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目的:探讨循环单核细胞亚群联合肾功能对急性ST段抬高心肌梗死(ST segment elevation myocardial infarction,STEMI)患者预后危险分层的评估。方法:入选发病后接受急诊冠状动脉介入治疗(percutaneous coronary intervention,PCI)的初次STEMI患者。于入院第2天抽取患者外周血进行单核细胞亚群[经典型(CD14++CD16-,Mon1)、中间型(CD14++CD16+,Mon2)和非经典型(CD14+CD16++,Mon3)]流式细胞术分析。随访患者3年内主要不良心血管事件(major adverse cardiovascular events,MACE)的发生情况。采用COX比例风险模型分析循环单核细胞亚群水平及肾功能与MACE的关系。根据循环单核细胞亚群及肾功能不全的最佳截断值对STEMI患者进行危险分层,采用Kaplan-Meier生存分析法比较各危险分层的无事件生存率。结果:3年随访221例患者中有50例发生MACE(MACE组)。与非MACE组患者相比,MACE组患者年龄更大、Mon2计数水平更高,差异具有统计学意义(P=0.009和P<0.001);估测肾小球滤过率(estimated glomerular filtration rate,eGFR)、左心室射血分数值更低(P=0.01和P<0.001)。多变量COX回归分析显示,校正了传统危险因素后,Mon2>32.1cells/μl(HR2.33,95%CI 1.24~4.38,P=0.008)、eGFR<60 ml·min~(-1)·1.73m~(-2)(HR2.43,95%CI1.01~5.85,P=0.048)是STEMI患者发生MACE的独立危险因素。以eGFR的临界值60ml·min~(-1)·1.73m~(-2)、Mon2的最佳截断值32.1cells/μl对STEMI患者进行为危险分层,相对于低危组,中危组患者发生MACE的风险增加了2.00倍(95%CI 1.65~5.30,P<0.001),高危组患者发生MACE的风险增加了3.37倍(95%CI2.44~11.5,P<0.01)。Kaplan-Meier生存分析结果同上述一致。结论:循环单核细胞Mon2联合eGFR能够预测STEMI患者3年内MACE的发生,具有潜在临床应用价值。
Objective: To evaluate the prognostic risk stratification in patients with ST segment elevation myocardial infarction (STEMI) by circulating monocyte subsets combined with renal function. METHODS: Initial STEMI patients were enrolled in the study after percutaneous coronary intervention (PCI). Peripheral blood mononuclear cells (CD14 ++ CD16-, Mon1), intermediate (CD14 ++ CD16 +, Mon2) and non-canonical (CD14 + CD16 ++, Mon3) Flow cytometry analysis. The incidence of major adverse cardiovascular events (MACE) within 3 years was followed up. Cox proportional hazards model was used to analyze the relationship between circulating monocyte subsets and renal function and MACE. STEMI patients were stratified according to the optimal cut-off value of circulating monocyte subsets and renal insufficiency, and Kaplan-Meier survival analysis was used to compare the risk-free survival rates of various risk strata. Results: MACE (MACE group) occurred in 50 out of 221 patients at 3 years of follow-up. Compared with non-MACE patients, MACE patients were older and Mon2 count was higher, the difference was statistically significant (P = 0.009 and P <0.001); estimated glomerular filtration rate eGFR) and lower left ventricular ejection fraction (P = 0.01 and P <0.001). Multivariable COX regression analysis showed that Mon2> 32.1cells / μl (HR2.33, 95% CI 1.24-4.48, P = 0.008), eGFR <60 ml · min -1 (1.73) after correction of the traditional risk factors The m ~ (-2) (HR2.43, 95% CI1.01 ~ 5.85, P = 0.048) was an independent risk factor for MACE in STEMI patients. The patients with STEMI were stratified as the risk stratification according to the cutoff value of eGFR 60ml · min -1 (1.73m -2) and the best cutoff value 32.1cells / μl for Mon 2 The risk of developing MACE increased 2.00 times (95% CI 1.65-5.30, P <0.001), and the risk of MACE increased by 3.37 times (95% CI 2.44-1.5, P <0.01) in high-risk patients. The Kaplan-Meier survival analysis is consistent with the above. Conclusion: Monocyte combined with eGFR can predict the occurrence of MACE within 3 years in patients with STEMI, which has potential clinical value.