摘要
目的探讨血小板淋巴细胞比值(platelet to lymphocyte ratio,PLR)、生长分化因子15(growth differentiation factor-15,GDF-15)对急性心肌梗死(acute myocardial infarction,AMI)患者院内心力衰竭预测价值。方法选取2020年1月至2023年10月本院心内科收治住院的AMI患者329例。依据AMI患者住院期间是否发生心力衰竭分为心衰组(41例)和非心衰组(135例),心衰组中包括Killip分级Ⅱ级17例、Ⅲ级21例和Ⅳ级3例。比较不同分组相关指标的差异,进行Pearson相关性分析,采用Logistic回归模型进行影响因素分析,采用受试者操作特征(receiver operator characteristic,ROC)曲线分析各指标的预测价值。结果心衰组心房颤动比例、陈旧性心肌梗死比例、肌酸激酶同工酶(creatine kinase-MB,CK-MB)峰值、心肌肌钙蛋白I(cardiac troponin I,cTnI)峰值、病变血管≥2支比例、全球急性冠状动脉事件注册(Global Registry of Acute Coronary Events,GRACE)评分及N末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)、超敏C反应蛋白(hypersensitive C reactive protein,hs-CRP)、同型半胱氨酸(homocysteine,Hcy)、纤维蛋白原(fibrinogen,Fib)、PLR、GDF-15水平高于非心衰组,高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)、左室射血分数(left ventricular ejection fraction,LVEF)低于非心衰组(P<0.05)。Killip分级Ⅳ级心衰患者PLR、GDF-15、CK-MB峰值、cTnI峰值、NT-proBNP水平高于Killip分级Ⅱ级和Ⅲ级(P<0.05),Killip分级Ⅲ级心衰患者PLR、GDF-15、CK-MB峰值、cTnI峰值、NT-proBNP水平高于Killip分级Ⅱ级心衰患者,差异均有统计学意义(P<0.05)。Pearson相关性分析显示,PLR及GDF-15与CK-MB峰值、cTnI峰值、NT-proBNP均呈正相关(P<0.05)。Logistic回归分析结果显示,心房颤动、CK-MB、cTnI、GRACE评分、NT-proBNP、PLR、GDF-15为AMI患者院内心衰发生的危险因素,而HDL-C、LVEF为院内心衰发生的保护因素(P<0.05)。ROC曲线分析显示,PLR与GDF-15联合预测AMI患者院内心衰的曲线下面积为0.883,均高于二者单独预测(Z=2.702、2.915,P=0.031、0.019)。结论PLR及GDF-15对AMI患者院内心衰具有独立的预测价值,二者联合后其预测能力能够进一步提升。
Objective To investigate the value of platelet to lymphocyte ratio(PLR)and growth differentiation factor-15(GDF-15)in predicting in-hospital heart failure in patients with acute myocardial infarction(AMI).Methods A total of 329 patients with AMI admitted to the cardiology department of our hospital from January 2020 to October 2023 were selected.According to the occurrence of heart failure during hospitalization,AMI patients were divided into heart failure group(41 cases)and non-heart failure group(135 cases).The heart failure group included 17 cases of Killip gradeⅡ,21 cases of Killip gradeⅢand 3 cases of Killip gradeⅣ.The differences of relevant indicators in different groups were compared,Pearson correlation analysis was carried out,influencing factors were analyzed by Logistic regression model,and the predictive value of each indicator was analyzed by receiver operator characteristic(ROC)curve.Results The proportion of atrial fibrillation,the proportion of old myocardial infarction,the peak of creatine kinaseMB(CK-MB),the peak of cardiac troponin I(cTnI),the proportion of≥2 diseased vessels,the Global Registry of Acute Coronary Events(GRACE)score and the levels of N-terminal pro brain natriuretic peptide(NT-proBNP),hypersensitive C reactive protein(hsCRP),homocysteine(Hcy),fibrinogen(Fib),PLR and GDF-15 in heart failure group were higher than those in non-heart failure group.The levels of high-density lipoprotein cholesterol(HDL-C)and left ventricular ejection fraction(LVEF)in heart failure group were lower than those in non-heart failure group(P<0.05).The levels of PLR,GDF-15,the peak of CK-MB,the peak of cTnI and NT-proBNP in the heart failure patients with Killip gradeⅣwere higher than those with Killip gradeⅡandⅢ(P<0.05).The levels of PLR,GDF-15,the peak of CK-MB,the peak of cTnI and NT-proBNP in the heart failure patients with Killip gradeⅢwere higher than those with Killip gradeⅡ,and the differences were statistically significant(P<0.05).Pearson correlation analysis showed that PLR and GDF-15 were positively correlated with CK-MB peak,cTnI peak and NT-proBNP(P<0.05).Logistic regression analysis showed that atrial fibrillation,CK-MB,cTnI,GRACE score,NT-proBNP,PLR and GDF-15 were risk factors for the occurrence of inhospital heart failure in AMI patients,while HDL-C and LVEF were protective factors for the occurrence of in-hospital heart failure(P<0.05).ROC curve analysis showed that the AUC of in-hospital heart failure in AMI patients predicted by PLR and GDF-15combined was 0.883,which was higher than that predicted by the two alone(Z=2.702,2.915;P=0.031,0.019).Conclusion PLR and GDF-15 have independent predictive value for in-hospital heart failure in AMI patients,and their predictive ability can be further improved after the combination of the two.
作者
赵海歌
赵迎新
冯实
梁淑新
蔺美霖
郑海亮
杨超
崔雯萱
ZHAO Haige;ZHAO Yingxin;FENG Shi;LIANG Shuxin;LIN Meilin;ZHENG Hailiang;YANG Chao;CUI Wenxuan(Department of Clinical Laboratory,Afiliated Hospital of Hebei University,Baoding 071030,China;Department of Cardiology.Affiliated Hospital of Hebei University,Baoding 071030,China;Department of Clinical Laboratory,Hebei Sheng Di-san Rongjun Youfu Hospital,Baoding 071033,China)
出处
《中国分子心脏病学杂志》
CAS
2024年第5期6369-6375,共7页
Molecular Cardiology of China
基金
河北省卫生健康委资助项目(20242279)。
关键词
急性心肌梗死
血小板淋巴细胞比值
生长分化因子15
心力衰竭
预测
Acute myocardial infarction
Platelet to lymphocyte ratio
Growth differentiation factor 15
Heart failure
Forecast
