Value of inflammatory burden index in evaluating clinical prognosis of patients with ST-segment elevation myocardial infarction after percutaneous coronary intervention
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摘要:
目的 探讨炎症负荷指数（IBI）与ST段抬高型心肌梗死（STEMI）患者在接受经皮冠状动脉介入（PCI）治疗后发生主要不良心血管事件（MACE）的相关性，并评估IBI对院内及长期随访期间发生MACE的预测效能。 方法 回顾性分析2017年12月至2021年12月在中国人民解放军联勤保障部队第九〇四医院接受PCI治疗的465例STEMI患者资料，计算每例患者的IBI。通过ROC曲线评估IBI对患者住院和长期随访期间发生MACE的预测价值，并根据最佳IBI临界值将人群分组进行临床特征分析。通过多因素logistic回归和Cox回归分析MACE的独立预测因子。通过Kaplan-Meier生存曲线和log-rank检验分析不同IBI组的MACE发生风险。 结果 IBI预测STEMI患者住院期间MACE的AUC值为0.687，预测长期随访期间MACE的AUC值为0.634。多因素logistic回归分析显示，高IBI（≥102.33 mg/L）的STEMI患者住院期间发生MACE的风险增加（OR=10.900，95%CI 4.273~29.180，P＜0.001）。多因素Cox回归分析表明，高IBI（≥55.88 mg/L）的STEMI患者在长期随访期间发生MACE的风险增加（HR=1.989，95%CI 1.128~3.506，P=0.018）。 结论 IBI是STEMI患者PCI术后住院和长期随访期间发生MACE的一个有价值的预测指标。 -
关键词:
- ST段抬高型心肌梗死 /
- 中性粒细胞 /
- 淋巴细胞 /
- C反应蛋白 /
- 经皮冠状动脉介入治疗 /
- 主要不良心血管事件
Abstract:Objective To investigate the correlation between the inflammatory burden index (IBI) and major adverse cardiovascular events (MACEs) in patients with ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI), and to assess the efficacy of IBI in predicting in-hospital and long-term MACEs. Methods This retrospective study included 465 STEMI patients who received PCI treatment in No. 904 Hospital of Joint Logistics Support Force of PLA from Dec. 2017 to Dec. 2021. The IBI was calculated for each patient. The predictive value for in-hospital and long-term MACEs was evaluated using receiver operating characteristic (ROC) curves, and the area under curve (AUC) was calculated. The population was grouped based on the optimal IBI cut-off value for clinical characteristic analysis. Multivariate logistic regression and Cox regression analyses were used to identify factors independently associated with MACEs. The Kaplan-Meier estimator and log-rank test were used to assess the MACE risk of different IBI groups. Results The AUC value for predicting MACEs during hospitalization in STEMI patients using IBI was 0.687, and the AUC value for predicting long-term MACEs was 0.634. Multivariate logistic regression analysis revealed that a high IBI (≥ 102.33 mg/L) independently increased the risk of MACEs during hospitalization in STEMI patients (odds ratio=10.900, 95% confidence interval [95%CI] 4.273-29.180, P < 0.001). Multivariate Cox regression analysis further indicated that during long-term follow-up of STEMI patients, a high IBI (≥55.88 mg/L) independently predicted MACEs (hazard ratio=1.989, 95%CI 1.128-3.506, P=0.018). Conclusion IBI is a valuable predictor for the occurrence of MACEs during hospitalization and long-term follow-up after PCI in STEMI patients. -
急性ST段抬高型心肌梗死（ST-segment elevation myocardial infarction，STEMI）是冠心病中最严重的类型之一，由冠状动脉粥样硬化引发的血栓形成和斑块破裂所致，可使心肌细胞缺血坏死，具有高致死率和致残率[1]，尤其在低收入和中等收入国家[2]。尽管经皮冠状动脉介入（percutaneous coronary intervention，PCI）可有效恢复冠状动脉血流[3]，但部分患者术后面临主要不良心血管事件（major adverse cardiovascular event，MACE）的风险仍较高，总体预后尚未显著改善[4]。因此，术前的精确风险评估及早期识别高危患者对优化临床决策至关重要[5]。炎症是动脉粥样硬化发展的重要机制之一[6]，可促进动脉粥样硬化斑块的形成和不稳定性，引发心肌梗死和脑卒中等严重心脑血管事件[7]。此外，研究表明低度炎症与多种主要致死性疾病如心脑血管疾病、糖尿病和癌症的发病密切相关[8]。临床常用炎症标志物如CRP和白细胞计数与全因死亡风险增加有关[9]。石汉平教授团队提出的炎症负荷指数（inflammatory burden index，IBI）是一种综合评估炎症负荷的指标，能够更全面地评估全身性炎症状态，可作为肿瘤及多种慢性疾病的预后预测因子[10-12]。然而，IBI与PCI术后STEMI患者临床预后之间的关系尚未得到充分研究。本研究旨在分析血常规衍生指标与PCI术后预后的关联，验证IBI作为STEMI预后标志物的可行性，为STEMI患者的预后和治疗提供依据。
1 资料和方法
1.1 研究人群及冠状动脉评估方法
本研究方案已获得中国人民解放军联勤保障部队第九〇四医院伦理委员会批准（20241203）。
选取2017年12月至2021年12月在中国人民解放军联勤保障部队第九〇四医院接受PCI治疗的患者作为研究对象。纳入标准为疑似STEMI的急性胸痛并随后进行紧急冠状动脉造影而明确诊断的患者。排除标准：（1）未被诊断为STEMI的患者；（2）入院前长期服用口服抗凝剂或其他可能影响凝血功能药物者；（3）入院前6个月内曾发生急性血栓性疾病；（4）入院时伴有急性炎症性疾病、血液病、肿瘤、风湿病或肝肾功能不全；（5）住院期间临床资料不完整或出院后缺乏至少2年的随访数据。
STEMI诊断标准：（1）至少2个相邻胸导联显示ST段抬高≥0.2 mV和/或其他导联ST段抬高≥0.1 mV，或出现新的左束支传导阻滞；（2）心肌肌钙蛋白T检测到动态变化且至少有1个值超过第99百分位参考上限[13]。
所有患者在进行PCI前均需口服负荷剂量的阿司匹林（300 mg）和P2Y12受体抑制剂氯吡格雷300 mg或替格瑞洛180 mg[14]。随后，由至少2名对患者病情有深入了解的内科医师执行冠状动脉造影及PCI检查，详细记录血管造影参数以及冠状动脉病变的范围和严重程度。根据PCI检查结果，若3条主要冠状动脉（左前降支、左回旋支和右冠状动脉）的狭窄程度均达到或超过50%，则被分类为三支病变。若任一主要冠状动脉的狭窄程度达到或超过50%且伴有左主干受累，则被诊断为左主干病变。
冠状动脉病变的量化采用Gensini评分系统[15]：（1）将病变血管分为左主干、左前降支、左回旋支和右冠状动脉，并对各血管的狭窄程度进行定量评估，未发现异常评分为0分，狭窄程度≤25%为1分，狭窄程度26%~50%为2分，狭窄程度51%~75%为4分，狭窄程度76%~90%也为4分。（2）将不同节段冠状动脉的评分与相应的权重系数相乘得到各分支血管得分，其中左主干权重系数为5；左前降支近段为2.5，中间段为1.5，远段为1；第一对角分支为1；第二对角分支为0.5；左回旋支近段为2.5，远段为1；钝圆分支和后降支均为1；左心室后-后支为0.5；右冠状动脉近、中、远、后降支均为1。（3）每例患者的冠状动脉病变程度为所有病变血管得分的总和。
1.2 一般资料采集
收集患者的基础临床信息，包括年龄、性别、BMI、Killip分级（Ⅰ级表示无明显心力衰竭；Ⅱ级表示左心衰竭伴随少于50%肺野的肺部啰音；Ⅲ级表示急性肺水肿，全肺充满干湿啰音；Ⅳ级表示存在不同程度的血流动力学改变，如心源性休克）、高血压病史、糖尿病史、吸烟史、住院及出院后的用药情况、手术资料等。
1.3 实验室检查资料收集
所有患者在进行PCI治疗前均接受了全面的血液学检查，包括生物化学和凝血功能的综合评估。全血分析涵盖了对白细胞、中性粒细胞、淋巴细胞及血小板数量的测定。生物化学分析涵盖CRP、白蛋白、血肌酐、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、甘油三酯、总胆固醇、肌钙蛋白Ⅰ和肌红蛋白水平。凝血功能指标则包括了D-二聚体和纤维蛋白原水平。同时计算中性粒细胞与淋巴细胞比值（neutrophil-to-lymphocyte ratio，NLR）、血小板与淋巴细胞比值（platelet-to-lymphocyte ratio，PLR）、系统性免疫炎症指数（systemic immune-inflammation index，SII）及IBI，计算方法为：NLR＝中性粒细胞计数/淋巴细胞计数；PLR＝血小板计数/淋巴细胞计数；SII＝（中性粒细胞计数×血小板计数）/淋巴细胞计数；IBI＝CRP×中性粒细胞计数/淋巴细胞计数。
1.4 超声心动图检查
每例患者在PCI术后24 h内行床边超声心动图检查以确定心脏是否存在瓣膜疾病，并计算左心室射血分数（left ventricular ejection fraction，LVEF）。
1.5 住院期间和出院后MACE
记录患者在住院期间和出院后的MACE发生情况，其中住院期间MACE涵盖了心血管死亡、新发非致命性心肌梗死、急性心力衰竭、恶性心律失常（包括室性心动过速和心室颤动）及新发心房颤动，出院后MACE的范畴扩展至心血管死亡、新发非致命性心肌梗死、因不稳定型心绞痛再次行PCI治疗、恶性心律失常（包括室性心动过速和心室颤动）及心力衰竭。数据通过查阅医院病历或通过电话随访收集。随访时间为出院后2年，失访患者则不被纳入分析。
1.6 统计学处理
采用SPSS 27.0软件和GraphPad Prism 10.1.2软件进行统计分析和数据处理。使用Kolmogorov-Smirnov检验分析连续型变量的正态性，符合正态分布的计量资料以x±s表示，组间比较采用独立样本t检验；非正态分布的计量资料以M（Q1，Q3）表示，组间比较采用Mann-Whitney U检验。分类变量以例数和百分数表示，组间比较采用χ2检验或Fisher确切概率法。构建ROC曲线评估不同指标的预测价值，确定MACE的最佳临界值并计算AUC值，采用DeLong法评估各指标间的差异。采用logistic回归分析预测住院期间MACE的独立危险因素，采用Cox回归分析预测长期随访期间MACE的独立危险因素。采用Kaplan-Meier法绘制生存曲线，通过log-rank检验分析不同IBI组的MACE发生风险。检验水准（α）为0.05（双侧检验）。
2 结果
2.1 研究对象的基线特征及随访事件分布
患者纳入流程如图 1所示，共纳入465例接受PCI治疗的STEMI患者，其中164例（35.3%）住院期间发生MACE，包括心血管死亡21例，新发非致命性心肌梗死1例，急性心力衰竭134例，恶性心律失常40例，新发心房颤动29例。住院期间发生MACE组患者的年龄、糖尿病患者比例、入院时Killip分级≥Ⅱ级的患者比例、中性粒细胞计数、CRP、血肌酐、甘油三酯、肌钙蛋白Ⅰ峰值、肌红蛋白、D-二聚体、纤维蛋白原、IBI、Gensini评分及有左主干病变、左前降支病变及三支病变或左主干病变的患者比例均高于住院期间未发生MACE组（均P＜0.05），而淋巴细胞计数、白蛋白、LVEF均低于非MACE组（均P＜0.05），其余因素如高血压病史、吸烟史、β受体阻滞剂使用等在两组间差异均无统计学意义（均P＞0.05）。见表 1。
图 1 患者纳入流程图Fig. 1 Patient inclusion flow chartPCI: Percutaneous coronary intervention; STEMI: ST-segment elevation myocardial infarction; MACE: Major adverse cardiovascular event.
