中文摘要：

目的：探讨循环单核细胞亚群联合肾功能对急性ST段抬高心肌梗死（ST segment elevation myocardial infarction,STEMI）患者预后危险分层的评估。方法：入选发病后接受急诊冠状动脉介入治疗（percutaneous coronary intervention,PCI）的初次STEMI患者。于入院第2天抽取患者外周血进行单核细胞亚群[经典型（CD14^＋＋CD16^-,Mon1）、中间型（CD14^＋＋CD16^＋,Mon2）和非经典型（CD14＋CD16^＋＋,Mon3）]流式细胞术分析。随访患者3年内主要不良心血管事件（major adverse cardiovascular events,MACE）的发生情况。采用COX比例风险模型分析循环单核细胞亚群水平及肾功能与MACE的关系。根据循环单核细胞亚群及肾功能不全的最佳截断值对STEMI患者进行危险分层,采用Kaplan-Meier生存分析法比较各危险分层的无事件生存率。结果：3年随访221例患者中有50例发生MACE（MACE组）。与非MACE组患者相比,MACE组患者年龄更大、Mon2计数水平更高,差异具有统计学意义（P=0.009和P〈0.001）;估测肾小球滤过率（estimated glomerular filtration rate,eGFR）、左心室射血分数值更低（P=0.01和P〈0.001）。多变量COX回归分析显示,校正了传统危险因素后,Mon2〉32.1cells/μl（HR2.33,95%CI 1.24~4.38,P=0.008）、eGFR〈60 ml·min~（-1）·1.73m~（-2）（HR2.43,95%CI1.01~5.85,P=0.048）是STEMI患者发生MACE的独立危险因素。以eGFR的临界值60ml·min~（-1）·1.73m~（-2）、Mon2的最佳截断值32.1cells/μl对STEMI患者进行为危险分层,相对于低危组,中危组患者发生MACE的风险增加了2.00倍（95%CI 1.65~5.30,P〈0.001）,高危组患者发生MACE的风险增加了3.37倍（95%CI2.44~11.5,P〈0.01）。Kaplan-Meier生存分析结果同上述一致。结论：循环单核细胞Mon2联合eGFR能够预测STEMI患者3年内MACE的发生,具有潜在临床应用价值。

英文摘要：

peripheral blood was collected on day 2of STEMI onset for flow cytometry（FCM）analysis of circulation monocyte subsets[classical CD14^＋＋CD16^-（Mon1）,intermediate CD14^＋＋CD16^＋（Mon2）,and nonclassical CD14＋CD16^＋＋（Mon3）].Major adverse cardiac events（MACE）were followed for 3years. Cumulative survival rates stratified by monocyte subset count and renal function categories were estimated using Kaplan-Meier survival analysis and Cox proportional hazards regression model.Result：During a median follow-up of three years,among 211 STEMI cases recruited,50 first MACE were recorded.Compared with patients without MACE,the patients with MACE were older,more likely to have high Mon2 monocyte count（P=0.09 and P〈0.001）,and along with lower eGFR and left ventricular ejection fraction（LVEF）（P=0.01 and P〈0.001）.After adjustment of conventional risk factors,Mon2 monocyte count and renal insufficiency remained to be the independent predictive factor of MACE：HR2.33,95%CI 1.24-4.38,P=0.008 and HR2.43,95%CI1.01-5.85,P=0.048,respectively.According to stratification of Mon2 monocyte count in combination with renal insufficiency,the patients were divided into low-,intermediate-,and high-risk groups.Compared with the low-risk group,the risk of MACE increased 2.00times（95%CI 1.65-5.30,P〈0.001）in the patients of intermediate-risk group,and the risk increased 4.37times（95%CI2.44-11.48,P〈0.01）in the patients of high-risk group.Kaplan-Meier Survival Analysis supports the above results.Conclusion：Mon2monocyte and renal insufficiency are independent risk factors for predictor of MACE,which has potential clinical value.