本文選題：梗死相關動脈 + 中性粒細胞計數/淋巴細胞計數比值��； 參考：《吉林大學》2017年碩士論文

【摘要】：目的:探索行急診PCI治療的急性STEMI患者術前梗死相關動脈血流異常的預測因素及其預后情況。方法:回顧性分析2014年01月至2014年12月,因急性ST段抬高型心肌梗死發(fā)病12 h就診于吉林大學第一醫(yī)院心血管疾病診治中心并接受急診經皮冠狀動脈介入治療(PCI)的患者561例,根據入選及排除標準最終506例患者(男性354例,女性152例,平均年齡61.19歲±10.07歲)符合此次臨床研究。根據PCI前梗死相關動脈心肌梗死溶栓治療(TIMI)分級情況將患者分為血流正常組(TIMI血流3級,69例)和血流異常組(TIMI血流≤2級,437例)。記錄研究對象的基本臨床特征、冠狀動脈造影情況、治療情況、實驗室檢查情況、Grace評分及隨訪18個月的預后情況,并計算入院時中性粒細胞計數與淋巴細胞計數的比值。應用多元Logistic回歸分析法分析影響PCI前梗死相關動脈血流的因素,采用受試者工作特征(ROC)曲線評估NLR預測PCI前梗死相關動脈血流異常的敏感性、特異性及預測價值,應用Kaplan-Meier生存分析法比較兩組隨訪18個月的生存狀況。結果:1.與血流正常組相比血流異常組白細胞計數[(12.04±3.53)×109/L vs(10.84±2.79)×109/L,P0.05]、中性粒細胞計數[(9.99±3.48)×109/L vs(8.23±2.69)×109/L,P0.001]、空腹血糖水平[(7.84±4.00)mmmol/L vs(6.23±1.83)mmol/L,P0.001]及NLR[8.03(4.54,10.92)vs 5.14(2.97,7.02),P0.001]水平高于血流正常組,差異有統計學意義;血流異常組淋巴細胞計數、LVEF值和吸煙比例低于血流正常組,差異有統計學意義(P0.05)。2.將空腹血糖、NLR、吸煙、白細胞計數、中性粒細胞計數、淋巴細胞計數、LVEF進行多元Logistic回歸分析,提示空腹血糖和NLR是PCI前梗死相關動脈血流異常的獨立危險因素。3.應用受試者工作特征(ROC)曲線分析顯示NLR預測血流異常的曲線下面積(AUC)為0.685(95%CI:0.624~0.745),最佳截點值為7.22時,此時預測的敏感度、特異度分別為47.6%和81.2%。當NLR聯合空腹血糖時預測PCI前梗死相關動脈血流異常的曲線下面積(AUC)為0.743(95%CI:0.689~0.794)。4.與血流正常組相比,血流異常組有更高在院呼吸機使用率及心力衰竭發(fā)生率(8.2%vs 0%,P0.05;18.5%vs 8.7%,P0.05),差異有統計學意義。雖然兩組患者住院天數及在院死亡率間的比較無統計學差異,但血流異常組患者隨訪6個月MACEs發(fā)生率(13%vs 2.9%,P0.05)、隨訪12個月MACEs發(fā)生率(16.2%vs 5.8%,P0.05)、隨訪18個月MACEs發(fā)生率及全因死亡率(19%vs7.2%,P0.05;6.2%vs 0%,P0.05)較血流正常組顯著增高。5.應用Kaplan-Meier生存分析比較急性STEMI患者隨訪18個月的預后情況,血流異常組患者無全因死亡及無MACEs生存概率下降趨勢較血流正常組快,兩組間生存結局比較差異有統計學意義(Log-Rank,P0.05)。結論:1.空腹血糖、NLR是PCI前梗死相關動脈血流異常的獨立危險因素。2.NLR聯合空腹血糖可以顯著提高對PCI前梗死相關動脈血流異常的預測價值。3.PCI前梗死相關動脈血流異�；颊咻^血流正�；颊哳A后差(隨訪18個月)。
[Abstract]:Objective: to explore the prognostic factors and prognosis of infarct related artery blood flow abnormality in acute STEMI patients treated with emergency PCI. Methods: from January 2014 to December 2014, 561 patients with acute ST-segment elevation myocardial infarction who were admitted to the Cardiovascular Disease diagnosis and treatment Center of the first Hospital of Jilin University and received emergency percutaneous coronary intervention (PCI) for 12 hours were analyzed retrospectively. According to the inclusion and exclusion criteria, 506 patients (354 males and 152 females, mean age 61.19 鹵10.07 years) were eligible for this clinical study. According to the classification of thrombolytic therapy in infarct-related artery myocardial infarction before PCI, the patients were divided into normal group (69 cases) and abnormal group (437 cases). The basic clinical features, coronary arteriography, treatment, laboratory examination, Grace score and prognosis of 18 months follow-up were recorded, and the ratio of neutrophil count to lymphocyte count at admission was calculated. Multivariate Logistic regression analysis was used to analyze the factors affecting the blood flow of infarct-related artery before PCI. The sensitivity, specificity and predictive value of NLR in predicting the abnormal blood flow of infarct-related artery before PCI were evaluated by using the operating characteristics of subjects. Kaplan-Meier survival analysis was used