The predictive effect of systemic inflammatory index on adverse cardiovascular events in stable angina pectoris patients with hemodynamic disturbances
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摘要: 目的 探究系统免疫炎症指数(SII)对血流动力学紊乱的稳定型心绞痛患者主要不良心血管事件(MACE)的预测作用。方法 连续入选2018年6月—2020年12月因稳定型心绞痛就诊于新疆医科大学第一附属医院心脏中心行血流储备分数(FFR)检查的215例患者，收集患者临床信息及入院检查结果，根据血常规检查计算SII。根据随访期间是否发生MACE，将患者分为MACE组(44例)和非MACE组(171例)。根据SII中位数(434)，将患者分为低SII组(108例)和高SII组(107例)。采用Cox回归分析评估SII对血流动力学紊乱的稳定型心绞痛患者预后的影响。采用Kaplan-Meier法绘制生存曲线，运用log-rank检验比较不同SII水平患者的生存率。结果 与非MACE组比较，MACE组患者SII水平显著升高[393.66(286.42，602.08) vs 473.80(301.40，941.98)，P=0.037]。多因素Cox回归分析显示，SII与血流紊乱稳定型心绞痛患者MACE独立相关(HR=1.001，95%CI：1.000~1.002，P=0.002)。Kaplan-Meier生存分析表明，高SII组患者生存率明显降低(P=0.04)。结论 SII是血流动力学紊乱的稳定型心绞痛患者MACE的独立预测因子。Abstract: Objective To explore the predictive effect of systemic immune inflammatory index(SII) on major adverse cardiovascular events(MACE) in stable angina pectoris patients with hemodynamic disturbances.Methods A total of 215 patients who underwent fractional flow reserve(FFR) examination due to stable angina pectoris at the Heart Center of the First Affiliated Hospital of Xinjiang Medical University from June 2018 to December 2020 were selected consecutively. Clinical information and admission examination results were collected, and SII was calculated based on blood routine examination. Patients were divided into the MACE group(n=44) and non-MACE group(n=171) according to whether MACE occurred during the follow-up period. According to the median SII(434), patients were divided into the low-SII group(n=108) and high-SII group(n=107). Cox regression analysis was used to evaluate the effect of SII on the prognosis of stable angina patients with hemodynamic disturbances. Kaplan Meier method was used to plot survival curves, and log-rank analysis was used to compare the differences in the survival rate among patients with different SII levels.Results Compared with the non-MACE group, patients in the MACE group had significantly higher levels of SII[393.66(286.42, 602.08) vs 473.80(301.40, 941.98), P=0.037]. Multivariate Cox regression analysis showed that SII was independently associated with MACE in stable angina pectoris patients with hemodynamic disturbances(HR=1.001, 95%CI: 1.000-1.002, P=0.002). Kaplan-Meier survival analysis showed that the high-SII group had significantly lower survival rate(P=0.04).Conclusion SII is an independent predictor of MACE in stable angina pectoris patients with hemodynamic disturbances.
