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| 全身免疫炎症反应指数与冠心病患者冠状动脉狭窄程度及其远期主要不良心血管事件的相关性分析 |
| 王张羽1,2,曹少清1,2,李成思1,2,王玉琴1,2,叶江平1,2,宗刚军1,2,3* |
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(1. 安徽医科大学无锡临床学院心内科, 无锡 214044;
2. 安徽医科大学第五临床医学院, 合肥 230032;
3. 中国人民解放军联勤保障部队第九〇四医院心内科, 无锡 214044
*通信作者) |
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| 摘要: |
| 目的 探讨全身免疫炎症反应指数(SIIRI)与冠心病患者冠状动脉狭窄严重程度及其远期主要不良心血管事件(MACE)发生风险的关系。方法 回顾性连续纳入 2020 年 12 月至 2021 年 12 月因胸痛在中国人民解放军联勤保障部队第九〇四医院住院治疗并行冠状动脉造影检查的 545 例患者,根据冠状动脉造影检查结果分为冠心病组(435 例)和非冠心病组(110 例),根据 Gensini 评分将冠心病患者分为冠状动脉重度狭窄组(Gensini 评分 ≥ 30 分, 272 例)和冠状动脉轻度狭窄组(Gensini 评分为 1~<30 分, 163 例)。SIIRI 计算公式为 SIIRI=中性粒细胞计数×单核细胞计数×血小板计数/淋巴细胞计数。冠心病患者随访 1 年,成功随访 216 例患者,根据有无终点事件分为 MACE 组(77 例)、非 MACE 组(139 例)。采用 logistic 回归模型分析冠心病和冠状动脉重度狭窄的独立预测因素,采用 Cox 比例风险回归模型分析冠心病患者经皮冠状动脉介入(PCI)治疗后发生 MACE 的独立危险因素,采用 ROC 曲线分析 SIIRI 对冠状动脉重度狭窄和 MACE 的预测价值。结果 冠心病组的 SIIRI 高于非冠心病组[305.19×1018(170.98×1018, 550.76×1018)/L2 vs 121.25×1018(91.17×1018, 194.41×1018)/L2, P<0.001]; 当SIIRI 取临界值 251.02×1018/L2 时预测冠心病的效能最高,灵敏度和特异度分别为 58.9 % 和 90.9 %。冠状动脉重度狭窄组的 SIIRI 高于冠状动脉轻度狭窄组[420.75×1018(238.76×1018, 810.13×1018)/L2 vs 185.41×1018(127.39×1018,294.07×1018)/L2, P<0.001];当 SIIRI 取临界值 304.86×1018/L2 时预测冠状动脉重度狭窄的效能最高,灵敏度和特异度分别为 68.0 % 和 79.1 %。MACE 组的 SIIRI 高于非 MACE 组[942.38×1018(528.00×1018, 1 494.43×1018)/L2vs 319.93×1018(176.41×1018, 498.90×1018)/L2, P<0.001];当 SIIRI 取临界值 650.23×1018/L2 时对冠心病患者行PCI 治疗后发生 MACE 的预测能力最强,灵敏度和特异度分别为 71.4 % 和 84.9 %。SIIRI 预测冠心病和冠状动脉重度狭窄及 PCI 治疗后发生 MACE 的 AUC 值分别为 0.809(95 % CI 0.770~0.848)、0.775(95 % CI 0.732~0.819)、0.798(95 % CI 0.732~0.864),均高于系统性免疫炎症指数、系统性炎症反应指数、血小板与淋巴细胞比值、中性粒细胞与淋巴细胞比值和单核细胞与淋巴细胞比值。结论 SIIRI 是冠心病及冠状动脉重度狭窄的独立危险因素,也对冠心病患者行 PCI 治疗后远期发生 MACE 具有较好的预测价值。 |
| 关键词: 全身免疫炎症反应指数 冠心病 Gensini评分 疾病严重程度 主要不良心血管事件 |
| DOI：10.16781/j.CN31-2187/R.20230362 |
| 投稿时间：2023-06-27修订日期：2023-11-09 |
| 基金项目:江苏省卫生健康委员会重大课题(ZD2021020). |
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| Correlations between systemic immune-inflammation response index and severity of coronary artery stenosis and long-term major adverse cardiovascular events in patients with coronary heart disease |
| WANG Zhangyu1,2,CAO Shaoqing1,2,LI Chengsi1,2,WANG Yuqin1,2,YE Jiangping1,2,ZONG Gangjun1,2,3* |
(1. Department of Cardiology, Wuxi Clinical College of Anhui Medical University, Wuxi 214044, Jiangsu, China;
2. The Fifth Clinical Medical College, Anhui Medical University, Hefei 230032, Anhui, China;
3. Department of Cardiology, No. 904 Hospital of Joint Logistics Support Force of PLA, Wuxi 214044, Jiangsu, China
*Corresponding author) |
| Abstract: |