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表 1 住院期间发生MACE与未发生MACE的STEMI患者临床资料比较Table 1 Comparison of clinical data of STEMI patients between in-hospital MACE group and non-MACE groupCharacteristic Non-MACE group N＝301 MACE group N＝164 P value Age/year, M (Q1, Q3) 57 (48, 66) 69 (58, 78) ＜0.001 Male, n (%) 215 (71.4) 117 (71.3) 0.984 BMI/(kg·m－2), M (Q1, Q3) 24.22 (22.65, 26.34) 23.97 (22.09, 25.95) 0.103 Hypertension, n (%) 172 (57.1) 106 (64.6) 0.115 Diabetes mellitus, n (%) 72 (23.9) 68 (41.5) ＜0.001 Smoking, n (%) 157 (52.2) 91 (55.5) 0.492 Killip class≥Ⅱ, n (%) 16 (5.3) 101 (61.6) ＜0.001 Medical treatment, n (%) ACEI/ARB 216 (71.8) 130 (79.3) 0.076 CCB 38 (12.6) 27 (16.5) 0.254 β-blocker 259 (86.0) 139 (84.8) 0.705 White blood cell count/(L－1, ×109), M (Q1, Q3) 9.97 (8.10, 12.66) 10.64 (8.43, 13.76) 0.072 Neutrophil count/(L－1, ×109), M (Q1, Q3) 7.10 (4.81, 9.61) 7.52 (5.68, 10.59) 0.012 Lymphocyte count/(L－1, ×109), M (Q1, Q3) 1.95 (1.38, 2.84) 1.56 (1.05, 2.42) ＜0.001 Platelet count/(L－1, ×109), M (Q1, Q3) 205.00 (169.50, 252.00) 210.00 (165.00, 248.75) 0.748 C reactive protein/(mg·L－1), M (Q1, Q3) 5.63 (2.25, 12.78) 17.71 (5.00, 51.20) ＜0.001 Albumin/(g·L－1), M (Q1, Q3) 38.42±3.87 36.44±4.27 ＜0.001 Serum creatinine/(μmol·L－1), M (Q1, Q3) 69.00 (61.50, 80.00) 81.50 (67.00, 106.75) ＜0.001 LDL-C/(mmol·L－1), M (Q1, Q3) 2.68 (2.20, 3.18) 2.58 (2.13, 3.12) 0.400 HDL-C/(mmol·L－1), M (Q1, Q3) 1.02 (0.89, 1.18) 1.03 (0.92, 1.18) 0.664 Triglyceride/(mmol·L－1), M (Q1, Q3) 1.34 (0.87, 2.02) 1.46 (1.20, 2.10) 0.001 Total cholesterol/(mmol·L－1), M (Q1, Q3) 4.28 (3.59, 4.90) 4.35 (3.84, 5.12) 0.174 Peak troponin Ⅰ/(ng·mL－1), M (Q1, Q3) 13.35 (4.86, 26.22) 19.93 (6.32, 50.00) 0.013 Myoglobin/(ng·mL－1), M (Q1, Q3) 61.80 (22.91, 215.74) 183.51 (47.62, 400.00) ＜0.001 D-dimer/(mg·L－1), M (Q1, Q3) 0.28 (0.19, 0.45) 0.66 (0.34, 1.73) ＜0.001 Fibrinogen/(g·L－1), M (Q1, Q3) 3.01 (2.50, 3.73) 3.54 (2.76, 4.48) ＜0.001 IBI/(mg·L－1), M (Q1, Q3) 20.15 (5.26, 59.48) 104.26 (17.65, 297.63) ＜0.001 LVEF/%, M (Q1, Q3) 60.00 (58.00, 62.00) 57.50 (47.25, 60.00) ＜0.001 Number of PCI implanted stents, M (Q1, Q3) 1.0 (1.0, 2.0) 1.5 (1.0, 2.0) 0.235 Lesion branch, n (%) LM 21 (7.0) 26 (15.9) 0.002 LAD 165 (54.8) 107 (65.2) 0.029 LCX 34 (11.3) 21 (12.8) 0.630 RCA 110 (36.5) 49 (29.9) 0.148 Three-vessel or LM 87 (28.9) 78 (47.6) ＜0.001 Gensini score, M (Q1, Q3) 50.00 (36.50, 80.00) 80.00 (49.25, 94.75) ＜0.001 MACE: Major adverse cardiovascular event; STEMI: ST-segment elevation myocardial infarction; BMI: Body mass index; ACEI/ARB: Angiotensin converting enzyme inhibitor/angiotensin Ⅱ receptor blocker; CCB: Calcium channel blocker; LDL-C: Low density lipoprotein-cholesterol; HDL-C: High density lipoprotein-cholesterol; IBI: Inflammatory burden index; LVEF: Left ventricular ejection fraction; PCI: Percutaneous coronary intervention; LM: Left main coronary artery; LAD: Left anterior descending coronary artery; LCX: Left circumflex coronary artery; RCA: Right coronary artery. 在长期随访的410例患者中，77例（18.8%）发生MACE，包括心血管死亡2例，新发非致命性心肌梗死8例，因不稳定型心绞痛再次行PCI治疗42例，恶性心律失常4例，心力衰竭29例。与长期随访的非MACE组相比，MACE组患者入院时年龄、Killip分级≥Ⅱ级的患者比例、CRP、纤维蛋白原、IBI、植入支架数、Gensini评分及合并左旋支病变、右冠状动脉病变、三支或左主干病变的患者比例均较高（均P＜0.05），而白蛋白、LVEF均较低（均P＜0.05，表 2）。
表 2 长期随访期间发生MACE与未发生MACE的STEMI患者临床资料比较Table 2 Comparison of clinical data of STEMI patients between MACE group and non-MACE group during long-term follow-up periodCharacteristic Non-MACE group N＝333 MACE group N＝77 P value Age/year, M (Q1, Q3) 59 (49, 67) 65 (55, 74) ＜0.001 Male, n (%) 243 (73.0) 52 (67.5) 0.338 BMI/(kg·m－2), M (Q1, Q3) 24.22 (22.65, 26.20) 24.16 (22.04, 26.01) 0.211 Hypertension, n (%) 193 (58.0) 51 (66.2) 0.182 Diabetes mellitus, n (%) 93 (27.9) 22 (28.6) 0.910 Smoking, n (%) 179 (53.8) 42 (54.5) 0.900 Killip class≥Ⅱ, n (%) 47 (14.1) 31 (40.3) ＜0.001 Medical treatment, n (%) ACEI/ARB 238 (71.5) 59 (76.6) 0.362 CCB 41 (12.3) 4 (5.2) 0.072 β-blocker 283 (85) 70 (90.9) 0.176 White blood cell count/(L－1, ×109), M (Q1, Q3) 9.97 (8.07, 12.60) 10.85 (8.35, 13.55) 0.178 Neutrophil count/(L－1, ×109), M (Q1, Q3) 6.97 (5.06, 9.53) 7.51 (4.80, 11.27) 0.215 Lymphocyte count/(L－1, ×109), M (Q1, Q3) 1.87 (1.30, 2.71) 1.79 (1.16, 2.46) 0.418 Platelet count/(L－1, ×109), M (Q1, Q3) 207.00 (171.00, 252.50) 210.00 (152.50, 246.00) 0.573 C reactive protein/(mg·L－1), M (Q1, Q3) 6.18 (2.35, 15.10) 16.52 (4.27, 48.72) ＜0.001 Albumin/(g·L－1), M (Q1, Q3) 38.34±3.78 36.35±4.64 ＜0.001 Serum creatinine/(μmol·L－1), M (Q1, Q3) 71.00 (62.00, 82.00) 73.00 (60.50, 87.00) 0.382 LDL-C/(mmol·L－1), M (Q1, Q3) 2.65 (2.19, 3.16) 2.73 (2.25, 3.18) 0.556 HDL-C/(mmol·L－1), M (Q1, Q3) 1.04 (0.89, 1.18) 1.04 (0.90, 1.20) 0.744 Triglyceride/(mmol·L－1), M (Q1, Q3) 1.40 (0.97, 2.10) 1.34 (1.03, 1.97) 0.789 Total cholesterol/(mmol·L－1), M (Q1, Q3) 4.30 (3.69, 4.96) 4.43 (3.91, 5.01) 0.424 Peak troponin Ⅰ/(ng·mL－1), M (Q1, Q3) 15.11 (4.97, 33.64) 14.23 (5.48, 38.78) 0.669 Myoglobin/(ng·mL－1), M (Q1, Q3) 68.50 (23.70, 269.30) 92.91 (28.07, 265.59) 0.501 D-dimer/(mg·L－1), M (Q1, Q3) 0.33 (0.21, 0.52) 0.27 (0.20, 0.43) 0.086 Fibrinogen/(g·L－1), M (Q1, Q3) 3.06 (2.51, 3.76) 3.50 (2.74, 4.11) 0.006 IBI/(mg·L－1), M (Q1, Q3) 23.72 (5.55, 72.74) 63.34 (12.47, 217.87) ＜0.001 LVEF/%, M (Q1, Q3) 60.00 (58.00, 62.00) 58.00 (55.50, 60.00) 0.001 Number of PCI implanted stents, M (Q1, Q3) 1.0 (1.0, 2.0) 2.0 (1.0, 2.0) 0.020 Lesion branch, n (%) LM 31 (9.3) 9 (11.7) 0.526 LAD 286 (85.9) 67 (87) 0.797 LCX 154 (46.2) 46 (59.7) 0.033 RCA 189 (56.8) 64 (83.1) ＜0.001 Three-vessel or LM 98 (29.4) 41 (53.2) ＜0.001 Gensini score, M (Q1, Q3) 54.00 (38.00, 82.00) 66.00 (45.00, 91.50) 0.017 MACE: Major adverse cardiovascular event; STEMI: ST-segment elevation myocardial infarction; BMI: Body mass index; ACEI/ARB: Angiotensin converting enzyme inhibitor/angiotensin Ⅱ receptor blocker; CCB: Calcium channel blocker; LDL-C: Low density lipoprotein-cholesterol; HDL-C: High density lipoprotein-cholesterol; IBI: Inflammatory burden index; LVEF: Left ventricular ejection fraction; PCI: Percutaneous coronary intervention; LM: Left main coronary artery; LAD: Left anterior descending coronary artery; LCX: Left circumflex coronary artery; RCA: Right coronary artery. 2.2 IBI对住院期间MACE和长期随访期间MACE的预测作用