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表 1 非MACE组和MACE组基线特征比较
Table 1. Comparison of baseline characteristics between the MACE and non-MACE groups
例(%), X ± S, M(P25, P75) 项目 非MACE组(171例) MACE组(44例) P 年龄/岁 59±9 59±10 0.955 男性 132(77.2) 34(77.3) 0.991 吸烟 99(57.9) 24(54.5) 0.689 糖尿病 45(26.3) 13(25.9) 0.667 高血压 115(67.3) 28(63.6) 0.650 PCI史 47(27.5) 14(31.8) 0.570 LVEF/% 62±5 62±4 0.564 血红蛋白/(g/L) 142.63±13.38 147.00±13.62 0.015 尿酸/(μmol/L) 333.40±90.58 329.26±90.70 0.781 白蛋白/(g/L) 41.60±3.90 42.70±5.14 0.110 BMI/(kg/m2) 26.55±3.32 25.18±3.51 0.013 血小板/(×109/L) 220.95±50.41 227.10±58.14 0.473 血糖/(mmol/L) 5.28(4.65，6.61) 5.38(4.42，6.93) 0.985 白细胞/(×109/L) 6.72(5.75，8.11) 6.68(5.87，8.02) 0.641 甘油三酯/(mmol/L) 1.60(1.10，2.40) 1.43(0.89，2.01) 0.072 TC/(mmol/L) 3.45(2.85，4.29) 2.98(2.59，3.51) 0.012 HDL-C/(mmol/L) 0.99(0.84，1.18) 0.95(0.81，1.14) 0.206 LDL-C/(mmol/L) 1.98(1.63，2.74) 1.79(1.44，2.24) 0.030 中性粒细胞/(×109/L) 3.81(2.99，4.98) 4.07(3.39，5.67) 0.126 淋巴细胞/(×109/L) 1.99(1.59，2.52) 1.75(1.41，2.21) 0.053 Gensini评分 16(12，25) 12(16，24) 0.671 FFR/% 0.74±0.06 0.72±0.05 0.257 SII 393.66(286.42，602.08) 473.80(301.40，941.98) 0.037 
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表 2 低SII组和高SII组基线特征比较
Table 2. Comparison of baseline characteristics between the low and high SII groups
例(%), X ± S, M(P25, P75) 项目 低SII组(108例) 高SII组(107例) P 年龄/岁 59±10 59±10 0.969 男性 80(74.1) 86(80.4) 0.271 吸烟 58(53.7) 65(60.7) 0.297 糖尿病 27(25.0) 31(29.0) 0.512 高血压 64(59.3) 79(73.8) 0.024 PCI史 58(53.7) 54(50.5) 0.635 LVEF/% 62±4 62±5 0.446 血红蛋白/(g/L) 142.28±13.44 144.62±13.83 0.202 尿酸/(μmol/L) 337.53±92.05 328.49±88.71 0.541 白蛋白/(g/L) 41.99±4.71 41.61±3.69 0.886 BMI/(kg/m2) 26.17±3.32 26.31±3.50 0.590 血小板/(×109/L) 201.63±40.99 243.12±54.75 < 0.001 血糖/(mmol/L) 5.11(4.55，6.60) 5.41(4.68，6.61) 0.282 白细胞/(×109/L) 6.21(5.48，7.28) 7.58(6.08，8.76) < 0.001 甘油三酯/(mmol/L) 1.52(1.01，2.20) 1.57(1.11，2.24) 0.539 TC/(mmol/L) 3.22(2.66，4.32) 3.37(2.86，4.04) 0.518 HDL-C/(mmol/L) 1.00(0.85，1.19) 0.96(0.82，1.16) 0.212 LDL-C/(mmol/L) 1.19(1.49，2.72) 1.98(1.63，2.49) 0.628 中性粒细胞/(×109/L) 3.28(2.70，3.85) 4.99(4.02，6.21) < 0.001 淋巴细胞/(×109/L) 2.19(1.86，2.69) 1.73(1.33，2.09) < 0.001 Gensini评分 16(11，24) 16(12，23) 0.667 FFR/% 73±6 74±6 0.661 SII 296.31(240.92，345.80) 652.97(516.75，940.01) < 0.001
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表 3 单因素及多因素Cox回归分析
Table 3. Univariate and multivariate Cox regression analysis
变量 单因素 多因素 HR(95%CI) P HR(95%CI) P BMI 0.881(0.800~0.971) 0.010 0.910(0.825~1.004) 0.059 甘油三酯 0.741(0.539~1.020) 0.066 LDL-C 0.664(0.444~0.994) 0.047 0.639(0.418~0.978 0.039 FFR 0.081(0.001~6.832) 0.267 SII 1.003(1.002~1.006) 0.001 1.001(1.000~1.002) 0.002
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