论文部分内容阅读
目的:探讨循环单核细胞亚群联合左心室射血分数(LVEF)对急性ST段抬高型心肌梗死(STEMI)患者预后危险分层的评估价值。方法:入选发病后24小时内就诊于武警后勤学院附属医院心脏中心并接受经皮冠状动脉介入(PCI)治疗的STEMI患者,采用流式细胞术检测外周血单核细胞3个亚群:经典型单核细胞(CD14~(++)CD16~-)、中间型单核细胞(CD14~(++)CD16~+)和非经典型单核细胞(CD14~+CD16~(++))。随访患者3年内主要不良心血管事件(MACE)的发生情况;采用COX比例风险模型分析单核细胞亚群及LVEF与MACE的关系;采用受试者工作特征(ROC)曲线结合多元Logistic回归分析建立相关MACE预测模型。结果:3年的随访中221例患者共50例发生MACE。与非MACE患者相比,MACE患者年龄更大[(63.82±11.88)岁vs(58.84±11.40)岁,P=0.009]、糖尿病病史更多(28.0%vs18.7%,P<0.001)、LDL-C(2.77 mmol/L vs 2.41 mmol/L,P=0.003)、CD14~(++)CD16~+单核细胞值(47.17 cells/μl vs 21.47 cells/μl,P<0.001)更高;LVEF值(52%vs 46%,P<0.001)更低。多变量COX回归分析显示,CD14~(++)CD16~+(HR=2.211,95%CI:1.211~3.635,P=0.016)、LVEF(HR=2.014,95%CI:1.038~2.933,P=0.022)是STEMI患者发生MACE的独立危险因素。多元Logistic回归分析联合ROC曲线结果显示,CD14~(++)CD16~+单核细胞联合LVEF对MACE的预测价值(AUC=0.744,95%CI:0.664~0.823,P<0.001)高于单指标CD14~(++)CD16~+单核细胞(AUC=0.683,95%CI:0.598~0.768,P<0.001)及LVEF(AUC=0.640,95%CI:0.552~0.729,P=0.003)。结论:循环CD14~(++)CD16~+单核细胞联合LVEF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 value of circulating monocyte subsets combined with left ventricular ejection fraction (LVEF) in assessing the risk stratification of patients with acute ST-segment elevation myocardial infarction (STEMI). METHODS: STEMI patients who were treated within 24 hours after onset of illness in the heart of Affiliated Hospital of Armed Police Forces Hospital and underwent percutaneous coronary intervention (PCI) were enrolled. Three subpopulations of peripheral blood mononuclear cells were detected by flow cytometry. Monocytes (CD14 ~ (++) CD16 ~), intermediate monocytes (CD14 ~ (++) CD16 ~ +) and nonclassical monocytes (CD14 ~ + CD16 ~ (++)). The incidence of major adverse cardiovascular events (MACE) within 3 years was followed up. The relationship between monocyte subpopulation and LVEF and MACE was analyzed by COX proportional hazards model. Multivariate logistic regression analysis was used to establish the receiver operating characteristic (ROC) curve Related MACE prediction model. Results: MACE occurred in 221 of 221 patients at 3 years of follow-up. Patients with MACE were older (63.82 ± 11.88 years vs 58.84 ± 11.40 years, P = 0.009), had a greater history of diabetes mellitus (28.0% vs18.7%, P <0.001), and had a lower prevalence of LDL CD14 + (+) CD16 + monocytes (47.17 cells / μl vs 21.47 cells / μl, P <0.001) Values (52% vs 46%, P <0.001) lower. Multivariate Cox regression analysis showed that there was no significant difference in the number of CD14 ~ + CD16 + (HR = 2.211,95% CI: 1.211-3.635, P = 0.016), LVEF (HR = 2.014, 95% CI 1.038-2.933, 0.022) is an independent risk factor for MACE in STEMI patients. Multivariate logistic regression analysis combined with ROC curve showed that the predictive value of CD14 ~ (+ +) CD16 ~ + monocytes combined with LVEF on MACE was significantly higher (AUC = 0.744,95% CI: 0.664-0.823, P <0.001) CD14 + CD16 + monocytes (AUC = 0.683, 95% CI: 0.598-0.768, P <0.001) and LVEF (AUC = 0.640, 95% CI: 0.552-0.729, P = 0.003). Conclusion: Circulating CD14 + CD16 + monocytes combined with LVEF can predict the occurrence of MACE within 3 years in patients with STEMI, which has potential clinical value.