ROC曲线（图 2）分析显示，IBI对预测住院期间MACE有显著优势（AUC值为0.687，95%CI 0.633~0.740），优于NLR（AUC值为0.614，95%CI 0.558~0.666；P＜0.001）、PLR（AUC值为0.581，95%CI 0.525~0.637；P＝0.004）和SII（AUC值为0.595，95%CI 0.543~0.650；P＜0.001）。IBI的最佳临界值为102.33 mg/L，预测STEMI患者PCI术后住院期间发生MACE的灵敏度为50.6%，特异度为84.1%。
图 2 各综合炎症指标对STEMI患者住院期间发生MACE预测价值的ROC曲线分析Fig. 2 ROC curve analysis of predictive value of various comprehensive inflammatory indicators for MACE during hospitalization in STEMI patientsSTEMI: ST-segment elevation myocardial infarction; MACE: Major adverse cardiovascular event; ROC: Receiver operating characteristic; IBI: Inflammatory burden index; SII: Systemic immune-inflammation index; PLR: Platelet-to-lymphocyte ratio; NLR: Neutrophil-to-lymphocyte ratio; AUC: Area under curve.下载:
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在长期随访期间，NLR、PLR和SII对MACE没有显著预测价值，IBI展现出显著预测效能（AUC值为0.634，95%CI 0.557~0.704）。IBI的最佳临界值为55.88 mg/L，预测STEMI患者PCI术后长期随访期间发生MACE的灵敏度为55.8%，特异度为71.5%。见图 3。
图 3 各综合炎症指标对STEMI患者长期随访期间发生MACE预测价值的ROC曲线分析Fig. 3 ROC curve analysis of predictive value of various comprehensive inflammatory indicators for MACE during long-term follow-up period in STEMI patientsSTEMI: ST-segment elevation myocardial infarction; MACE: Major adverse cardiovascular event; ROC: Receiver operating characteristic; IBI: Inflammatory burden index; SII: Systemic immune-inflammation index; PLR: Platelet-to-lymphocyte ratio; NLR: Neutrophil-to-lymphocyte ratio; AUC: Area under curve.下载:
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进一步对IBI预测PCI术后STEMI患者住院期间与长期随访期间发生MACE的预测效能进行纵向比较，结果显示IBI预测住院期间发生MACE的效能（AUC值为0.687）与预测长期随访期间发生MACE的效能（AUC值为0.634）差异无统计学意义（P＝0.253）。
2.3 基于IBI分组的STEMI患者临床特征比较
以IBI最佳临界值102.33 mg/L为基准，将住院期间发生MACE的465例STEMI患者分为高IBI组（IBI≥102.33 mg/L，n＝130）和低IBI组（IBI＜102.33 mg/L，n＝335）。高IBI组患者年龄、糖尿病患者比例、Killip分级≥Ⅱ级的患者比例、使用β受体阻滞剂的患者比例、白细胞计数、中性粒细胞计数、CRP、血肌酐、D-二聚体、纤维蛋白原、Gensini评分及植入支架数均高于低IBI组（均P＜0.05），而淋巴细胞计数、白蛋白、低密度脂蛋白胆固醇、LVEF均低于低IBI组（均P＜0.05）。见表 3。
表 3 住院期间不同IBI组STEMI患者的临床资料比较Table 3 Comparison of clinical data of STEMI patients during hospitalization between high- and low-IBI groupsCharacteristic IBI＜102.33 mg·L－1 N＝335 IBI≥102.33 mg·L－1 N＝130 P value Age/year, M (Q1, Q3) 60 (50, 69) 65 (53, 75) 0.005 Male, n (%) 240 (71.6) 92 (70.8) 0.852 BMI/(kg·m－2), M (Q1, Q3) 24.22 (22.49, 26.12) 24.22 (22.84, 26.35) 0.717 Hypertension, n (%) 193 (57.6) 85 (65.4) 0.125 Diabetes mellitus, n (%) 92 (27.5) 48 (36.9) 0.046 Smoking, n (%) 183 (54.6) 65 (50.0) 0.369 Killip class≥Ⅱ, n (%) 59 (17.6) 58 (44.6) ＜0.001 Medical treatment, n (%) ACEI/ARB 249 (74.3) 97 (74.6) 0.949 CCB 43 (12.8) 22 (16.9) 0.254 β-blocker 279 (83.3) 119 (91.5) 0.023 White blood cell count/(L－1, ×109), M (Q1, Q3) 9.75 (7.87, 12.22) 11.39 (9.40, 14.86) ＜0.001 Neutrophil count/(L－1, ×109), M (Q1, Q3) 6.43 (4.70, 8.85) 9.05 (6.92, 11.86) ＜0.001 Lymphocyte count/(L－1, ×109), M (Q1, Q3) 2.05 (1.40, 3.03) 1.40 (0.96, 1.90) ＜0.001 Platelet count/(L－1, ×109), M (Q1, Q3) 205.00 (169.00, 252.00) 210.00 (165.00, 252.00) 0.681 C reactive protein/(mg·L－1), M (Q1, Q3) 4.76 (1.77, 8.30) 50.35 (31.12, 88.94) ＜0.001 Albumin/(g·L－1), M (Q1, Q3) 38.40±3.91 35.97±4.16 ＜0.001 Serum creatinine/(μmol·L－1), M (Q1, Q3) 71.00 (62.00, 84.00) 78.50 (67.00, 93.00) 0.001 LDL-C/(mmol·L－1), M (Q1, Q3) 2.70 (2.23, 3.18) 2.51 (1.99, 3.08) 0.023 HDL-C/(mmol·L－1), M (Q1, Q3) 1.02 (0.89, 1.16) 1.05 (0.92, 1.21) 0.157 Triglyceride/(mmol·L－1), M (Q1, Q3) 1.40 (0.96, 2.11) 1.40 (1.15, 1.88) 0.562 Total cholesterol/(mmol·L－1), M (Q1, Q3) 4.30 (3.76, 4.95) 4.35 (3.54, 5.06) 0.683 Peak troponin Ⅰ/(ng·mL－1), M (Q1, Q3) 14.40 (4.87, 32.46) 17.22 (7.49, 40.65) 0.138 Myoglobin/(ng·mL－1), M (Q1, Q3) 80.80 (24.51, 288.67) 93.65 (34.65, 319.64) 0.356 D-dimer/(mg·L－1), M (Q1, Q3) 0.32 (0.20, 0.53) 0.48 (0.26, 1.15) ＜0.001 Fibrinogen/(g·L－1), M (Q1, Q3) 2.95 (2.43, 3.55) 3.90 (3.18, 4.98) ＜0.001 LVEF/%, M (Q1, Q3) 60.00 (58.00, 62.00) 58.00 (50.00, 60.00) ＜0.001 Number of PCI implanted stents, M (Q1, Q3) 1.0 (1.0, 2.0) 2.0 (1.0, 2.0) 0.002 Lesion branch, n (%) LM 36 (10.7) 11 (8.5) 0.463 LAD 189 (56.4) 83 (63.8) 0.145 LCX 38 (11.3) 17 (13.1) 0.603 RCA 120 (35.8) 39 (30.0) 0.235 Three-vessel or LM 115 (34.3) 50 (38.5) 0.403 Gensini score, M (Q1, Q3) 55.00 (40.00, 82.00) 71.00 (45.00, 92.00) 0.002 IBI: Inflammatory burden index; STEMI: ST-segment elevation myocardial infarction; BMI: Body mass index; ACEI/ARB: Angiotensin converting enzyme inhibitor/angiotensin Ⅱ receptor blocker; CCB: Calcium channel blocker; LDL-C: Low density lipoprotein-cholesterol; HDL-C: High density lipoprotein-cholesterol; LVEF: Left ventricular ejection fraction; PCI: Percutaneous coronary intervention; LM: Left main coronary artery; LAD: Left anterior descending coronary artery; LCX: Left circumflex coronary artery; RCA: Right coronary artery. 以IBI最佳临界值55.88 mg/L为基准，将长期随访期间发生MACE的410例STEMI患者分为高IBI组（IBI≥55.88 mg/L，n＝137）和低IBI组（IBI＜55.88 mg/L，n＝273）。如表 4所示，高IBI组入院时Killip分级≥Ⅱ的患者比例、使用β受体阻滞剂的患者比例、白细胞计数、中性粒细胞计数、CRP、肌红蛋白、D-二聚体、Gensini评分均高于低IBI组（均P＜0.05），而使用钙通道阻滞剂的患者比例、淋巴细胞计数、白蛋白、血肌酐、LVEF均低于低IBI组（均P＜0.05）。
