摘要
目的探讨急性心肌梗死(AMI)并发心脏破裂(CR)的影响因素,以及中性粒细胞与淋巴细胞比值(NLR)对预后的预测价值。方法选取2019年5月—2023年8月咸阳市中心医院收治的AMI病人共976例,将其中并发CR病人作为CR组(观察组,27例),按照1∶4的比例随机选取未发生CR者为非CR组(对照组,108例)。以院内病死为终点事件,将观察组再分为生存组(12例)和死亡组(15例)。检测中性粒细胞计数(N计数)与淋巴细胞计数(L计数),并计算NLR。采用受试者工作特征(ROC)曲线分析NLR对AMI并发CR病人预后的预测价值;采用多因素Logistic回归分析探讨AMI病人发生CR的危险因素。结果与对照组比较,观察组年龄、白细胞计数、N计数和NLR等指标均明显高于对照组,而收缩压和L计数则明显低于对照组(t=2.190~19.852,P均<0.05)。多因素Logistic回归分析显示,年龄≥70岁、收缩压≤16.7 kPa、白细胞计数≥10.0×10^(9)/L、N计数≥9.0×10^(9)/L、L计数≤2.0×10^(9)/L以及NLR≥5.9等变量均是AMI并发CR的独立危险因素(OR=2.188~3.554,95%CI=(1.168~1.955)~(3.161~6.461),P均<0.05)。生存组N计数和NLR均明显低于死亡组,而L计数则显著高于死亡组(t=7.749~15.052,P均<0.05)。N计数、L计数及NLR预测AMI并发CR病人预后的ROC曲线下面积分别为0.719、0.841和0.927(95%CI=(0.674~0.882)~(0.769~0.977),P均<0.05),其中以NLR的特异度(85.6%)最高。结论高年龄、低收缩压、高白细胞计数、高N计数、低L计数和高NLR等变量均是AMI并发CR的独立危险因素,其中NLR对AMI并发CR预后不良具有较高的预测价值。
Objective To investigate the influencing factors for acute myocardial infarction(AMI)complicated by cardiac rupture(CR)and the value of neutrophil-to-lymphocyte ratio(NLR)in predicting the prognosis of patients.Methods A total of 976 AMI patients who were admitted to Xianyang Central Hospital from May 2019 to August 2023 were enrolled,among whom 27 patients comorbid with CR were enrolled as CR group(observation group),and the patients without CR were randomly selected as non-CR group at a ratio of 1∶4(control group with 108 patients).With in-hospital mortality as the endpoint event,the patients in the observation group were further divided into survival group with 12 patients and death group with 15 patients.Neutrophil count and lymphocyte count were measured,and NLR was calculated.The receiver operating characteristic(ROC)curve was used to investigate the value of NLR in predicting the prognosis of AMI patients comorbid with CR,and a multivariate logistic regression analysis was used to investigate the risk factors for CR in AMI patients.Results Compared with the control group,the observation had significantly higher age,white blood cell count,neutrophil count,and NLR and significantly lower systolic blood pressure and lymphocyte count(t=2.190-19.852,all P<0.05).The multivariate Logistic regression analysis showed that age≥70 years,systolic blood pressure≤16.7 kPa,white blood cell count≥10.0×10^(9)/L,neutrophil count≥9.0×10^(9)/L,lymphocyte count≤2.0×10^(9)/L,and NLR≥5.9 were independent risk factors for AMI complicated by CR(OR=2.188-3.554,95%CI=1.168-1.955 to 3.161-6.461,all P<0.05).Compared with the death group,the survival group had significantly lower neutrophil count and NLR and a significantly higher lymphocyte count(t=7.749-15.052,all P<0.05).Neutrophil count,lymphocyte count,and NLR had an area under the ROC curve of 0.719,0.841,and 0.927,respectively,in predicting the prognosis of AMI patients with CR,with a 95%confidence interval of 0.674-0.882 to 0.769-0.977(all P<0.05),and NLR had the highest specificity of 85.63%.Conclusion High age,low systolic blood pressure,high white blood cell count,high neutrophil count,low lymphocyte count,and high NLR are risk factors for CR in AMI patients,among which NLR has a high value in predicting the poor prognosis of AMI complicated by CR.
作者
韩芳旗
秦黎明
张恒
卫聪颖
陈斌
HAN Fangqi;QIN Liming;ZHANG Heng;WEI Congying;CHEN Bin(Department Ⅰ of Cardiovascular,Xianyang Central Hospital,Xianyang 712000,China)
出处
《青岛大学学报(医学版)》
2025年第3期411-415,共5页
Journal of Qingdao University(Medical Sciences)
基金
陕西省重点研发计划项目(2022SF-291)。
关键词
心肌梗死
心脏破裂
梗死后
影响因素分析
白细胞计数
预后
预测
myocardial infarction
heart rupture,post-infarction
root cause analysis
leukocyte count
prognosis
forecasting
作者简介
第一作者:韩芳旗(1987-),男,硕士,主治医师;通信作者:陈斌(1984-),男,硕士,主治医师。E-mail:chenbinccbbb@163.com。
