中性粒细胞/淋巴细胞比值预测急性心肌梗死患者新发心房颤动的临床意义  

Clinical significance of the neutrophil-to-lymphocyte ratio in predicting new-onset atrial fibrillation in patients with acute myocardial infarction

作　　者：张智文 王山岭[2] 刘静静[2] 吴金涛[2] 王婷[2] 赵丹清 范宪伟[2] 杨海涛[2] Zhang Zhiwen;Wang Shanling;Liu Jingjing;Wu Jintao;Wang Ting;Zhao Danqing;Fan Xianwei;Yang Haitao(Department of Cardiology,Henan University People s Hospital,Henan Province People s Hospital,Zhengzhou 450003,China;Heart Center of Henan Province People s Hospital,Fuwai Central China Cardiovascular Hospital,Zhengzhou 450003,China)

机构地区：[1]河南大学人民医院河南省人民医院心内科,郑州450003 [2]河南省人民医院心脏中心,阜外华中心血管病医院,郑州450003

出　　处：《中国心血管杂志》2020年第5期432-436,共5页Chinese Journal of Cardiovascular Medicine

基　　金：河南省科技攻关计划项目(182102310175);河南省医学科技攻关计划项目(LHGJ20190784)。

摘　　要：目的探讨中性粒细胞/淋巴细胞比值(NLR)预测急性心肌梗死(AMI)患者新发心房颤动(NOAF)的临床意义。方法纳入2017年1月至2019年1月于河南省人民医院就诊的458例AMI患者,按照是否发生NOAF分为NOAF组48例和窦性心律(SR)组410例。分析两组患者的一般临床资料、实验室检查指标、超声心动图指标、冠状动脉造影结果和治疗药物之间是否存在差异。采用logistic回归方程分析AMI患者发生NOAF的相关因素,使用受试者工作特征(ROC)曲线评价NLR预测AMI患者发生NOAF的价值。结果与SR组相比,NOAF组的患者年龄更大,ST段抬高型心肌梗死和高血压患者更多,中性粒细胞计数、NLR和左心房内径较高,淋巴细胞计数和左心室射血分数较低,右冠状动脉闭塞者较多(均为P<0.05);而在性别、吸烟、饮酒、体质指数、急性心力衰竭、糖尿病、血脂异常、住院时间、其他冠状动脉闭塞和治疗方法上比较,两组差异无统计学意义(均为P>0.05)。多元logistic回归分析显示,高血压、中性粒细胞升高、淋巴细胞降低、NLR升高和左心室射血分数降低是AMI患者发生NOAF的独立危险因素(均为P<0.05)。ROC曲线结果显示,NLR预测AMI患者发生NOAF的曲线下面积为0.717(95%CI:0.673~0.758,P<0.001),灵敏度68.8%,特异度67.8%。结论本研究提示在AMI患者中,NLR水平与NOAF独立相关,高水平的NLR对预测AMI患者发生NOAF具有一定的参考价值。Objective To investigate the clinical significance of neutrophil-to-lymphocyte ratio(NLR)in predicting new-onset atrial fibrillation(NOAF)in patients with acute myocardial infarction(AMI).Methods The 458 AMI patients included in the study were divided into NOAF group(n=48)and sinus rhythm(SR)group(n=410)according to whether or not NOAF occurred.Analyze whether there are any differences between the two groups of patients in general clinical data,laboratory examination indicators,echocardiographic indicators,coronary angiography results,and treatment drugs.The logistic regression equation was used to analyze the related factors of NOAF in AMI patients,and the value of NLR in predicting NOAF in AMI patients was evaluated by using ROC curve.Results Compared with SR group,patients in NOAF group were older,more patients with ST-segment elevation myocardial infarction and hypertension,they have higher neutrophil count,NLR and left atrial diameter,and lower lymphocyte count and left ventricular ejection fraction(LVEF),there were more right coronary artery occlusion(all P<0.05).There was no significant difference in sex,smoking,drinking,body mass index,acute heart failure,diabetes,dyslipidemia,hospital stay,other coronary artery occlusion and treatment between the two groups(all P>0.05).Multivariate logistic regression equations showed that hypertension,elevated neutrophils,decreased lymphocytes,increased NLR,and decreased LVEF were independent risk factors for NOAF in patients with AMI(all P<0.05).The ROC curve showed that the NLR predicted the AUC of NOAF in AMI patients was 0.717(95%CI:0.673-0.758,P<0.001).Conclusions This study suggests that in AMI patients NLR level is independently related to NOAF,and high levels NLR have certain reference value in predicting the occurrence of NOAF in patients with AMI.

关 键 词：中性粒细胞 淋巴细胞 炎症反应 急性心肌梗死 新发心房颤动 

分 类 号：R54[医药卫生—心血管疾病]