表 4 长期随访期间不同IBI组STEMI患者的临床资料比较Table 4 Comparison of clinical data of STEMI patients during long-term follow-up period between high- and low-IBI groupsCharacteristic IBI＜55.88 mg·L－1 N＝273 IBI≥55.88 mg·L－1 N＝137 P value Age/year, M (Q1, Q3) 59 (49, 68) 62 (52, 69) 0.135 Male, n (%) 196 (71.8) 99 (72.3) 0.921 BMI/(kg·m－2), M (Q1, Q3) 24.22 (22.54, 26.12) 24.22 (22.49, 26.15) 0.945 Hypertension, n (%) 158 (57.9) 86 (62.8) 0.341 Diabetes mellitus, n (%) 74 (27.1) 41 (29.9) 0.549 Smoking, n (%) 145 (53.1) 76 (55.5) 0.651 Killip class≥Ⅱ, n (%) 37 (13.6) 41 (29.9) ＜0.001 Medical treatment, n (%) ACEI/ARB 201 (73.6) 96 (70.1) 0.448 CCB 36 (13.2) 9 (6.6) 0.043 β-blocker 228 (83.5) 125 (91.2) 0.033 White blood cell count/(L－1, ×109), M (Q1, Q3) 9.56 (7.76, 12.19) 11.06 (9.45, 13.92) ＜0.001 Neutrophil count/(L－1, ×109), M (Q1, Q3) 6.21 (4.575, 8.73) 8.40 (6.63, 11.47) ＜0.001 Lymphocyte count/(L－1, ×109), M (Q1, Q3) 2.08 (1.46, 3.08) 1.42 (1.05, 2.08) ＜0.001 Platelet count/(L－1, ×109), M (Q1, Q3) 203.00 (169.00, 251.00) 214.00 (169.00, 246.50) 0.357 C reactive protein/(mg·L－1), M (Q1, Q3) 3.75 (1.35, 6.85) 36.19 (17.99, 63.37) ＜0.001 Albumin/(g·L－1), M (Q1, Q3) 38.66±3.86 36.59±4.01 ＜0.001 Serum creatinine/(μmol·L－1), M (Q1, Q3) 2.72 (2.25, 3.25) 2.51 (2.07, 3.10) 0.030 LDL-C/(mmol·L－1), M (Q1, Q3) 1.02 (0.89, 1.16) 1.05 (0.91, 1.21) 0.157 HDL-C/(mmol·L－1), M (Q1, Q3) 1.41 (0.955, 2.19) 1.38 (1.06, 1.90) 0.989 Triglyceride/(mmol·L－1), M (Q1, Q3) 4.33 (3.79, 4.95) 4.36 (3.58, 5.03) 0.742 Total cholesterol/(mmol·L－1), M (Q1, Q3) 0.30 (0.20, 0.48) 0.32 (0.21, 0.57) 0.075 Peak troponin Ⅰ/(ng·mL－1), M (Q1, Q3) 65.63 (23.45, 251.54) 93.00 (30.60, 303.48) 0.164 Myoglobin/(ng·mL－1), M (Q1, Q3) 69.00 (62.00, 81.00) 74.00 (64.00, 85.50) 0.033 D-dimer/(mg·L－1), M (Q1, Q3) 2.91 (2.38, 3.48) 3.70 (3.02, 4.48) ＜0.001 Fibrinogen/(g·L－1), M (Q1, Q3) 14.23 (4.55, 30.39) 16.25 (6.62, 41.40) 0.128 LVEF/%, M (Q1, Q3) 60.00 (58.00, 62.00) 58.00 (56.50, 61.00) 0.020 Number of PCI implanted stents, M (Q1, Q3) 1.0 (1.0, 2.0) 2.0 (1.0, 2.0) 0.051 Lesion branch, n (%) LM 27 (9.9) 13 (9.5) 0.897 LAD 230 (84.2) 123 (89.8) 0.127 LCX 130 (47.6) 70 (51.1) 0.507 RCA 171 (62.6) 82 (59.9) 0.584 Three-vessel or LM 90 (33.0) 49 (35.8) 0.572 Gensini score, M (Q1, Q3) 52.00 (37.00, 80.00) 64.00 (45.00, 89.00) 0.004 IBI: Inflammatory burden index; STEMI: ST-segment elevation myocardial infarction; BMI: Body mass index; ACEI/ARB: Angiotensin converting enzyme inhibitor/angiotensin Ⅱ receptor blocker; CCB: Calcium channel blocker; LDL-C: Low density lipoprotein-cholesterol; HDL-C: High density lipoprotein-cholesterol; LVEF: Left ventricular ejection fraction; PCI: Percutaneous coronary intervention; LM: Left main coronary artery; LAD: Left anterior descending coronary artery; LCX: Left circumflex coronary artery; RCA: Right coronary artery. 2.4 不同IBI组患者的MACE发生情况分析
如表 5所示，在465例STEMI住院患者中，有164例（35.3%）发生MACE。高IBI组MACE发生率（63.8%，83/130）高于低IBI组（24.2%，81/335；P＜0.001）。与低IBI组相比，高IBI组心血管死亡（P＜0.001）、急性心力衰竭（P＜0.001）、恶性心律失常（P＜0.001）和新发心房颤动（P＝0.012）的发生率较高。然而，两组在新发非致死性心肌梗死的发生率方面差异无统计学意义（P＝0.280）。
表 5 不同IBI组STEMI患者住院期间发生MACE的统计结果Table 5 MACE outcomes of STEMI patients during hospitalization in high- and low-IBI groupsn (%) Outcome All patients N＝465 IBI＜102.33 mg·L－1 N＝335 IBI≥102.33 mg·L－1 N＝130 P value MACE 164 (35.3) 81 (24.2) 83 (63.8) ＜0.001 Cardiovascular death 21 (4.5) 6 (1.8) 15 (11.5) ＜0.001 New-onset nonfatal myocardial 1 (0.2) 0 1 (0.8) 0.280 Acute heart failure 134 (28.8) 65 (19.4) 69 (53.1) ＜0.001 Malignant arrhythmias 40 (8.6) 19 (5.7) 21 (16.2) ＜0.001 New-onset atrial fibrillation 29 (6.2) 15 (4.5) 14 (10.8) 0.012 IBI: Inflammatory burden index; STEMI: ST-segment elevation myocardial infarction; MACE: Major adverse cardiovascular event. 在410例接受长期随访的STEMI患者中，77例（18.8%）发生MACE。高IBI组MACE发生率（31.4%，43/137）高于低IBI组（12.5%，34/273；P＜0.001）。与低IBI组相比，高IBI组因不稳定型心绞痛再次行PCI治疗的患者比例（P＝0.038）、急性心力衰竭发生率（P＜0.001）均高于低IBI组。然而，在心血管死亡、新发非致死性心肌梗死或恶性心律失常的发生率方面，两组间差异均无统计学意义（均P＞0.05）。见表 6。
表 6 不同IBI组STEMI患者长期随访期间发生MACE的统计结果Table 6 MACE outcomes of STEMI patients during long-term follow-up period in high- and low-IBI groupsn (%) Outcome All patients N＝410 IBI＜55.88 mg·L－1 N＝273 IBI≥55.88 mg·L－1 N＝137 P value MACE 77 (18.8) 34 (12.5) 43 (31.4) ＜0.001 Cardiovascular death 2 (0.5) 1 (0.4) 0 0.479 New-onset nonfatal myocardial 8 (2.0) 3 (1.1) 4 (3.0) 0.178 Revascularization in unstable angina 42 (10.2) 22 (8.2) 20 (14.9) 0.038 Malignant arrhythmias 4 (1.0) 2 (0.7) 2 (1.5) 0.477 Acute heart failure 29 (7.1) 8 (3.0) 20 (14.9) ＜0.001 IBI: Inflammatory burden index; STEMI: ST-segment elevation myocardial infarction; MACE: Major adverse cardiovascular event. 2.5 IBI是STEMI患者PCI术后住院和长期随访期间发生MACE的独立预测因子
多因素logistic回归分析显示，年龄、入院时Killip分级≥Ⅱ级、低CRP、高血肌酐、高D-二聚体、IBI≥102.33 mg/L、LVEF均是STEMI患者PCI术后住院期间发生MACE的独立危险因素（均P＜0.05，表 7）。
