南方医科大学学报

南方医科大学学报 ›› 2026, Vol. 46 ›› Issue (10): 2405-2414.doi: 10.12122/j.issn.1673-4254.2026.10.10

• • 上一篇    

基于心肌整体纵向应变和外周血中性粒细胞与淋巴细胞比值精准预测首发急性心肌梗死患者经皮冠状动脉介入治疗术后发生主要不良心血管事件风险：一项单中心前瞻性队列研究

何梦茹1(), 金串1, 余亦璇3, 王静娴1, 童旭1, 陈沐岩3, 宋宏伟2, 王颖2, 周莉2, 王钧1, 王洪巨1, 李妙男1()   

  1. 1.蚌埠医科大学第一附属医院，心血管内科，安徽 蚌埠 233004
    2.蚌埠医科大学第一附属医院，放射科，安徽 蚌埠 233004
    3.蚌埠医科大学第一临床医学院，安徽 蚌埠 233030
  • 收稿日期:2026-03-20 出版日期:2026-10-20 发布日期:2026-10-26
  • 通讯作者: 李妙男 E-mail:3021997475@qq.com;13855265385@163.com
  • 作者简介:何梦茹，在读硕士研究生，E-mail: 3021997475@qq.com
  • 基金资助:
    安徽省临床医学研究转化专项(202304295107020086);安徽省教育厅自然科学研究重点项目(2022AH051477);蚌埠医学院第一附属医院2022年度高新技术(2022050)

Myocardium global longitudinal strain and peripheral blood neutrophil-to-lymphocyte ratio for predicting MACE risks following percutaneous coronary intervention for first-time acute myocardial infarction: a prospective cohort study

Mengru HE1(), Chuan JIN1, Yixuan YU3, Jingxian WANG1, Xu TONG1, Muyan CHEN3, Hongwei SONG2, Ying WANG2, Li ZHOU2, Jun WANG1, Hongju WANG1, Miaonan LI1()   

  1. 1.Department of Cardiology, Bengbu Medical University, Bengbu 233030, China
    2.Department of Radiology, First Affiliated Hospital of Bengbu Medical University, Bengbu 233004, China, Bengbu Medical University, Bengbu 233030, China
    3.First Clinical Medical College, Bengbu Medical University, Bengbu 233030, China
  • Received:2026-03-20 Online:2026-10-20 Published:2026-10-26
  • Contact: Miaonan LI E-mail:3021997475@qq.com;13855265385@163.com

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摘要：

目的 探讨心脏磁共振（CMR）指标心肌整体纵向应变（GLS）与外周血炎症指标中性粒细胞/淋巴细胞比值（NLR）联合对首发急性心肌梗死（AMI）患者经皮冠状动脉介入治疗（PCI）术后发生主要不良心血管事件（MACEs）的预测价值。 方法 本研究为一项单中心、前瞻性队列研究。纳入2022年6月~2025年7月于蚌埠医学院第一附属医院首次确诊为AMI的患者134例，其中男性99例，女性35例，年龄33~83（60.19±11.7）岁，出院后对其进行中位时间为538 d的门诊或电话随访，根据是否发生MACEs分为2组：非MACEs组（n=103），MACEs组（n=31）。 结果 基线资料显示MACEs组患者年龄、白细胞计数、中性粒细胞计数、NLR、PLR、NT-pro BNP明显高于非MACEs组（P<0.05），单核细胞计数明显低于非MACEs组（P<0.05）。MACEs组患者Gensini评分、前壁心肌梗死的发生率及左前降支（LAD）作为罪犯血管的比例显著高于非MACEs组（P<0.05），右冠状动脉（RCA）作为罪犯血管的比例及胸痛TIMI低危比例明显低于非MACEs组（P<0.05）。CMR结果分析表明，MACEs组患者的LGE、左室收缩末期容积指数、矛盾运动及室壁瘤发生率均显著高于非MACEs组（P<0.05），而左室射血分数、梗死节段径向、周向、纵向及整体径向、周向、纵向的应变值均显著低于非MACEs组（P<0.05）。多因素Logistic回归结果显示NLR、GLS是MACEs的独立预测因素（P<0.05）。受试者工作特征（ROC）曲线分析结果显示GLS及NLR对首发AMI患者PCI术后是否发生MACEs有一定预测能力，曲线下面积（AUC）分别为0.825、0.820；二者联合的AUC为0.921，高于单一指标（P<0.05）。 结论 心脏磁共振GLS与外周血NLR均与首发AMI患者PCI术后预后密切相关，二者联合应用能够更好地预测首发AMI患者的预后。

关键词: 急性心肌梗死, 心脏磁共振, 整体纵向应变, 中性粒细胞/淋巴细胞, 主要不良心血管事件

Abstract:

Objective To investigate the combined predictive value of cardiac magnetic resonance (CMR)‑derived global longitudinal strain (GLS) and peripheral blood neutrophil-to-lymphocyte ratio (NLR) for major adverse cardiovascular events (MACEs) following percutaneous coronary intervention (PCI) in patients with first-time acute myocardial infarction (AMI). Methods In this single-center prospective cohort study, 134 patients with first-time AMI (99 male and 35 female patients aged 33-83 years, mean 60.19±11.7 years) were enrolled between June, 2022 and July, 2025. All the patients underwent PCI and were followed up via outpatient visits or telephone for a median of 538 days post-discharge. The patients were divided into non-MACEs (n=103) and MACEs groups (n=31) for comparison of baseline clinical parameters. Results Baseline comparisons revealed that the MACEs group had a significantly older age, higher white blood cell count, neutrophil count, NLR, platelet-to-lymphocyte ratio, and NT-proBNP, and lower monocyte counts (all P<0.05) with had higher Gensini scores and incidences of anterior wall infarction, more frequent left anterior descending artery culprit lesions, but fewer right coronary artery lesions and lower rates of TIMI low-risk chest pain (P<0.05). In patients with MACEs, CMR findings revealed significantly higher frequencies of late gadolinium enhancement, end-systolic volume index, paradoxical motion, and aneurysmal wall formation, decreased left ventricular ejection fraction, and reduced infarct-segment and global radial, circumferential, and longitudinal strains (P<0.05). Multivariate logistic regression identified NLR and GLS as independent predictors for MACEs. ROC curve analysis demonstrated that both GLS (AUC=0.825) and NLR (AUC=0.820) alone had predictive ability for MACEs, but their combination significantly increased the AUC to 0.921 (P<0.05). Conclusion CMR-derived GLS and peripheral blood NLR are both strongly associated with post-PCI prognosis in first-time AMI patients, and their combination allows more accurate prediction of MACEs to facilitate effective early risk stratification and clinical decision-making.

Key words: acute myocardial infarction, cardiac magnetic resonance imaging, global longitudinal strain, neutrophil-to-lymphocyte ratio, major adverse cardiovascular events