中性粒细胞与淋巴细胞比值评价老年心脏再同步治疗患者疗效的临床意义  

Clinical significance of neutrophil-to-lymphocyte ratio in assessing response to cardiac resynchronization therapy in elderly patients

作　　者：范宪伟[1] 王山岭[1] 杨海涛[1] 吴金涛[1] 严丽洁[1] 刘静静[1] Fan Xianwei;Wang Shanling;Yang Haitao;Wu Jintao;Yan Lijie;Liu Jingjing(Henan Provincial People 's Hospital,Fuivai Huazhong Cardiovascular Hospital , Zhengzhou 450000,China)

机构地区：[1]河南省人民医院(阜外华中心血管病医院)心血管内科,郑州450000

出　　处：《中华老年医学杂志》2019年第4期378-382,共5页Chinese Journal of Geriatrics

摘　　要：目的探讨中性粒细胞与淋巴细胞比值(NLR)评价老年接受心脏再同步治疗(CRT)患者反应性的临床意义。 方法回顾性分析2006年1月至2017年1月在我院接受CRT的105例老年慢性心力衰竭患者临床资料,按照CRT后6个月是否有反应分为无反应组42例和有反应组63例。比较两组患者一般临床资料,采用Logistic回归方程分析CRT后无反应性相关因素,采用受试者工作特征(ROC)曲线评价NLR预测CRT后无反应性的价值。 结果与有反应性组比较,无反应性组基线资料中初始QRS波宽度、血肌酐、尿酸水平较高(P<0.05);两组CRT前左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD),左心室收缩末期内径(LVESD)、NYHA心功能分级、中性粒细胞、淋巴细胞计数、NLR比较差异无统计学意义(均P>0.05);无反应组CRT后6个月时LVEDD、NYHA心功能分级、中性粒细胞计数、NLR均高于有反应组,LVEF和淋巴细胞计数低于有反应组(P<0.05);无反应组CRT后6个月与CRT前的NLR差值(ΔNLR)高于有反应组(P<0.05)。多元Logistic回归分析结果显示,CRT后6个月时NLR(OR=1.895,95%CI:1.538~5.284,P=0.031)、ΔNLR(OR=2.579,95%CI:2.110~8.329,P=0.005)是CRT后无反应性的独立预测因素。ROC曲线分析结果显示,治疗前后NLR差值(ΔNLR)预测CRT后无反应性的曲线下面积(AUC)为0.891(95%CI:0.832~0.937),高于CRT后6个月时NLR的面积0.813(95%CI:0.765~0.864),两者比较差异有统计学意义(Z=2.712,P<0.05)。 结论CRT后NLR水平升高可能是预测无反应性的早期预警信号,应当加强对NLR的动态检测以评估患者预后。Objective To investigate the clinical significance of neutrophil-to-lymphocyte ratio(NLR)in assessing response to cardiac resynchronization therapy(CRT)in elderly patients. Methods Clinical data of 105 elderly patients with chronic heart failure(CHF)who had received CRT at our hospital from January 2006 to January 2017 were retrospectively analyzed, and patients were divided into a no-response group(n=42)and a response group(n=63)according to CRT outcomes after 6 months.General clinical data were compared between the two groups.Factors influencing response to CRT were analyzed by logistic regression model analysis.The receiver-operating characteristic(ROC)curve was used to assess the predictive value of NLR in response to CRT. Results Compared with the response group, the no-response group had increased baseline levels of initial QRS width, serum creatinine(Scr)and uric acid(UA)(P<0.05). There was no significant difference in left ventricular ejection fraction(LVEF), left ventricular end-diastolic diameter(LVEDD), left ventricular end-systolic diameter(LVESD), the New York Heart Association(NYHA)functional classification, neutrophil count, lymphocyte count and NLR between the two groups before CRT(P>0.05). After 6 months of CRT, the LVEDD, NYHA functional class, neutrophil count and NLR were higher, and LVEF and lymphocyte count were lower in the no-response group than in the response group(P<0.05). The difference in NLR between 6 months after CRT and before CRT(ΔNLR)was higher in the no-response group than in the response group(P<0.05). Multi-factor Cox regression analysis showed that NLR(OR=1.895, 95%CI: 1.538~5.284, P=0.031)and ΔNLR(OR=2.579, 95%CI: 2.110~8.329, P=0.005)were independent risk factors for CRT(HR=1.590, 95%CI: 1.215~2.146, P=0.013). ROC curve analysis showed that ROCAUC of ΔNLR in the no-response group was 0.891, 95%CI: 0.832~0.937, which was higher than that at 6 months after CRT(0.813, 95%CI: 0.765~0.864)(Z=2.712, P<0.05). Conclusions The increase in NLR after CRT may be an early sign for no

关 键 词：中性粒细胞 淋巴细胞 心力衰竭 

分 类 号：R541.6[医药卫生—心血管疾病]