表 7 STEMI患者PCI术后住院期间发生MACE预测因素的logistic回归分析Table 7 Logistic regression analysis of predictive factors for MACE in STEMI patients during hospitalization after PCIVariable Univariate analysis Multivariate analysis P value OR (95%CI) P value OR (95%CI) Age ＜0.001 1.064 (1.046, 1.082) 0.023 1.030 (1.005, 1.060) Diabetes mellitus ＜0.001 2.253 (1.499, 3.394) 0.503 1.260 (0.640, 2.429) Killip class≥Ⅱ ＜0.001 28.560 (16.180, 53.360) ＜0.001 14.870 (7.180, 32.770) Neutrophil 0.007 1.073 (1.020, 1.130) 0.822 0.990 (0.900, 1.088) Lymphocyte 0.306 0.927 (0.797, 1.069) C reactive protein ＜0.001 1.013 (1.008, 1.069) 0.024 0.990 (0.974, 0.998) Albumin ＜0.001 0.884 (0.840, 0.929) 0.221 0.950 (0.878, 1.029) Serum creatinine ＜0.001 1.031 (1.021, 1.041) ＜0.001 1.020 (1.011, 1.037) LDL-C 0.317 0.890 (0.706, 1.005) Triglyceride 0.419 1.049 (0.931, 1.186) Peak troponin Ⅰ 0.049 1.008 (1.000, 1.015) 0.724 1.000 (0.989, 1.015) Myoglobin 0.001 1.001 (1.000, 1.001) 0.130 1.000 (0.999, 1.001) D-dimer ＜0.001 5.229 (3.191, 9.210) 0.005 2.140 (1.286, 3.736) Fibrinogen 0.011 1.209 (1.052, 1.407) 0.278 0.890 (0.693, 1.078) IBI≥102.33 mg·L－1 ＜0.001 5.538 (3.597, 8.623) ＜0.001 10.900 (4.273, 29.180) LVEF ＜0.001 0.854 (0.819, 0.888) 0.004 0.930 (0.883, 0.977) LM lesion 0.003 2.512 (1.368, 4.665) 0.069 2.550 (0.930, 7.030) LAD lesion 0.001 3.216 (1.654, 6.885) 0.342 1.670 (0.602, 5.104) Three-vessel or LM lesion ＜0.001 2.231 (1.504, 3.317) 0.639 0.830 (0.387, 1.762) Gensini score ＜0.001 1.023 (1.015, 1.030) 0.189 1.010 (0.996, 1.021) STEMI: ST-segment elevation myocardial infarction; PCI: Percutaneous coronary intervention; MACE: Major adverse cardiovascular event; LDL-C: Low density lipoprotein-cholesterol; IBI: Inflammatory burden index; LVEF: Left ventricular ejection fraction; LM: Left main coronary artery; LAD: Left anterior descending coronary artery; OR: Odds ratio; 95%CI: 95% confidence interval. 多因素Cox回归分析结果表明，入院时Killip分级≥Ⅱ级、IBI≥55.88 mg/L、右冠状动脉狭窄是STEMI患者PCI术后长期随访期间发生MACE的独立预测因子（均P＜0.05，表 8）。
表 8 STEMI患者PCI术后长期随访期间发生MACE预测因素的Cox回归分析Table 8 Cox regression analysis of predictive factors for MACE in STEMI patients during long-term follow-up period after PCIVariable Univariate analysis Multivariate analysis P value HR (95%CI) P value HR (95%CI) Age ＜0.001 1.032 (1.014, 1.051) 0.176 1.014 (0.994, 1.035) Killip class≥Ⅱ ＜0.001 3.506 (2.222, 5.534) 0.009 2.035 (1.196, 3.463) C reactive protein ＜0.001 1.007 (1.003, 1.012) 0.887 1.000 (0.993, 1.008) Albumin ＜0.001 0.889 (0.839, 0.942) 0.140 0.955 (0.897, 1.015) Fibrinogen 0.006 1.292 (1.077, 1.550) 0.441 1.100 (0.863, 1.404) IBI≥55.88 mg·L－1 ＜0.001 2.740 (1.743, 4.308) 0.018 1.989 (1.128, 3.506) LVEF ＜0.001 0.950 (0.924, 0.976) 0.297 0.981 (0.945, 1.017) Number of PCI implanted stents 0.036 1.381 (1.021, 1.870) 0.237 1.213 (0.881, 1.671) LCX lesion 0.027 1.673 (1.061, 2.638) 0.904 1.045 (0.514, 2.124) RCA lesion ＜0.001 3.349 (1.844, 6.080) 0.005 2.642 (1.335, 5.225) Three-vessel or LM lesion ＜0.001 2.465 (1.575, 3.858) 0.603 1.229 (0.565, 2.675) Gensini score 0.005 1.011 (1.003, 1.019) 0.457 1.003 (0.994, 1.013) STEMI: ST-segment elevation myocardial infarction; PCI: Percutaneous coronary intervention; MACE: Major adverse cardiovascular event; IBI: Inflammatory burden index; LVEF: Left ventricular ejection fraction; LCX: Left circumflex coronary artery; RCA: Right coronary artery; LM: Left main coronary artery; HR: Hazard ratio; 95%CI: 95% confidence interval. 对长期随访期间发生MACE的410例STEMI患者进行Kaplan-Meier生存曲线分析，结果显示高IBI（≥55.88 mg/L）患者的长期无MACE生存率较低（log-rank检验，P＜0.001），支持IBI作为长期MACE风险的评估指标（图 4）。
图 4 STEMI患者PCI术后长期随访期间发生MACE的Kaplan-Meier生存曲线分析Fig. 4 Kaplan-Meier survival analysis of MACE in STEMI patients during long-term follow-up after PCISTEMI: ST-segment elevation myocardial infarction; PCI: Percutaneous coronary intervention; MACE: Major adverse cardiovascular event; IBI: Inflammatory burden index.下载:
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3 讨论
在心血管疾病领域，精准评估STEMI患者的预后至关重要。长期以来，临床上主要依赖全球急性冠状动脉事件登记（Global Registry of Acute Coronary Events，GRACE）风险评分预测患者预后，然而其计算复杂，临床应用不便，因此寻找一种简化且可靠的预后预测指标成为当务之急[16]。既往研究表明，血常规衍生指标在多种疾病诊断和预后评估中具有重要意义[17]，CRP水平升高与心血管事件和死亡率上升相关，这可能与持续炎症引发的心脏和血管病变有关。在急性心肌梗死发作期间，心肌组织损伤释放炎症介质，刺激肝脏合成CRP增加[18]，CRP通过激活补体系统促进炎症细胞的聚集和活化，进而加重心肌炎症损伤。同时，CRP还能诱导内皮细胞功能障碍，促进血栓形成，进一步影响冠状动脉的血流灌注[19]。多项研究证明急性心肌梗死患者血清中CRP水平在早期显著上升，并与心肌梗死的面积相关[20-21]。
STEMI发生过程中淋巴细胞显著减少，可能与淋巴细胞凋亡及T细胞和自然杀伤细胞减少有关[22-23]，而淋巴细胞减少可导致免疫监视功能下降和炎症失控，加重心肌损伤。Forteza等[24]观察到STEMI患者和猪心肌缺血再灌注模型的循环淋巴细胞凋亡显著增加，导致淋巴细胞显著减少，心肌梗死区大量T淋巴细胞浸润。此外，STEMI患者的心脏MRI检查显示PCI术后1周和6个月时，24 h循环T淋巴细胞数量与心肌梗死程度呈负相关。
急性心肌梗死患者的中性粒细胞计数通常升高，且与梗死面积呈正相关[25]。Jiang等[26]研究发现，抑制消皮素D可减缓急性心肌梗死后炎症发展，从而显著减少梗死面积、减轻心脏损伤并提高急性心肌梗死患者的存活率；此外，抑制中性粒细胞的活化或聚集可以减小梗死面积并改善心脏功能。
CRP作为全身性炎症指标，反映了机体炎症状态，而NLR是急性心肌梗死预后的重要预测因子[27-28]。本研究通过结合中性粒细胞、淋巴细胞计数和CRP水平得到炎症标志物指数IBI，研究其与STEMI患者接受PCI治疗后MACE发生风险的关系。IBI整合了CRP和NLR，考虑了炎症与免疫反应的动态交互，克服了单一炎症标志物的局限性，能够更全面地评估患者的炎症负荷状态，有助于个体化风险评估。与GRACE风险评分相比，IBI计算简便、无需额外成本，适用于高危STEMI患者的快速筛查。
本研究结果表明，相较于未发生MACE的患者，住院和长期随访期间发生MACE的STEMI患者IBI均升高。进一步通过ROC曲线分析IBI与NLR、PLR、SII的预测效果，结果表明，IBI在预测住院及长期随访期间MACE均有较高的AUC值。多因素logistic回归和Cox回归分析结果显示，住院期间IBI≥102.33 mg/L时MACE的发生风险较高，长期随访期间IBI≥55.88 mg/L时MACE的发生风险较高。Kaplan-Meier生存曲线亦表明，IBI≥55.88 mg/L的STEMI患者在PCI术后2年内发生MACE的风险高于IBI＜55.88 mg/L的患者。从病理生理学角度来看，在STEMI患者中，高炎症状态可促使斑块不稳定、血栓形成增加及心肌损伤加重，这些病理变化与MACE的发生紧密相关。此外，本研究结果显示，IBI预测MACE的最佳临界值在住院期间和长期随访期间存在明显差异。在住院期间，IBI的最佳临界值较高（102.33 mg/L），更有助于识别短期高危患者。而在长期随访期间，随着炎症反应逐渐消退、治疗干预生效，患者的整体IBI下降，相应地，预测长期MACE的最佳临界值（55.88 mg/L）降低。从统计学角度来看，最佳临界值的变化并不意味着IBI预测能力的减弱，而是反映了疾病病程中炎症负担的动态演变。在临床实践中，IBI作为一种简便、经济的预测工具，具有重要的临床意义。通过检测入院时的IBI可快速筛选高危患者并优先进行介入治疗或强化监护，而针对高IBI患者，探索针对性抗炎治疗（如IL-1β抑制剂）对MACE的预防作用能够为临床决策提供科学依据。与以往研究相比，本研究进一步凸显了IBI在STEMI患者预后评估中的价值。以往研究多侧重于单一炎症标志物或其他传统危险因素对MACE的预测，而IBI综合了多种血液学炎症相关指标，具有更好的预测准确性和全面性。同时，本研究兼顾住院期间和长期随访情况，为STEMI患者的全程管理提供了有力依据。综上所述，IBI作为评估STEMI患者预后的有效工具，有助于指导治疗。
本研究存在以下局限性。首先，这是一项回顾性的单中心研究，样本量相对较小，研究结论需要进行更大样本量的前瞻性多中心研究来进一步验证。其次，在数据收集过程中省略了某些临床数据，如脑利尿钠肽、血红蛋白和单核细胞计数，这可能导致实验结果偏倚。最后，本研究仅关注了PCI术前的IBI，而没有检查PCI术后或随访期间IBI的变化，未来研究仍需进一步探索IBI在随访期的动态变化与MACE发生风险的关系，且本研究的长期随访时间为出院后2年，尚未能评估IBI对更长期（如5年或10年）MACE的预测价值。未来更大规模、更长随访时间的研究对于证实和扩展IBI的临床应用价值至关重要。
本研究证实了IBI在预测STEMI患者PCI术后MACE方面的诊断价值。IBI是院内和长期MACE的独立危险因素，可作为STEMI患者不良预后的实用预测标志物，为临床决策提供重要依据。
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图 1 患者纳入流程图
Fig. 1 Patient inclusion flow chart
PCI: Percutaneous coronary intervention; STEMI: ST-segment elevation myocardial infarction; MACE: Major adverse cardiovascular event.
