循环单核细胞亚群联合左心室射血分数对急性ST段抬高型心肌梗死患者预后危险分层的评估

摘要

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/山vs 21.47 cells/μl,P＜0.001)更高;LVEF值(52％ vs 46％,P＜0.001厦低.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 explore the prognostic value for circulating monocyte subsets combining left ventricular ejection fraction (LVEF) in patients with acute ST-segment elevation myocardial infarction (STEMI).Methods:STEMI patients admitted within 24 h of onset received PCI in Pingjin hospital heart center were enrolled.Flow cytometry (FCM) was used to examine 3 subsets of monocyte in peripheral blood as classical CD14++CD16-monocyte,intermediate CD14++CD16+ monocyte and non-classical CD14+CD16++ monocyte.The patients were followedup in 3 years for major adverse cardiac events (MACE) occurrence.The relationship between monocyte subsets,LVEF and MACE occurrence was studied by COX model analysis and MACE prediction model was established by ROC combining multivariate Logistic regression analysis.Results:There were 50/221 patients suffered from MACE during 3-year follow-up period.Compared with Non-MACE patients,MACE patients had the elder age (63.82±11.88) years vs (58.84±11.40) years,P=0.009;more diabetes mellitus (28.0％ vs 18.7％),P＜0.001;higher blood levels of LDL-C (2.77 mmol/L) vs (2.41 mmol/L),P=0.003 and CD14++CD16+ monocyte (47.17 cells/μl) vs (21.47 cells/μl),P＜0.001;lower LVEF (52％ vs 46％),P＜0.001.Multivariate Cox analysis indicated that CD14++CD16+ (HR=2.211,95％ CI 1.211-3.635,P=0.016) and LVEF (HR=2.014,95％ CI 1.038-2.933,P=0.022) were the independent risk factors for MACE occurrence in STEMI patients.ROC combining multivariate Logistic regression analysis presented that MACE predictive value of CD14++CD16+ monocyte combining LVEF (AUC=0.744,95％ CI 0.664-0.823,P＜0.001) was higher than the single value of CD14++CD16+ monocyte (AUC=0.683,95％ CI 0.598-0.768,P＜0.001) and LVEF(AUC=0.640,95％ CI 0.552-0.7291,P=0.003) respectively.Conclusion:Circulating level of CD14++CD16+ monocyte combining LVEF may predict MACE occurrence within 3 years in STEMI patients;it had potential value in clinical practice.