炎症负担指数对急性心肌梗死患者PCI术后 左心室重构的预测价值

Predictive Value of Inflammatory Burden Index for Left Ventricular Remodeling in Patients with Acute Myocardial Infarction after PCI

摘要: 目的：探讨炎症负荷指数(IBI)对急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)术后左心室重构(LVR)的预测价值，并与传统炎症及肝功能指标进行比较。方法：回顾性纳入319例STEMI患者，根据PCI术后6个月及12个月心脏超声结果分为左心室重构组(n = 136)与非重构组(n = 183)。收集患者临床资料及实验室指标，计算炎症负荷指数(IBI)，公式为：IBI = (CRP × 中性粒细胞计数)/淋巴细胞计数。采用单因素及多因素Logistic回归分析LVR的独立危险因素，并通过受试者工作特征(ROC)曲线评估各指标的预测效能。结果：左心室重构组IBI、C反应蛋白、肌酸激酶同工酶、谷丙转氨酶、谷草转氨酶水平显著高于非重构组(P < 0.05)。多因素Logistic回归分析显示，IBI (OR = 1.012, 95% CI: 1.000~1.024, P = 0.04)和谷丙转氨酶(OR = 1.011, 95% CI: 1.004~1.019, P < 0.01)是LVR的独立危险因素。ROC曲线分析表明，IBI的AUC为0.752，谷丙转氨酶的AUC为0.651，二者联合的AUC为0.750。当IBI最佳截断值取10.156时，预测LVR的敏感度为73.5%，特异度为63.4%，Youden指数为0.369。结论：炎症负荷指数是STEMI患者PCI术后左心室重构的独立预测因子，其预测效能优于传统单一炎症指标，与谷丙转氨酶联用未能进一步提高预测能力。当IBI > 10.156时，患者发生左心室重构的风险显著增加。IBI作为一种简便、易得的复合指标，可用于早期识别高危患者。

Abstract: Objective: To investigate the predictive value of the Inflammatory Burden Index (IBI) for left ventricular remodeling (LVR) in patients with acute ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI), and to compare its predictive performance with traditional inflammatory and liver function markers. Methods: A total of 319 STEMI patients were retrospectively enrolled and divided into the LVR group (n = 136) and non-LVR group (n = 183) based on echocardiographic findings at 6 and 12 months after PCI. Clinical data and laboratory indicators were collected. The IBI was calculated using the formula: IBI = (CRP × neutrophil count)/lymphocyte count. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for LVR. The predictive performance of each indicator was assessed using receiver operating characteristic (ROC) curves. Results: The levels of IBI, C-reactive protein (CRP), creatine kinase-MB (CK-MB), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were significantly higher in the LVR group than in the non-LVR group (all P < 0.05). Multivariate logistic regression analysis showed that IBI (OR = 1.012, 95% CI: 1.000~1.024, P = 0.04) and ALT (OR = 1.011, 95% CI: 1.004~1.019, P < 0.01) were independent risk factors for LVR. ROC curve analysis revealed that the area under the curve (AUC) of IBI was 0.752, that of ALT was 0.651, and that of their combination was 0.750. When the optimal cut-off value of IBI was set at 10.156, the sensitivity and specificity for predicting LVR were 73.5% and 63.4%, respectively, with a Youden index of 0.369. Conclusion: The Inflammatory Burden Index is an independent predictor of left ventricular remodeling in STEMI patients after PCI, with better predictive performance than traditional single inflammatory markers. Combining IBI with ALT did not further improve predictive ability. When IBI exceeds 10.156, the risk of LVR increases significantly. As a simple and easily accessible composite indicator, IBI can be used for early identification of high-risk patients.