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急性心肌梗死(AMI)是由冠状动脉一支或多支发生急性闭塞,从而引起心肌细胞缺血坏死。研究[1-2]显示,约40%AMI病人存在多支血管病变(MVD),合并MVD的AMI病人并发症较多,治疗难度大,且术后恢复效果不好,死亡风险高。病人体内中性粒细胞水平与AMI病人的预后恢复效果有关[3],而淋巴细胞水平与AMI病人冠状动脉病变程度及全因死亡率存在相关性[4],因此中性粒细胞数与淋巴细胞数比值(NLR)目前逐渐成为研究的热点,其作为一种整合的指标,相比单一的指标而言,可以更好地对AMI的发生及病人预后进行预测[5]。然而NLR对AMI合并MVD病人的预后及不良心脑血管事件(MACCE)发生的预测作用鲜见报道。本研究对我院2016年1月至2018年5月收治的AMI合并MVD病人进行2年随访,探讨NLR对AMI合并MVD病人术后全因死亡率及MACCE发生率的影响,为临床上改善和提高AMI合并MVD病人的术后治疗效果提供依据。
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通过ROC曲线得出NLR预测2年全因死亡的截点值为3.65(曲线下面积为0.855,敏感度为81.3%,特异度为88.5%),根据截点值将病人分为高NLR组60例(NLR≥3.65),低NLR组156例(NLR < 3.65)。216例病人2年全因死亡共5例,其中高NLR组全因死亡率6.67%(4/60),高于低NLR组的0.64%(1/156)(χ2=4.55,P < 0.05);高NLR组病人MACCE发生率为21.67%(13/60),与低NLR组的12.82(20/156)比较差异无统计学意义(χ2=2.62,P>0.05)。
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高NLR组病人年龄、高血压患病率、白细胞计数、中性粒细胞计数及高敏C反应蛋白水平均高于低NLR组(P < 0.05~P < 0.01),淋巴细胞计数低于低NLR组(P < 0.01),2组性别、BMI、糖尿病、血脂异常及血红蛋白含量差异均无统计学意义(P>0.05)(见表 1)。
分组 n 年龄/岁 男 女 BMI/(kg/m2) 吸烟 高血压 糖尿病 血脂异常 血红蛋白/(g/L) 白细胞计数/(×109/L) 中性粒细胞计数/(×109/L) 淋巴细胞计数/(×109/L) 高敏C反应蛋白/(mg/L) 否 是 无 有 无 有 无 有 高NLR组 60 61.7±12.5 12 48 26.0±3.9 50 10 22 38 42 18 24 36 138.2±19.3 9.3±4.2 8.5±4.5 1.3±0.7 86.7±55.6 低NLR组 156 57.3±11.6 30 126 25.8±3.2 133 23 81 75 109 47 62 94 135.3±18.1 7.1±3.5 4.3±2.7 2.4±0.5 54.7±49.8 t — 2.14 0.02* 0.39 0.12* 4.04* 0.00* 0.00* 1.04 3.91 8.39 12.88 4.09 P — < 0.05 >0.05 >0.05 >0.05 < 0.05 >0.05 >0.05 >0.05 < 0.01 < 0.01 < 0.01 < 0.01 *示χ2值 表 1 2组病人基线临床资料及实验室指标比较(x±s)
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多因素COX回归分析结果显示,NLR、高血压及中性粒细胞计数为影响AMI合并MVD病人全因死亡的独立危险因素(P < 0.05~P < 0.01),NLR和中性粒细胞计数为影响病人MACCE发生的独立影响因素(P < 0.05和P < 0.01)(见表 2)。
变量 B SE Waldχ2 P HR(95%CI) 全因死亡 NLR 0.750 0.244 9.47 < 0.01 2.116(1.313~3.411) 高血压 0.100 0.005 5.21 < 0.05 1.690(1.110~2.568) 中性粒细胞计数 0.139 0.043 7.67 < 0.05 1.176(1.058~1.240) MACCE发生 NLR 0.565 0.230 4.71 < 0.05 1.610(1.028~2.523) 中心粒细胞计数 0.059 0.019 9.77 < 0.01 1.060(1.022~1.101) 表 2 AMI合并MVD病人2年全因死亡及MACCE发生的多因素Cox回归分析
中性粒细泡/淋巴细胞比值对急性心肌梗死合并多支血管病变病人预后的预测
Prediction of neutrophil to lymphocyte ratio on prognosis of patients with acute myocardial infarction combined with multi-vessel disease
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摘要:
目的探讨中性粒细泡/淋巴细胞比值(NLR)对急性心肌梗死(AMI)合并多支血管病变(MVD)病人预后的预测价值。 方法纳入216例临床资料完整的AMI合并MVD病人,根据ROC曲线确定NLR预测2年全因死亡的截点值,将病人分为高NLR组60例,低NLR组156例,通过Cox回归分析AMI合并MVD病人的NLR对其远期预后的预测作用。 结果ROC曲线结果得出NLR预测2年全因死亡的截点值为3.65。高NLR组病人年龄、高血压患病率、白细胞计数、中性粒细胞计数及高敏C反应蛋白含量均高于低NLR组(P < 0.05~P < 0.01),淋巴细胞计数低于低NLR组(P < 0.01)。多因素COX回归分析结果显示,NLR、高血压及中性粒细胞计数为影响AMI合并MVD病人全因死亡的独立危险因素(P < 0.05~P < 0.01),NLR和中性粒细胞计数为影响病人MACCE发生的独立影响因素(P < 0.05和P < 0.01)。 结论NLR预测2年全因死亡的截点值为3.65,NLR是影响AMI合并MVD病人预后的独立因素。 -