| Objective To explore the relationships between systemic immune-inflammation response index (SIIRI) and the severity of coronary artery stenosis and long-term major adverse cardiovascular events (MACEs) in patients with coronary heart disease (CHD). Methods A total of 545 patients admitted to No. 904 Hospital of Joint Logistics Support Force of PLA due to chest pain and underwent coronary angiography from Dec. 2020 to Dec. 2021 were retrospectively enrolled. According to the results of coronary angiography, the patients were divided into CHD group (n=435) and non-CHD group (n=110). According to the Gensini score, the CHD patients were divided into severe coronary artery stenosis group (Gensini score ≥ 30, n=272) and mild coronary artery stenosis group (Gensini score 1-<30, n=163). The SIIRI calculation formula was:SIIRI=neutrophil count×monocyte count×platelet count÷lymphocyte count. The CHD patients were followed up for 1 year and 216 patients were successfully followed up. Based on the follow-up results, the 216 patients were divided into MACE group (n=77) and non-MACE group (n=139). Logistic regression model was used to analyze the independent predictors of CHD and severe coronary artery stenosis. Cox proportional hazard regression model was used to analyze the independent risk factors of MACEs in CHD patients after percutaneous coronary intervention (PCI). Receiver operating characteristic curve was used to analyze the predictive value of SIIRI for severe coronary artery stenosis and MACEs. Results The SIIRI of the CHD group was significantly higher than that of the non-CHD group (305.19×1018[170.98×1018, 550.76×1018]/L2 vs 121.25×1018[91.17×1018, 194.41×1018]/L2, P<0.001). The ability to predict CHD was the strongest when the SIIRI cutoff value was 251.02×1018/L2, with a sensitivity of 58.9 % and a specificity of 90.9 %. The SIIRI of the severe coronary artery stenosis group was significantly higher than that of the mild coronary artery stenosis group (420.75×1018[238.76×1018, 810.13×1018]/L2 vs 185.41×1018[127.39×1018, 294.07×1018]/L2, P<0.001). When the SIIRI cutoff value was 304.86×1018/L2, the efficacy of predicting severe coronary artery stenosis was the highest, with a sensitivity of 68.0 % and a specificity of 79.1 %. The SIIRI of the MACE group was significantly higher than that of the non-MACE group (942.38×1018[528.00×1018, 1 494.43×1018]/L2 vs 319.93×1018[176.41×1018, 498.90×1018]/L2, P<0.001). When the SIIRI cutoff value was 650.23×1018/L2, the predictive ability for MACEs after PCI was the strongest, with a sensitivity of 71.4 % and a specificity of 84.9 %. The values of area under curve for SIIRI in predicting CHD, severe coronary artery stenosis, and MACEs were 0.809 (95 % confidence interval[CI]0.770-0.848), 0.775 (95 % CI 0.732-0.819), and 0.798 (95 % CI 0.732-0.864), respectively, and were all higher than those of systemic immune-inflammation index, systemic inflammatory response index, platelet to lymphocyte ratio, neutrophil to lymphocyte ratio, and monocyte to lymphocyte ratio. Conclusion SIIRI is an independent risk factor of CHD and severe coronary artery stenosis. It also has good predictive value for long-term MACEs in CHD patients after PCI. |
| Key words: systemic immune-inflammation response index coronary heart disease Gensini score disease severity major adverse cardiovascular events |
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