摘要
目的 探讨ST段抬高型心肌梗死(STEMI)患者糖化血红蛋白(HbA1c)水平、红细胞分布宽度(RDW)、中性粒细胞与淋巴细胞绝对值比率(NLR)与冠状动脉病变程度及预后的关系。方法 回顾性分析2019年1月至2020年12月收治的125例STEMI患者(STEMI组),同时选择同期体检的健康志愿者85例作为健康对照组。将STEMI患者根据冠状动脉狭窄程度积分(Gensini法)分为轻度病变组、中度病变组与重度病变组3组,比较不同冠状动脉病变程度组STEMI患者及健康对照组HbA1c水平、RDW、NLR,采用Spearman相关分析法分析STEMI患者HbA1c水平、RDW、NLR与冠状动脉病变程度的相关性。记录STEMI患者治疗后随访6个月内心血管不良事件(MACE)发生情况,并以是否发生MACE作为预后评估标准将其分为预后良好组及预后不良组,比较HbA1c水平、RDW、NLR;采用多因素logistic回归分析法分析STEMI患者预后不良影响因素;绘制受试者操作特征(ROC)曲线评估HbA1c水平、RDW、NLR单独及联合检测评估STEMI患者预后的价值。结果 STEMI组患者HbA1c水平、RDW、NLR高于健康对照组,且差异均有统计学意义(P<0.05)。随着冠状动脉病变严重程度的增加,STEMI患者HbA1c、RDW、NLR水平逐渐升高(P<0.05)。Spearman相关分析结果显示,STEMI患者HbA1c水平、RDW、NLR与冠状动脉病变程度均呈正相关(r=0.472、0.491、0.528,P<0.05);预后不良组STEMI患者HbA1c水平、RDW、NLR高于预后良好组,且差异均有统计学意义(P<0.05);多因素logistic回归分析结果显示,HbA1c水平、RDW、NLR升高均是STEMI患者预后不良的独立危险因素(P<0.05);ROC曲线显示,HbA1c水平、RDW、NLR单独评估STEMI患者预后的曲线下面积(AUC)分别为0.650、0.678、0.781,联合检测评估的AUC为0.786,均可作为预测指标。结论 STEMI患者HbA1c水平、RDW、NLR均升高,且与冠状动脉病变程度呈正相关,尽早检测可作为评估其预后的指标。
Objective To investigate the relationship between levels of glycosylated hemoglobin(HbA1c),red blood cell distribution width(RDW) and neutrophil-to-lymphocyte ratio(NLR) and coronary artery disease degree and prognosis in patients with ST-segment elevation myocardial infarction(STEMI).Methods Totally 125 patients with STEMI between January 2019 and December 2020 were selected as STEMI group,and 85 volunteers who received physical examination during the same period were selected as healthy control group.The patients in STEMI group were divided into three groups according to the coronary artery stenosis degree(Gensini method),including mild disease group,moderate disease group and severe disease group.The levels of HbA1c,RDW and NLR were compared different coronary artery disease degree subgroups and healthy control group.Spearman correlation analysis was used to analyze the relationship between levels of HbA1c,RDW and NLR and degree of coronary artery disease in patients with STEMI.The occurrence of major adverse cardiovascular events(MACE) were recorded in STEMI group within 6 months of follow-up,and the patients were divided into good prognosis group and poor prognosis group based on the occurrence or not as criteria for prognosis evaluation,and the levels of HbA1c,RDW and NLR were compared.Multivariate logistic regression analysis was used to analyze the influencing factors for poor prognosis.Receiver operating characteristic(ROC) curve was used to evaluate the judgement value of HbA1c,RDW,and NLR levels individually and in combination on the prognosis of patients with STEMI.Results The levels of HbA1c,RDW and NLR in STEMI group were significantly higher than those in healthy control group(P<0.05).There were statistically significant differences in the levels of HbA1c,RDW and NLR among the subgroups of different coronary artery disease degrees(P <0.05).As the severity of the disease increased,the levels of HbA1c,RDW,and NLR were gradually increased(P <0.05).Spearman correlation analysis showed that the levels of HbA1c,RDW and NLR in patients with STEMI were positively correlated with the degree of coronary artery disease(P<0.05).The levels of HbA1c,RDW and NLR in poor prognosis group were significantly higher than those in good prognosis group(P<0.05).Multivariate logistic regression analysis showed that the increased expressions of HbA1c,RDW and NLR were independent risk factors for poor prognosis in patients with STEMI(P<0.05).ROC curves showed that the areas under the curves(AUC) of HbA1c,RDW,and NLR individually in assessing the prognosis of patients with STEMI were 0.650,0.678 and 0.781,and the AUC of the combined test was 0.786.And all of them could be used as predictive indicators.Conclusion The levels of HbA1c,RDW and NLR in patients with STEMI are highly expressed to a certain degree,and are directly proportional to the degree of coronary artery disease.Early detection can be used as a sensitive indicator to evaluate the prognosis.
作者
唐羚
刘玉花
TANG Ling;LIU Yu-hua(Department of Laboratory Medicine,Bozhou Hospital of Traditional Chinese Medicine,Bozhou 236800,Anhui,China)
出处
《中国分子心脏病学杂志》
CAS
2022年第1期4444-4449,共6页
Molecular Cardiology of China
基金
安徽省医学会临床研究项目(Ky2019013)。
