

ADDRESS: NO.77 PUHE ROAD

SHENYANG NORTH NEW AREA, SHENYANG

LIAONING PROVINCE, P.R. CHINA