关键词:
- 急性心肌梗死 /
- 多支血管病变 /
- 中性粒细泡/淋巴细胞比值
Abstract:ObjectiveTo analyze the predictive value of neutrophil to lymphocyte ratio(NLR) on prognosis of patients with acute myocardial infarction(AMI) combined multi-vessel disease(MVD). MethodsA total of 216 cases of AMI combined with MVD with complete clinical data were included.Patients were divided into high NLR group(60 cases) and low NLR group(156 cases) according to the optimal cut-off value of admission NLR to predict 2-year all-cause mortality.The predictive effect of NLR on the long-term prognosis of AMI patients combined with MVD was analyzed by Cox regression analysis. ResultsThe results of ROC curve showed that the cut-off point value of 2-year all-cause mortality predicted by NLR was 3.65.Compared with patients in the low NLR group, patients in the high NLR group were older and had a higher incidence of hypertension(P < 0.05), and the white blood cell count, neutrophil count and high sensitivity C reactive protein were higher, and the lymphocyte count was lower(P < 0.01).The results of multivariate Cox risk regression analysis showed that NLR, hypertension and neutrophil count were the independent factors affecting all-cause mortality in AMI patients combined with MVD(P < 0.05 to P < 0.01), and NLR and neutrophil count were independent factors affecting the occurrence of MACCE(P < 0.05 and P < 0.01). ConclusionsThe cut-off point value of NLR predicting 2-year all-cause mortality is 3.65.NLR is an independent factor affecting the prognosis of AMI patients combined with MVD. -
表 1 2组病人基线临床资料及实验室指标比较(x±s)
分组 n 年龄/岁 男 女 BMI/(kg/m2) 吸烟 高血压 糖尿病 血脂异常 血红蛋白/(g/L) 白细胞计数/(×109/L) 中性粒细胞计数/(×109/L) 淋巴细胞计数/(×109/L) 高敏C反应蛋白/(mg/L) 否 是 无 有 无 有 无 有 高NLR组 60 61.7±12.5 12 48 26.0±3.9 50 10 22 38 42 18 24 36 138.2±19.3 9.3±4.2 8.5±4.5 1.3±0.7 86.7±55.6 低NLR组 156 57.3±11.6 30 126 25.8±3.2 133 23 81 75 109 47 62 94 135.3±18.1 7.1±3.5 4.3±2.7 2.4±0.5 54.7±49.8 t — 2.14 0.02* 0.39 0.12* 4.04* 0.00* 0.00* 1.04 3.91 8.39 12.88 4.09 P — < 0.05 >0.05 >0.05 >0.05 < 0.05 >0.05 >0.05 >0.05 < 0.01 < 0.01 < 0.01 < 0.01 *示χ2值 表 2 AMI合并MVD病人2年全因死亡及MACCE发生的多因素Cox回归分析
变量 B SE Waldχ2 P HR(95%CI) 全因死亡 NLR 0.750 0.244 9.47 < 0.01 2.116(1.313~3.411) 高血压 0.100 0.005 5.21 < 0.05 1.690(1.110~2.568) 中性粒细胞计数 0.139 0.043 7.67 < 0.05 1.176(1.058~1.240) MACCE发生 NLR 0.565 0.230 4.71 < 0.05 1.610(1.028~2.523) 中心粒细胞计数 0.059 0.019 9.77 < 0.01 1.060(1.022~1.101) -
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