Abstract: Background　Monocyte to lymphocyte ratio（MLR），mean platelet volume to lymphocyte ratio（MPVLR），neutrophil to lymphocyte ratio（NLR） are all new markers of inflammatory response，which are related to the adverse outcomes in patients with acute ST segment elevation myocardial infarction（STEMI）.However，few studies at home and abroad have been found to explore the relationship between these hematological parameters，and the clinical value of the combination of them in predicting the prognosis of acute STEMI patients.Objective　To investigate the clinical value of hematological parameters in predicting major adverse cardiovascular events（MACE） after percutaneous coronary intervention（PCI） in patients with acute STEMI.Methods　A total of 524 patients who were diagnosed with acute STEMI and who underwent emergency PCI for the first time at the First Affiliated Hospital，School of Medicine，Shihezi University from August 2017 to February 2019 were enrolled.They were divided into MACE group and non-MACE group according to whether MACE occurred during the follow-up period.Baseline characteristics were collected，including age，proportions of males，smokers，diabetes，hypertension，and hyperlipidemia，Killip class of post-admission acute myocardial infarction-induced heart failure，admission GRACE score，pre-PCI clinical indicators〔fasting blood glucose，creatine kinase isoenzyme（CK-MB） peak，peak troponin T（TnT），total cholesterol，triacylglycerol，low-density lipoprotein，high-density lipoprotein，left ventricular ejection fraction，C-reactive protein（CRP），N-terminal brain natriuretic peptide precursor（NT-proBNP），white blood cell count，neutrophil count，lymphocyte count，hemoglobin，platelet count，monocyte count，MPV，MLR，MPVLR，NLR，red blood cell distribution width，platelet distribution width〕and culprit vessels detected by coronary angiography，number of stents，time from symptom onset to PCI，no-reflow prevalence，and medical treatment.Cox regression analysis was used to investigate the influencing factors of MACE in STEMI patients after PCI.The receiver operating characteristic curve was plotted to evaluate the predictive value of MLR，MPVLR and NLR，alone and in double-combination forms，for MACE after PCI in patients with acute STEMI.Results　In this study，a total of 56 patients developed MACE during the follow-up period，including 23 cases of cardiogenic or all-cause death，15 cases of heart failure，7 cases of recurrent angina pectoris，5 cases of malignant arrhythmia，4 cases of recurrent myocardial infarction and 2 cases of stroke.Compared to those without MACE，MACE patients had greater mean age，higher mean admission GRACE score，peak TnT，CRP，NT-proBNP，neutrophil count，monocyte count，MPV，MLR，MPVLR，and NLR，and also a higher proportion of admission Killip class ≥Ⅱ.Moreover，MACE patients had lower levels of lymphocyte count as well as LVEF（P<0.05）.And they had a higher no-reflow prevalence（P<0.05）.Multivariate Cox regression analysis showed that lymphocyte count〔HR=0.884，95%CI（0.817，0.966），P<0.001〕，monocyte count〔HR=1.169，95%CI（1.104，1.463），P=0.009〕，MPV〔HR=1.333，95%CI（1.005，1.752），P=0.039〕，MLR〔HR=1.701，95%CI（1.332，2.172），P<0.001〕，MPVLR〔HR=1.372，95%CI（1.196，1.443），P<0.001〕and NLR〔HR=1.428，95%CI（1.037，1.576），P=0.015〕were the influencing factors of MACE in acute STEMI patients after PCI.MLR was positively correlated with NLR（rs=0.195，P<0.001） and MPVLR（rs=0.210，P<0.001）.NLR was positively correlated with MPVLR（rs=0.483，P<0.001）.MLR+NLR，MLR+MPVLR，or NLR+MPVLR was better than MLR，NLR，or MPVLR in predicting MACE after PCI in acute STEMI patients（P<0.05）.Conclusion　Hematological parameters such as MLR，MPVLR，and NLR shortly after admission are related to the prognosis of acute STEMI patients.And combined application of these hematological parameters can more effectively identify high-risk patients and predict the occurrence of MACE.

