中性粒细胞/淋巴细胞比值与AMI患者PPCI术前后梗死相关冠状动脉血流状态的相关性  

Correlation between neutrophil/lymphocyte ratio and infarct related coronary flow before and after PPCI in patients with acute myocardial infarction

作　　者：胡圣大[1] 陈光奇 曹明强[1] 李晓波[1] 钱璐[1] HU Shengda;CHEN Guangqi;CAO Mmgqiang;LI Xiaobo;QIAN Lu(Department of Cardiology,the First Affiliated Hospital of Soochow University,Suzhou,Jiangsu 215006,China;Caohu People's Hospital of Xiangcheng District,Suzhou,Jiangsu 215000,China)

机构地区：[1]苏州大学附属第一医院心内科,江苏省苏州市215006 [2]相城区漕湖人民医院,江苏省苏州市215000

出　　处：《中国动脉硬化杂志》2018年第12期1273-1277,共5页Chinese Journal of Arteriosclerosis

摘　　要：目的探讨中性粒细胞/淋巴细胞比值(NLR)与急性心肌梗死(AMI)患者行直接经皮冠状动脉介入治疗(PPCI)前后梗死相关冠状动脉(IRA)血流状态的关系。方法连续入选598例接受PPCI的AMI(包括STEMI和NSTEMI)患者,依据PPCI前后IRA血流状况分为三组:A组为PPCI前IRA血流TIMI Ⅲ级;B组为PPCI前IRA血流TIMI 0~Ⅱ级,PPCI后IRA血流TIMI Ⅲ级;C组为PPCI前IRA血流TIMI 0~Ⅱ级,PPCI后IRA血流TIMI 0~Ⅱ级,同时检测各组NLR以及相关临床参数,进行统计分析并对相关数据行Logistic回归分析。结果三组间高敏C反应蛋白(hs-CRP)、NLR、心肌肌钙蛋白T(cTnT)及左心室射血分数(LVEF)等指标存在显著性差异。A组患者hs-CRP、NLR和cTnT值最低,而LVEF值最高;C组患者hs-CRP、NLR和cTnT值最高,而LVEF值最低,且心功能Killip分级≥2级者更常见;C组患者死亡率最高,与IRA血流恢复不佳、NLR升高独立相关。多因素Logistic回归分析显示NLR与IRA血流状态独立相关,高NLR预示PPCI前后IRA血流TIMI 0~Ⅱ级的发生率更高。结论NLR是IRA血流状态的一个强有力的独立预测因子,高NLR预示AMI患者预后更差,其对行PPCI的AMI患者的早期危险分层具有一定的价值。Aim To investigate the relationship between neutrophil /lymphocyte ratio ( NLR) and the blood flow status of infarct related artery ( IRA) in patients with acute myocardial infarction ( AMI) before and after primary percutaneous coronary intervention ( PPCI) . Methods 598 patients with AMI ( including STEMI and NSTEMI) treated with PPCI were divided into three groups according to the blood flow status of IRA before and after PPCI: group A: the blood flow of IRA before PPCI was TIMI Ⅲ grade; group B: the blood flow of IRA was TIMI 0~Ⅱ grade before PPCI,and TIMI Ⅲ grade after PPCI; group C: the blood flow of IRA was TIMI 0 ~Ⅱ grade before PPCI and after PPCI. At the same time,NLR and related clinical parameters were detected and Logistic regression analysis was performed. Results There were significant differences in high sensitivity C-reactive protein ( hs-CRP) ,NLR,cardiac troponin T( cTnT) and left ventricular ejection fraction ( LVEF) among the three groups. In group A,the values of hs-CRP,NLR and cTnT were the lowest,and LVEF was the highest. In group C,the values of hs-CRP,NLR and cTnT were the highest,while LVEF was the lowest,and the Killip classification≥2 was more common. The mortality was the highest in group C. Multivariate Logistic regression analysis showed that NLR was independently correlated with the blood flow status of IRA,high NLR predicted a higher incidence of TIMI 0~Ⅱ grade in IRA blood flow before and after PPCI. Conclusions NLR is a strong and independent predictor of blood flow status of IRA. High NLR indicates a worse prognosis in AMI patients,which is useful for early risk stratification in patients with AMI undergoing PPCI.

关 键 词：急性心肌梗死 中性粒细胞/淋巴细胞比值 直接经皮冠状动脉介入治疗 TIMI血流分级 

分 类 号：R5[医药卫生—内科学]