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图 2 各综合炎症指标对STEMI患者住院期间发生MACE预测价值的ROC曲线分析
Fig. 2 ROC curve analysis of predictive value of various comprehensive inflammatory indicators for MACE during hospitalization in STEMI patients
STEMI: ST-segment elevation myocardial infarction; MACE: Major adverse cardiovascular event; ROC: Receiver operating characteristic; IBI: Inflammatory burden index; SII: Systemic immune-inflammation index; PLR: Platelet-to-lymphocyte ratio; NLR: Neutrophil-to-lymphocyte ratio; AUC: Area under curve.
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图 3 各综合炎症指标对STEMI患者长期随访期间发生MACE预测价值的ROC曲线分析
Fig. 3 ROC curve analysis of predictive value of various comprehensive inflammatory indicators for MACE during long-term follow-up period in STEMI patients
STEMI: ST-segment elevation myocardial infarction; MACE: Major adverse cardiovascular event; ROC: Receiver operating characteristic; IBI: Inflammatory burden index; SII: Systemic immune-inflammation index; PLR: Platelet-to-lymphocyte ratio; NLR: Neutrophil-to-lymphocyte ratio; AUC: Area under curve.
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图 4 STEMI患者PCI术后长期随访期间发生MACE的Kaplan-Meier生存曲线分析
Fig. 4 Kaplan-Meier survival analysis of MACE in STEMI patients during long-term follow-up after PCI
STEMI: ST-segment elevation myocardial infarction; PCI: Percutaneous coronary intervention; MACE: Major adverse cardiovascular event; IBI: Inflammatory burden index.
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表 1 住院期间发生MACE与未发生MACE的STEMI患者临床资料比较
Table 1 Comparison of clinical data of STEMI patients between in-hospital MACE group and non-MACE group
Characteristic Non-MACE group N＝301 MACE group N＝164 P value Age/year, M (Q1, Q3) 57 (48, 66) 69 (58, 78) ＜0.001 Male, n (%) 215 (71.4) 117 (71.3) 0.984 BMI/(kg·m－2), M (Q1, Q3) 24.22 (22.65, 26.34) 23.97 (22.09, 25.95) 0.103 Hypertension, n (%) 172 (57.1) 106 (64.6) 0.115 Diabetes mellitus, n (%) 72 (23.9) 68 (41.5) ＜0.001 Smoking, n (%) 157 (52.2) 91 (55.5) 0.492 Killip class≥Ⅱ, n (%) 16 (5.3) 101 (61.6) ＜0.001 Medical treatment, n (%) ACEI/ARB 216 (71.8) 130 (79.3) 0.076 CCB 38 (12.6) 27 (16.5) 0.254 β-blocker 259 (86.0) 139 (84.8) 0.705 White blood cell count/(L－1, ×109), M (Q1, Q3) 9.97 (8.10, 12.66) 10.64 (8.43, 13.76) 0.072 Neutrophil count/(L－1, ×109), M (Q1, Q3) 7.10 (4.81, 9.61) 7.52 (5.68, 10.59) 0.012 Lymphocyte count/(L－1, ×109), M (Q1, Q3) 1.95 (1.38, 2.84) 1.56 (1.05, 2.42) ＜0.001 Platelet count/(L－1, ×109), M (Q1, Q3) 205.00 (169.50, 252.00) 210.00 (165.00, 248.75) 0.748 C reactive protein/(mg·L－1), M (Q1, Q3) 5.63 (2.25, 12.78) 17.71 (5.00, 51.20) ＜0.001 Albumin/(g·L－1), M (Q1, Q3) 38.42±3.87 36.44±4.27 ＜0.001 Serum creatinine/(μmol·L－1), M (Q1, Q3) 69.00 (61.50, 80.00) 81.50 (67.00, 106.75) ＜0.001 LDL-C/(mmol·L－1), M (Q1, Q3) 2.68 (2.20, 3.18) 2.58 (2.13, 3.12) 0.400 HDL-C/(mmol·L－1), M (Q1, Q3) 1.02 (0.89, 1.18) 1.03 (0.92, 1.18) 0.664 Triglyceride/(mmol·L－1), M (Q1, Q3) 1.34 (0.87, 2.02) 1.46 (1.20, 2.10) 0.001 Total cholesterol/(mmol·L－1), M (Q1, Q3) 4.28 (3.59, 4.90) 4.35 (3.84, 5.12) 0.174 Peak troponin Ⅰ/(ng·mL－1), M (Q1, Q3) 13.35 (4.86, 26.22) 19.93 (6.32, 50.00) 0.013 Myoglobin/(ng·mL－1), M (Q1, Q3) 61.80 (22.91, 215.74) 183.51 (47.62, 400.00) ＜0.001 D-dimer/(mg·L－1), M (Q1, Q3) 0.28 (0.19, 0.45) 0.66 (0.34, 1.73) ＜0.001 Fibrinogen/(g·L－1), M (Q1, Q3) 3.01 (2.50, 3.73) 3.54 (2.76, 4.48) ＜0.001 IBI/(mg·L－1), M (Q1, Q3) 20.15 (5.26, 59.48) 104.26 (17.65, 297.63) ＜0.001 LVEF/%, M (Q1, Q3) 60.00 (58.00, 62.00) 57.50 (47.25, 60.00) ＜0.001 Number of PCI implanted stents, M (Q1, Q3) 1.0 (1.0, 2.0) 1.5 (1.0, 2.0) 0.235 Lesion branch, n (%) LM 21 (7.0) 26 (15.9) 0.002 LAD 165 (54.8) 107 (65.2) 0.029 LCX 34 (11.3) 21 (12.8) 0.630 RCA 110 (36.5) 49 (29.9) 0.148 Three-vessel or LM 87 (28.9) 78 (47.6) ＜0.001 Gensini score, M (Q1, Q3) 50.00 (36.50, 80.00) 80.00 (49.25, 94.75) ＜0.001 MACE: Major adverse cardiovascular event; STEMI: ST-segment elevation myocardial infarction; BMI: Body mass index; ACEI/ARB: Angiotensin converting enzyme inhibitor/angiotensin Ⅱ receptor blocker; CCB: Calcium channel blocker; LDL-C: Low density lipoprotein-cholesterol; HDL-C: High density lipoprotein-cholesterol; IBI: Inflammatory burden index; LVEF: Left ventricular ejection fraction; PCI: Percutaneous coronary intervention; LM: Left main coronary artery; LAD: Left anterior descending coronary artery; LCX: Left circumflex coronary artery; RCA: Right coronary artery. 表 2 长期随访期间发生MACE与未发生MACE的STEMI患者临床资料比较
Table 2 Comparison of clinical data of STEMI patients between MACE group and non-MACE group during long-term follow-up period
Characteristic Non-MACE group N＝333 MACE group N＝77 P value Age/year, M (Q1, Q3) 59 (49, 67) 65 (55, 74) ＜0.001 Male, n (%) 243 (73.0) 52 (67.5) 0.338 BMI/(kg·m－2), M (Q1, Q3) 24.22 (22.65, 26.20) 24.16 (22.04, 26.01) 0.211 Hypertension, n (%) 193 (58.0) 51 (66.2) 0.182 Diabetes mellitus, n (%) 93 (27.9) 22 (28.6) 0.910 Smoking, n (%) 179 (53.8) 42 (54.5) 0.900 Killip class≥Ⅱ, n (%) 47 (14.1) 31 (40.3) ＜0.001 Medical treatment, n (%) ACEI/ARB 238 (71.5) 59 (76.6) 0.362 CCB 41 (12.3) 4 (5.2) 0.072 β-blocker 283 (85) 70 (90.9) 0.176 White blood cell count/(L－1, ×109), M (Q1, Q3) 9.97 (8.07, 12.60) 10.85 (8.35, 13.55) 0.178 Neutrophil count/(L－1, ×109), M (Q1, Q3) 6.97 (5.06, 9.53) 7.51 (4.80, 11.27) 0.215 Lymphocyte count/(L－1, ×109), M (Q1, Q3) 1.87 (1.30, 2.71) 1.79 (1.16, 2.46) 0.418 Platelet count/(L－1, ×109), M (Q1, Q3) 207.00 (171.00, 252.50) 210.00 (152.50, 246.00) 0.573 C reactive protein/(mg·L－1), M (Q1, Q3) 6.18 (2.35, 15.10) 16.52 (4.27, 48.72) ＜0.001 Albumin/(g·L－1), M (Q1, Q3) 38.34±3.78 36.35±4.64 ＜0.001 Serum creatinine/(μmol·L－1), M (Q1, Q3) 71.00 (62.00, 82.00) 73.00 (60.50, 87.00) 0.382 LDL-C/(mmol·L－1), M (Q1, Q3) 2.65 (2.19, 3.16) 2.73 (2.25, 3.18) 0.556 HDL-C/(mmol·L－1), M (Q1, Q3) 1.04 (0.89, 1.18) 1.04 (0.90, 1.20) 0.744 Triglyceride/(mmol·L－1), M (Q1, Q3) 1.40 (0.97, 