Efficacy and significance of heart rate variability combined with neutrophil count in predicting acute myocardial infarction in patients with stable coronary heart disease
Efficacy and significance of heart rate variability combined with neutrophil count in predicting acute myocardial infarction in patients with stable coronary heart disease
王平正 1张雨 1王淑萍2
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作者信息
1. 266300 山东省青岛市,青岛市胶州中心医院院感科
2. 266300 山东省青岛市,青岛市胶州中心医院心血管内一科
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摘要
目的 探究心率变异性(HRV)联合中性粒细胞计数(NEUT)预测稳定型冠心病(SCAD)患者发生急性心肌梗死(AMI)效能及意义.方法 选取2020年1月至2022年1月青岛市胶州中心医院收治的SCAD患者168例,对所有患者进行所有患者进行了 24 h Holter监测,获取HRV指标,包括时域指标:标准差(SDNN)、平均RR间期的标准差(rMSSD)和频域指标:低频(LF)、高频(HF),同时采集静脉血样本以计算NEUT.并对患者进行为期2年的随访,根据患者是否发生AMI,分为发生组(53例)和未发生组(115例).比较两组的HRV各项指标以及NEUT指标,采用logistic回归分析各因素与SCAD患者发生AMI的相关性,并绘制受试者特征(ROC)曲线验证其预测价值.结果 与未发生组相比,发生组的SDNN、rMSSD、HF指标均较低,而LF指标则较高,且差异具有统计学意义(P＜0.05).此外,发生组的NEUT指标亦高于未发生组,差异同样具有统计学意义(P＜0.05).经logistic回归分析显示,SDNN升高(OR=1.021,95％CI 1.005～1.037)、rMSSD升高(OR=1.080,95％CI 1.034～1.128)、HF升高(OR=1.016,95％CI 1.004～1.028)是发生 AMI 的危险因素(OR＞1,P＜0.05),LF 升高(OR=0.994,95％CI 0.990～0.999)、NEUT升高(OR=0.536,95％CI 0.429～0.671)是发生AMI保护因素(OR＜1,P＜0.05).经ROC分析,HRV参数指标(SDNN、rMSSD、LF、HF)、NEUT和联合指标的AUC值均＞0.600,说明上述指标对SCAD患者发生AMI具有良好的预测价值.结论 HRV与NEUT都能预测SCAD患者发生AMI,而联合指标的预测价值高于单一因素,为临床提供参考.
Abstract
Objective To explore the efficacy and significance of heart rate variability(HRV)combined with neutrophil count(NEUT)in predicting acute myocardial infarction(AMI)in patients with stable coronary heart disease(SCAD).Methods A total of 168 patients with SCAD admitted to Jiaozhou Central Hospital of Qingdao from January 2020 to January 2022 were selected.24 h Holter monitoring was conducted on all patients to obtain HRV indicators,including time domain indicators including standard deviation(SDNN),standard deviation of mean RR interval(rMSSD)and frequency domain indicator such as low frequency(LF)and high frequency(HF);and the venous blood samples were taken at the same time to calculate NEUT.The patients were followed up for two years and divided into two groups(53 cases)and 115 cases)according to whether AMI occurred.The HRV indexes and NEUT indexes of the two groups were compared.Logistic regression was used to analyze the correlation between each factor and AMI occurrence in SCAD patients,and receiver characteristic(ROC)curve was drawn to verify its predictive value.Results Compared with the non-occurrence group,the SDNN,rMSSD and HF in the occurrence group were lower,while the LF index was higher,and the difference was statistically significant(P＜0.05).In addition,the NEUT index of the occurrence group was also higher than that of the non-occurrence group,and the difference was also statistically significant(P＜0.05).Logistic regression analysis showed that SDNN increasing(OR=1.021,95％CI 1.005-1.037),rMSSD increasing(OR=1.080,95％CI 1.034-1.128)and HF increasing(OR=1.016,95％C1 1.004-1.028)were the resk factors for AMI(OR＞1,P＜0.05).The increase of LF(OR=0.994,95％CI 0.990-0.999)and NEUT(OR=0.536,95％CI 0.429-0.671)were the protective factors for AMI(OR＜1,P＜0.05).According to ROC analysis,the AUC values of HRV parameters(SDNN,rMSSD,LF,HF),NEUT and joint indexes were all above 0.600,which showed that the above indexes had good predictive value for AMI in SCAD patients.Conclusion Both HRV and NEUT can predict AMI in SCAD patients,and the predictive value of the combined index is higher than that of the single factor,which provides reference for clinical practice.
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