高光华, 韩志刚, 王磊, 高春城, 刘继荣, 唐靖鹏, 曹威. GRACE评分联合中性粒细胞与淋巴细胞比值对急性非ST段抬高型心肌梗死短期预后的预测价值[J]. 职业卫生与应急救援, 2020, 38(6): 574-579. DOI: 10.16369/j.oher.issn.1007-1326.2020.06.005
引用本文: 高光华, 韩志刚, 王磊, 高春城, 刘继荣, 唐靖鹏, 曹威. GRACE评分联合中性粒细胞与淋巴细胞比值对急性非ST段抬高型心肌梗死短期预后的预测价值[J]. 职业卫生与应急救援, 2020, 38(6): 574-579. DOI: 10.16369/j.oher.issn.1007-1326.2020.06.005
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GAO Guanghua, HAN Zhigang, WANG Lei, GAO Chuncheng, LIU Jirong, TANG Jingpeng, CAO Wei. Predictive value of GRACE score combined with NLR on short-term prognosis in patients with acute NSTEMI after PCI[J]. Occupational Health and Emergency Rescue, 2020, 38(6): 574-579. DOI: 10.16369/j.oher.issn.1007-1326.2020.06.005
Citation: GAO Guanghua, HAN Zhigang, WANG Lei, GAO Chuncheng, LIU Jirong, TANG Jingpeng, CAO Wei. Predictive value of GRACE score combined with NLR on short-term prognosis in patients with acute NSTEMI after PCI[J]. Occupational Health and Emergency Rescue, 2020, 38(6): 574-579. DOI: 10.16369/j.oher.issn.1007-1326.2020.06.005
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GRACE评分联合中性粒细胞与淋巴细胞比值对急性非ST段抬高型心肌梗死短期预后的预测价值

Predictive value of GRACE score combined with NLR on short-term prognosis in patients with acute NSTEMI after PCI

    摘要
  • 摘要:
    目的 探讨GRACE评分联合中性粒细胞与淋巴细胞比值（neutrolphil to lymphocyte ratio，NLR）对急性非ST段抬高型心肌梗死（non-ST-segment elevation myocardial infarction，NSTEMI）短期预后的预测价值。
    方法 回顾性分析2015年2月—2019年10月行经皮冠状动脉介入术（percutaneous coronary intervention，PCI）治疗的NSTEMI患者628例，以术后28 d未出现主要不良心血管事件（major adverse cardiovascular events，MACE）的529例患者为非MACE组，出现MACE的99例患者为MACE组。根据电子病历系统收集2组临床资料，分析GRACE、NLR对NSTEMI短期预后的影响。
    结果 多因素logistic回归分析结果显示，分别相比年龄≤ 65岁、NLR < 3.83、N末端B型脑钠肽≤ 478.83 ng/L、GRACE评分为中高危、Killip分级为Ⅰ~Ⅱ级的患者，年龄 > 65岁、NLR ≥ 3.83、N末端B型脑钠肽 > 478.83 ng/L、GRACE评分为低危、Killip分级为Ⅲ~Ⅳ级的NSTEMI患者PCI术后28 d出现MACE的危险性为1.14、1.99、1.68、2.53、1.73倍（P < 0.05）。ROC分析示NLR、GRACE评分及联合预测NSTEMI患者PCI术后28 d出现MACE的AUC分别为0.665（95% CI：0.587~0.743）、0.782（95% CI：0.718~0.847）、0.886（95% CI：0.825~0.948），联合预测的AUC高于单独预测（P < 0.05）。
    结论 GRACE评分、NLR是NSTEMI患者短期发生MACE的影响因素，两者联合对NSTEMI患者PCI术后28 d出现MACE具有较好的预测价值。

     

    Abstract:
    Objective To explore the predictive value of short-term prognosis in patients with non-ST-segment elevation myocardial infarction(NSTEMI) combined with GRACE score and neutrophil to lymphocyte ratio(NLR).
    Methods A total of 628 patients with NSTEMI were studied, who underwent PCI treatment in our hospital from February 2015 to October 2019, of whom 529 cases without major adverse cardiovascular events (MACE) within 28 days after PCI were as non-MACE group, 99 cases with MACE as MACE group. The clinical data in the electronic medical record system were collected to analyze the impact of GRACE and NLR on the short-term prognosis of patients with NSTEMI.
    Results Multivariate logistic regression analysis showed the following factors would be risk factors of MACE:the elder(OR=1.14, compared with patients aged ≤ 65); the NLR(OR=1.99, NLR ≥ 3.83 vs. NLR < 3.83); NT proBNP(OR=1.68, NT proBNP ≥ 478.83 ng/L vs. NT proBNP < 478.83 ng/L); the grace score (OR=2.53, low-risk vs. moderate and high risk); Killip grade (OR=1.73, Killip grade Ⅲ-Ⅳ vs. Killip grade Ⅰ-Ⅱ). ROC analysis showed that the AUC of prediction the MACE occurred within 28 days after PCI in NSTEMI patients by the NLR, GRACE scores and combination were 0.665 (95%CI:0.587-0.743), 0.782 (95%CI:0.718-0.847), 0.886 (95%CI:0.825-0.948), and the AUC of the prediction with combined indicators was higher than the single indicator (P < 0.05).
    Conclusions GRACE score and NLR were the influence factors for short-term MACE in NSTEMI patients, and the combined indicators had a high predictive value for the occurrence of MACE within 28 days after PCI.

     

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