2.10) 1.34 (1.03, 1.97) 0.789 Total cholesterol/(mmol·L－1), M (Q1, Q3) 4.30 (3.69, 4.96) 4.43 (3.91, 5.01) 0.424 Peak troponin Ⅰ/(ng·mL－1), M (Q1, Q3) 15.11 (4.97, 33.64) 14.23 (5.48, 38.78) 0.669 Myoglobin/(ng·mL－1), M (Q1, Q3) 68.50 (23.70, 269.30) 92.91 (28.07, 265.59) 0.501 D-dimer/(mg·L－1), M (Q1, Q3) 0.33 (0.21, 0.52) 0.27 (0.20, 0.43) 0.086 Fibrinogen/(g·L－1), M (Q1, Q3) 3.06 (2.51, 3.76) 3.50 (2.74, 4.11) 0.006 IBI/(mg·L－1), M (Q1, Q3) 23.72 (5.55, 72.74) 63.34 (12.47, 217.87) ＜0.001 LVEF/%, M (Q1, Q3) 60.00 (58.00, 62.00) 58.00 (55.50, 60.00) 0.001 Number of PCI implanted stents, M (Q1, Q3) 1.0 (1.0, 2.0) 2.0 (1.0, 2.0) 0.020 Lesion branch, n (%) LM 31 (9.3) 9 (11.7) 0.526 LAD 286 (85.9) 67 (87) 0.797 LCX 154 (46.2) 46 (59.7) 0.033 RCA 189 (56.8) 64 (83.1) ＜0.001 Three-vessel or LM 98 (29.4) 41 (53.2) ＜0.001 Gensini score, M (Q1, Q3) 54.00 (38.00, 82.00) 66.00 (45.00, 91.50) 0.017 MACE: Major adverse cardiovascular event; STEMI: ST-segment elevation myocardial infarction; BMI: Body mass index; ACEI/ARB: Angiotensin converting enzyme inhibitor/angiotensin Ⅱ receptor blocker; CCB: Calcium channel blocker; LDL-C: Low density lipoprotein-cholesterol; HDL-C: High density lipoprotein-cholesterol; IBI: Inflammatory burden index; LVEF: Left ventricular ejection fraction; PCI: Percutaneous coronary intervention; LM: Left main coronary artery; LAD: Left anterior descending coronary artery; LCX: Left circumflex coronary artery; RCA: Right coronary artery. 表 3 住院期间不同IBI组STEMI患者的临床资料比较
Table 3 Comparison of clinical data of STEMI patients during hospitalization between high- and low-IBI groups
Characteristic IBI＜102.33 mg·L－1 N＝335 IBI≥102.33 mg·L－1 N＝130 P value Age/year, M (Q1, Q3) 60 (50, 69) 65 (53, 75) 0.005 Male, n (%) 240 (71.6) 92 (70.8) 0.852 BMI/(kg·m－2), M (Q1, Q3) 24.22 (22.49, 26.12) 24.22 (22.84, 26.35) 0.717 Hypertension, n (%) 193 (57.6) 85 (65.4) 0.125 Diabetes mellitus, n (%) 92 (27.5) 48 (36.9) 0.046 Smoking, n (%) 183 (54.6) 65 (50.0) 0.369 Killip class≥Ⅱ, n (%) 59 (17.6) 58 (44.6) ＜0.001 Medical treatment, n (%) ACEI/ARB 249 (74.3) 97 (74.6) 0.949 CCB 43 (12.8) 22 (16.9) 0.254 β-blocker 279 (83.3) 119 (91.5) 0.023 White blood cell count/(L－1, ×109), M (Q1, Q3) 9.75 (7.87, 12.22) 11.39 (9.40, 14.86) ＜0.001 Neutrophil count/(L－1, ×109), M (Q1, Q3) 6.43 (4.70, 8.85) 9.05 (6.92, 11.86) ＜0.001 Lymphocyte count/(L－1, ×109), M (Q1, Q3) 2.05 (1.40, 3.03) 1.40 (0.96, 1.90) ＜0.001 Platelet count/(L－1, ×109), M (Q1, Q3) 205.00 (169.00, 252.00) 210.00 (165.00, 252.00) 0.681 C reactive protein/(mg·L－1), M (Q1, Q3) 4.76 (1.77, 8.30) 50.35 (31.12, 88.94) ＜0.001 Albumin/(g·L－1), M (Q1, Q3) 38.40±3.91 35.97±4.16 ＜0.001 Serum creatinine/(μmol·L－1), M (Q1, Q3) 71.00 (62.00, 84.00) 78.50 (67.00, 93.00) 0.001 LDL-C/(mmol·L－1), M (Q1, Q3) 2.70 (2.23, 3.18) 2.51 (1.99, 3.08) 0.023 HDL-C/(mmol·L－1), M (Q1, Q3) 1.02 (0.89, 1.16) 1.05 (0.92, 1.21) 0.157 Triglyceride/(mmol·L－1), M (Q1, Q3) 1.40 (0.96, 2.11) 1.40 (1.15, 1.88) 0.562 Total cholesterol/(mmol·L－1), M (Q1, Q3) 4.30 (3.76, 4.95) 4.35 (3.54, 5.06) 0.683 Peak troponin Ⅰ/(ng·mL－1), M (Q1, Q3) 14.40 (4.87, 32.46) 17.22 (7.49, 40.65) 0.138 Myoglobin/(ng·mL－1), M (Q1, Q3) 80.80 (24.51, 288.67) 93.65 (34.65, 319.64) 0.356 D-dimer/(mg·L－1), M (Q1, Q3) 0.32 (0.20, 0.53) 0.48 (0.26, 1.15) ＜0.001 Fibrinogen/(g·L－1), M (Q1, Q3) 2.95 (2.43, 3.55) 3.90 (3.18, 4.98) ＜0.001 LVEF/%, M (Q1, Q3) 60.00 (58.00, 62.00) 58.00 (50.00, 60.00) ＜0.001 Number of PCI implanted stents, M (Q1, Q3) 1.0 (1.0, 2.0) 2.0 (1.0, 2.0) 0.002 Lesion branch, n (%) LM 36 (10.7) 11 (8.5) 0.463 LAD 189 (56.4) 83 (63.8) 0.145 LCX 38 (11.3) 17 (13.1) 0.603 RCA 120 (35.8) 39 (30.0) 0.235 Three-vessel or LM 115 (34.3) 50 (38.5) 0.403 Gensini score, M (Q1, Q3) 55.00 (40.00, 82.00) 71.00 (45.00, 92.00) 0.002 IBI: Inflammatory burden index; STEMI: ST-segment elevation myocardial infarction; BMI: Body mass index; ACEI/ARB: Angiotensin converting enzyme inhibitor/angiotensin Ⅱ receptor blocker; CCB: Calcium channel blocker; LDL-C: Low density lipoprotein-cholesterol; HDL-C: High density lipoprotein-cholesterol; LVEF: Left ventricular ejection fraction; PCI: Percutaneous coronary intervention; LM: Left main coronary artery; LAD: Left anterior descending coronary artery; LCX: Left circumflex coronary artery; RCA: Right coronary artery. 表 4 长期随访期间不同IBI组STEMI患者的临床资料比较
Table 4 Comparison of clinical data of STEMI patients during long-term follow-up period between high- and low-IBI groups
Characteristic IBI＜55.88 mg·L－1 N＝273 IBI≥55.88 mg·L－1 N＝137 P value Age/year, M (Q1, Q3) 59 (49, 68) 62 (52, 69) 0.135 Male, n (%) 196 (71.8) 99 (72.3) 0.921 BMI/(kg·m－2), M (Q1, Q3) 24.22 (22.54, 26.12) 24.22 (22.49, 26.15) 0.945 Hypertension, n (%) 158 (57.9) 86 (62.8) 0.341 Diabetes mellitus, n (%) 74 (27.1) 41 (29.9) 0.549 Smoking, n (%) 145 (53.1) 76 (55.5) 0.651 Killip class≥Ⅱ, n (%) 37 (13.6) 41 (29.9) ＜0.001 Medical treatment, n (%) ACEI/ARB 201 (73.6) 96 (70.1) 0.448 CCB 36 (13.2) 9 (6.6) 0.043 β-blocker 228 (83.5) 125 (91.2) 0.033 White blood cell count/(L－1, ×109), M (Q1, Q3) 9.56 (7.76, 12.19) 11.06 (9.45, 13.92) ＜0.001 Neutrophil count/(L－1, ×109), M (Q1, Q3) 6.21 (4.575, 8.73) 8.40 (6.63, 11.47) ＜0.001 Lymphocyte count/(L－1, ×109), M (Q1, Q3) 2.08 (1.46, 3.08) 1.42 (1.05, 2.08) ＜0.001 Platelet count/(L－1, ×109), M (Q1, Q3) 203.00 (169.00, 251.00) 214.00 (169.00, 246.50) 0.357 C reactive protein/(mg·L－1), M (Q1, Q3) 3.75 (1.35, 6.85) 36.19 (17.99, 63.37) ＜0.001 Albumin/(g·L－1), M (Q1, Q3) 38.66±3.86 36.59±4.01 ＜0.001 Serum creatinine/(μmol·L－1), M (Q1, Q3) 2.72 (2.25, 3.25) 2.51 (2.07, 3.10) 0.030 LDL-C/(mmol·L－1), M (Q1, Q3) 1.02 (0.89, 1.16) 1.05 (0.91, 1.21) 0.157 HDL-C/(mmol·L－1), M (Q1, Q3) 1.41 (0.955, 2.19) 1.38 (1.06, 1.90) 0.989 Triglyceride/(mmol·L－1), M (Q1, Q3) 4.33 (3.79, 4.95) 4.36 (3.58, 5.03) 0.742 Total cholesterol/(mmol·L－1), M (Q1, Q3) 0.30 (0.20, 0.48) 0.32 (0.21, 0.57) 0.075 Peak troponin Ⅰ/(ng·mL－1), M (Q1, Q3) 65.63 (23.45, 