Key words: Myocardial infarction, Hematological parameters, Percutaneous coronary intervention, Adverse cardiovascular events, Prognosis

摘要： 背景　单核细胞与淋巴细胞比值（MLR）、平均血小板体积与淋巴细胞比值（MPVLR）、中性粒细胞与淋巴细胞比值（NLR）均为新型的炎性反应标志物，与急性ST段抬高型心肌梗死（STEMI）患者的不良结局相关，但目前国内外鲜有研究探讨这些血液学参数之间的相互联系以及其组合在预测急性STEMI患者预后方面的临床价值。目的　探讨血液学参数预测急性STEMI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（MACE）的临床价值。方法　选取2017年8月—2019年2月于石河子大学医学院第一附属医院明确诊断为急性STEMI并首次行急诊PCI的患者524例为研究对象，按照随访期间是否发生MACE分为MACE组和非MACE组。收集患者基线资料，包括年龄、男性比例、吸烟比例、糖尿病比例、高血压比例、高脂血症比例、入院时急性心肌梗死引起的心力衰竭（Killip）分级、入院时全球急性冠脉综合征注册（GRACE）评分，PCI术前临床指标〔空腹血糖（GLU）、肌酸激酶同工酶（CK-MB）峰值、肌钙蛋白T（TnT）峰值、总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）、左心室射血分数（LVEF）、C反应蛋白（CRP）、N末端脑钠肽前体（NT-proBNP）、白细胞计数、中性粒细胞计数、淋巴细胞计数、血红蛋白、血小板计数、单核细胞计数、平均血小板体积（MPV）、MLR、MPVLR、NLR、红细胞分布宽度、血小板分布宽度〕以及冠状动脉造影罪犯血管，支架植入数目，发生症状到PCI时间，无复流发生率，药物治疗情况。应用Cox回归分析探讨急性STEMI患者PCI术后发生MACE的影响因素，并绘制受试者工作特征（ROC）曲线评估MLR、MPVLR、NLR及其组合对急性STEMI患者PCI术后发生MACE的预测价值。结果　本研究共56例患者在随访期间发生MACE，其中心源性或全因死亡23例、急性心力衰竭15例、复发心绞痛7例、恶性心律失常5例、再发心肌梗死4例、卒中2例。MACE组患者年龄、入院时Killip分级≥Ⅱ级的比例、入院时GRACE评分、TnT峰值、CRP、NT-proBNP、中性粒细胞计数、单核细胞计数、MPV、MLR、MPVLR、NLR均高于非MACE组患者，LVEF、淋巴细胞计数低于非MACE组患者（P<0.05）。MACE组无复流发生率高于非MACE组（P<0.05）。多因素Cox回归分析结果显示，淋巴细胞计数〔HR=0.884，95%CI（0.817，0.966），P<0.001〕、单核细胞计数〔HR=1.169，95%CI（1.104，1.463），P=0.009〕、MPV〔HR=1.333，95%CI（1.005，1.752），P=0.039〕、MLR〔HR=1.701，95%CI（1.332，2.172），P<0.001〕、MPVLR〔HR=1.372，95%CI（1.196，1.443），P<0.001〕、NLR〔HR=1.428，95%CI（1.037，1.576），P=0.015〕均是急性STEMI患者PCI术后发生MACE的影响因素。MLR与NLR（rs=0.195，P<0.001）、MPVLR（rs=0.210，P<0.001）呈正相关，NLR与MPVLR呈正相关（rs=0.483，P<0.001）。MLR+NLR、MLR+MPVLR、NLR+MPVLR对急性STEMI患者PCI术后发生MACE预测效能优于MLR、NLR、MPVLR（P<0.05）。结论　入院早期MLR、MPVLR、NLR等血液学参数与急性STEMI患者预后相关，且血液学参数之间的联合应用能够更加高效地识别高危患者以及预测MACE的发生。

关键词: 心肌梗死, 血液学参数, 经皮冠状动脉介入治疗, 不良心血管事件, 预后