to compare the survival status of the two groups during a follow-up period of 18 months. The result is 1: 1. Compared with normal blood flow group, the white blood cell count (WBC), neutrophil count (9.99 鹵3.48) 脳 10 9 vs(8.23 鹵2.69 脳 10 9 / L P0.001, fasting blood glucose level (7.84 鹵1.83 mmol / L) and NLR (8.03 鹵4.544.410.92 vs 5.14 鹵4.97.77.02P 0.001) were significantly higher in abnormal group than those in normal group. The Lymphocyte count and smoking ratio in abnormal blood flow group were lower than those in normal blood flow group, and the difference was statistically significant. Multivariate Logistic regression analysis showed that fasting blood glucose (FBG), smoking, leukocyte count, neutrophil count and lymphocyte count were independent risk factors of infarct-related arterial blood flow abnormality before PCI. The area under the curve of NLR for predicting abnormal blood flow was 0.68595% CI0.6240.745, and the best cut-off point was 7.22. The predicted sensitivity and specificity were 47.6% and 81.2%, respectively. When NLR combined with fasting blood glucose, the area under the curve of predicting the abnormal blood flow of infarct-related artery before PCI was 0.74395% CI: 0.689 + 0.794n.4. Compared with normal blood flow group, the rate of ventilator utilization and heart failure in abnormal blood flow group was higher than that in normal group. The incidence of heart failure was 8.2% vs 0. 05%, 18. 5% vs 8. 7% P 0. 05. The difference was statistically significant. Although there was no statistical difference between the two groups in terms of the length of stay in hospital and the mortality rate in hospital, However, the incidence of MACEs in patients with abnormal blood flow was 13g vs 2.9 P0.05, the incidence of MACEs was 16.2vs 5.8 and P0.05in the 12 months follow-up. The incidence of MACEs and the total mortality rate of 19vs7.2VS7.2vs P0.05 were significantly higher than that of the normal blood flow group (P 0.05, P 0.05, P 0.05) in the group with abnormal blood flow at the follow up period of 6 months (P < 0.05), and the incidence of MACEs was significantly higher than that in the group with normal blood flow (P 0.05). Kaplan-Meier survival analysis was used to compare the prognosis of the patients with acute STEMI for 18 months. The survival probability of the patients with abnormal blood flow was decreased faster than that of the normal blood flow group. The difference of survival outcome between the two groups was statistically significant. Conclusion 1. FBG NLR is an independent risk factor for abnormal blood flow of infarct-related artery before PCI. 2. NLR combined with fasting blood glucose can significantly increase the predictive value of abnormal blood flow of infarct-related artery before PCI. 3. Patients with abnormal blood flow of infarct-associated artery before PCI The prognosis was worse than that in patients with normal blood flow (follow-up for 18 months).
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R542.22

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