251.54) 93.00 (30.60, 303.48) 0.164 Myoglobin/(ng·mL－1), M (Q1, Q3) 69.00 (62.00, 81.00) 74.00 (64.00, 85.50) 0.033 D-dimer/(mg·L－1), M (Q1, Q3) 2.91 (2.38, 3.48) 3.70 (3.02, 4.48) ＜0.001 Fibrinogen/(g·L－1), M (Q1, Q3) 14.23 (4.55, 30.39) 16.25 (6.62, 41.40) 0.128 LVEF/%, M (Q1, Q3) 60.00 (58.00, 62.00) 58.00 (56.50, 61.00) 0.020 Number of PCI implanted stents, M (Q1, Q3) 1.0 (1.0, 2.0) 2.0 (1.0, 2.0) 0.051 Lesion branch, n (%) LM 27 (9.9) 13 (9.5) 0.897 LAD 230 (84.2) 123 (89.8) 0.127 LCX 130 (47.6) 70 (51.1) 0.507 RCA 171 (62.6) 82 (59.9) 0.584 Three-vessel or LM 90 (33.0) 49 (35.8) 0.572 Gensini score, M (Q1, Q3) 52.00 (37.00, 80.00) 64.00 (45.00, 89.00) 0.004 IBI: Inflammatory burden index; STEMI: ST-segment elevation myocardial infarction; BMI: Body mass index; ACEI/ARB: Angiotensin converting enzyme inhibitor/angiotensin Ⅱ receptor blocker; CCB: Calcium channel blocker; LDL-C: Low density lipoprotein-cholesterol; HDL-C: High density lipoprotein-cholesterol; LVEF: Left ventricular ejection fraction; PCI: Percutaneous coronary intervention; LM: Left main coronary artery; LAD: Left anterior descending coronary artery; LCX: Left circumflex coronary artery; RCA: Right coronary artery. 表 5 不同IBI组STEMI患者住院期间发生MACE的统计结果
Table 5 MACE outcomes of STEMI patients during hospitalization in high- and low-IBI groups
n (%) Outcome All patients N＝465 IBI＜102.33 mg·L－1 N＝335 IBI≥102.33 mg·L－1 N＝130 P value MACE 164 (35.3) 81 (24.2) 83 (63.8) ＜0.001 Cardiovascular death 21 (4.5) 6 (1.8) 15 (11.5) ＜0.001 New-onset nonfatal myocardial 1 (0.2) 0 1 (0.8) 0.280 Acute heart failure 134 (28.8) 65 (19.4) 69 (53.1) ＜0.001 Malignant arrhythmias 40 (8.6) 19 (5.7) 21 (16.2) ＜0.001 New-onset atrial fibrillation 29 (6.2) 15 (4.5) 14 (10.8) 0.012 IBI: Inflammatory burden index; STEMI: ST-segment elevation myocardial infarction; MACE: Major adverse cardiovascular event. 表 6 不同IBI组STEMI患者长期随访期间发生MACE的统计结果
Table 6 MACE outcomes of STEMI patients during long-term follow-up period in high- and low-IBI groups
n (%) Outcome All patients N＝410 IBI＜55.88 mg·L－1 N＝273 IBI≥55.88 mg·L－1 N＝137 P value MACE 77 (18.8) 34 (12.5) 43 (31.4) ＜0.001 Cardiovascular death 2 (0.5) 1 (0.4) 0 0.479 New-onset nonfatal myocardial 8 (2.0) 3 (1.1) 4 (3.0) 0.178 Revascularization in unstable angina 42 (10.2) 22 (8.2) 20 (14.9) 0.038 Malignant arrhythmias 4 (1.0) 2 (0.7) 2 (1.5) 0.477 Acute heart failure 29 (7.1) 8 (3.0) 20 (14.9) ＜0.001 IBI: Inflammatory burden index; STEMI: ST-segment elevation myocardial infarction; MACE: Major adverse cardiovascular event. 表 7 STEMI患者PCI术后住院期间发生MACE预测因素的logistic回归分析
Table 7 Logistic regression analysis of predictive factors for MACE in STEMI patients during hospitalization after PCI
Variable Univariate analysis Multivariate analysis P value OR (95%CI) P value OR (95%CI) Age ＜0.001 1.064 (1.046, 1.082) 0.023 1.030 (1.005, 1.060) Diabetes mellitus ＜0.001 2.253 (1.499, 3.394) 0.503 1.260 (0.640, 2.429) Killip class≥Ⅱ ＜0.001 28.560 (16.180, 53.360) ＜0.001 14.870 (7.180, 32.770) Neutrophil 0.007 1.073 (1.020, 1.130) 0.822 0.990 (0.900, 1.088) Lymphocyte 0.306 0.927 (0.797, 1.069) C reactive protein ＜0.001 1.013 (1.008, 1.069) 0.024 0.990 (0.974, 0.998) Albumin ＜0.001 0.884 (0.840, 0.929) 0.221 0.950 (0.878, 1.029) Serum creatinine ＜0.001 1.031 (1.021, 1.041) ＜0.001 1.020 (1.011, 1.037) LDL-C 0.317 0.890 (0.706, 1.005) Triglyceride 0.419 1.049 (0.931, 1.186) Peak troponin Ⅰ 0.049 1.008 (1.000, 1.015) 0.724 1.000 (0.989, 1.015) Myoglobin 0.001 1.001 (1.000, 1.001) 0.130 1.000 (0.999, 1.001) D-dimer ＜0.001 5.229 (3.191, 9.210) 0.005 2.140 (1.286, 3.736) Fibrinogen 0.011 1.209 (1.052, 1.407) 0.278 0.890 (0.693, 1.078) IBI≥102.33 mg·L－1 ＜0.001 5.538 (3.597, 8.623) ＜0.001 10.900 (4.273, 29.180) LVEF ＜0.001 0.854 (0.819, 0.888) 0.004 0.930 (0.883, 0.977) LM lesion 0.003 2.512 (1.368, 4.665) 0.069 2.550 (0.930, 7.030) LAD lesion 0.001 3.216 (1.654, 6.885) 0.342 1.670 (0.602, 5.104) Three-vessel or LM lesion ＜0.001 2.231 (1.504, 3.317) 0.639 0.830 (0.387, 1.762) Gensini score ＜0.001 1.023 (1.015, 1.030) 0.189 1.010 (0.996, 1.021) STEMI: ST-segment elevation myocardial infarction; PCI: Percutaneous coronary intervention; MACE: Major adverse cardiovascular event; LDL-C: Low density lipoprotein-cholesterol; IBI: Inflammatory burden index; LVEF: Left ventricular ejection fraction; LM: Left main coronary artery; LAD: Left anterior descending coronary artery; OR: Odds ratio; 95%CI: 95% confidence interval. 表 8 STEMI患者PCI术后长期随访期间发生MACE预测因素的Cox回归分析
Table 8 Cox regression analysis of predictive factors for MACE in STEMI patients during long-term follow-up period after PCI
Variable Univariate analysis Multivariate analysis P value HR (95%CI) P value HR (95%CI) Age ＜0.001 1.032 (1.014, 1.051) 0.176 1.014 (0.994, 1.035) Killip class≥Ⅱ ＜0.001 3.506 (2.222, 5.534) 0.009 2.035 (1.196, 3.463) C reactive protein ＜0.001 1.007 (1.003, 1.012) 0.887 1.000 (0.993, 1.008) Albumin ＜0.001 0.889 (0.839, 0.942) 0.140 0.955 (0.897, 1.015) Fibrinogen 0.006 1.292 (1.077, 1.550) 0.441 1.100 (0.863, 1.404) IBI≥55.88 mg·L－1 ＜0.001 2.740 (1.743, 4.308) 0.018 1.989 (1.128, 3.506) LVEF ＜0.001 0.950 (0.924, 0.976) 0.297 0.981 (0.945, 1.017) Number of PCI implanted stents 0.036 1.381 (1.021, 1.870) 0.237 1.213 (0.881, 1.671) LCX lesion 0.027 1.673 (1.061, 2.638) 0.904 1.045 (0.514, 2.124) RCA lesion ＜0.001 3.349 (1.844, 6.080) 0.005 2.642 (1.335, 5.225) Three-vessel or LM lesion ＜0.001 2.465 (1.575, 3.858) 0.603 1.229 (0.565, 2.675) Gensini score 0.005 1.011 (1.003, 1.019) 0.457 1.003 (0.994, 1.013) STEMI: ST-segment elevation myocardial infarction; PCI: Percutaneous coronary intervention; MACE: Major adverse cardiovascular event; IBI: Inflammatory burden index; LVEF: Left ventricular ejection fraction; LCX: Left circumflex coronary artery; RCA: Right coronary artery; LM: Left main coronary artery; HR: Hazard ratio; 95%CI: 95% confidence interval. -
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