上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2024, Vol. 44 ›› Issue (3): 334-341.doi: 10.3969/j.issn.1674-8115.2024.03.005

• 论著 · 临床研究 • 上一篇    

全身免疫炎症指数及躯体化症状评分对首发心梗PCI术后发生院内主要不良心血管事件的预测价值

郑梦奕1(), 毛家亮2, 邹治国2, 张瑞雷3, 张厚1, 李世光3()   

  1. 1.蚌埠医科大学研究生院，蚌埠 233030
    2.上海交通大学医学院附属仁济医院心内科，上海 200127
    3.安徽省第二人民医院心内科，合肥 230041
  • 收稿日期:2023-10-31 接受日期:2024-01-26 出版日期:2024-03-28 发布日期:2024-04-29
  • 通讯作者: 李世光 E-mail:ZhengMY32@163.com;1191722600@qq.com
  • 作者简介:郑梦奕（1998—），女，住院医师，硕士生；电子信箱：ZhengMY32@163.com。
  • 基金资助:
    国家自然科学基金(82300366);安徽省高校科学研究项目(ZR2021B006);安徽省临床重点专科建设项目

Predictive value of systemic immune inflammation index and somatic symptom scale-China in the occurrence of in-hospital major adverse cardiovascular events after first-episode of acute myocardial infarction undergoing PCI

ZHENG Mengyi1(), MAO Jialiang2, ZOU Zhiguo2, ZHANG Ruilei3, ZHANG Hou1, LI Shiguang3()   

  1. 1.Graduate School of Bengbu Medical College, Bengbu 233030, China
    2.Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
    3.Department of Cardiology, The Second People′s Hospital of Anhui Province, Hefei 230041, China
  • Received:2023-10-31 Accepted:2024-01-26 Online:2024-03-28 Published:2024-04-29
  • Contact: LI Shiguang E-mail:ZhengMY32@163.com;1191722600@qq.com
  • Supported by:
    National Natural Science Foundation of China(82300366);Anhui Provincial University Scientific Research Project(ZR2021B006);Clinical Key Specialty Construction Project of Anhui Province

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摘要：

目的·探讨全身免疫炎症指数（systemic immune inflammation index，SII）及躯体化症状评分（somatic symptom scale-China，SSS-CN）对首发急性心肌梗死（acute myocardial infarction，AMI）患者接受经皮冠状动脉介入治疗术（percutaneous coronary intervention，PCI）后发生院内主要不良心血管事件（major adverse cardiovascular event，MACE）的预测价值。方法·连续纳入2021年9月至2023年9月就诊于安徽省第二人民医院心内科并接受PCI治疗的首发AMI患者305例。根据患者住院期间是否发生MACE相关事件分为MACEs组（n=203）与非MACEs组（n=102）。对2组患者的性别、年龄、实验室检查结果等资料进行描述性统计分析，并根据分析结果对有统计学意义的项目进行二元Logistic回归检验；进一步绘制受试者操作特征（receiver operating characteristic，ROC）曲线，评估SII及SSS-CN预测院内MACE发生的价值。在此基础上联合冠状动脉syntax评分（syntax score，SS），评价三者联合的预测效能，根据最大约登指数确定诊断的最佳cut-off值。结果·共有203例患者发生MACE事件，其中179例（88.1%）患者发生心力衰竭，16例（7.9%）患者发生严重心律失常，4例（2.0%）患者发生休克，2例（1.0%）患者发生再发心肌梗死，2例（1.0%）患者死亡。与非MACE组相比，MACEs组SII及SSS-CN评分显著升高（1 925.86 vs 934.23，38.57 vs 23.30；均P<0.05）；二元Logistic回归分析结果提示两者均为MACE发生的独立危险因素。ROC曲线显示：当SII≥952时预测效能最佳，敏感度达64.0%，特异度达62.7%（AUC 0.675，95%CI 0.612~0.737）；SSS-CN≥28.5分时预测效能最佳，敏感度达80.7%，特异度达77.5%（AUC 0.840，95%CI 0.794~0.886）；联合SS后，三者对MACE的预测效能进一步提高（AUC 0.898，95%CI 0.862~0.933）。结论·首发AMI患者的入院SII及SSS-CN分值为此类患者行PCI术后住院期间发生MACE的独立危险因素，早期监测首发AMI患者PCI术后SII变化，或对有明显躯体化症状的患者及时进行SSS-CN评分能帮助识别院内MACE发生的高危患者。

关键词: 全身免疫炎症指数, 躯体化症状评分, 首发急性心肌梗死, 主要不良心血管事件, 经皮冠状动脉介入治疗术

Abstract:

Objective ·To investigate the predictive value of systemic inflammatory index (SII) and somatization symptom score-China (SSS-CN) for major adverse cardiovascular events (MACEs) in patients with first-episode acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). Methods ·Three hundred and five first-episode AMI patients who received PCI treatment at the Cardiology Department of Anhui Second People's Hospital from September 2021 to September 2023 were included in the study. Enrolled patients were divided into MACEs group (n=203) and non-MACEs group (n=102) based on whether MACEs events occurred during hospitalization. Descriptive statistical analysis was performed on the general data such as gender, age and laboratory test results of the two groups of patients, and binary Logistic regression test was conducted for statistically significant items according to the analysis results. According to the results, receiver operating characteristic (ROC) curves were further drawn to evaluate the value of SII and SSS-CN in predicting the occurrence of MACEs in hospital. On this basis, coronary syntax score (SS) was combined to evaluate the predictive efficacy of the three combinations, and the optimal cut-off value was determined according to the maximum Jordan index. Results ·A total of 203 patients had MACEs events, among whom 179 (88.1%) had heart failure, 16 (7.9%) had severe arrhythmia, 4 (2.0%) had shock, 2 (1.0%) had recurrent myocardial infarction, and 2 (1.0%) died. Compared with the non-MACEs group, the SII and SSS-CN scores in the MACEs group were significantly increased (1 925.86 vs 934.23, 38.57 vs 23.30; both P<0.05). The binary Logistic results suggested that both SII and SSS-CN were independent risk factors for the occurrence of MACEs. The ROC curve results showed that the prediction efficiency was the best when SII ≥ 952, with a sensitivity of 64.0% and a specificity of 62.7% (AUC 0.675, 95% CI 0.612?0.737). The prediction efficiency was the best when SSS-CN ≥ 28.5, with a sensitivity of 80.7% and a specificity of 77.5% (AUC 0.840, 95% CI 0.794?0.886). The predictive performance was further improved after combining the syntax score (AUC 0.898, 95% CI 0.862?0.933). Conclusion ·The admission SII and SSS-CN scores of first-episode AMI patients are independent risk factors for the occurrence of MACEs during hospitalization after PCI. Early monitoring of SII changes in first-episode AMI patients after PCI or SSS-CN scores for patients with obvious Somatization symptoms can help identify high-risk patients for the occurrence of MACEs in the hospital.

Key words: systemic immune inflammation index (SII), somatization symptom score-China (SSS-CN), first episode of acute myocardial infarction, major adverse cardiovascular event (MACE), percutaneous coronary intervention (PCI)

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