外周血中性粒细胞/淋巴细胞比值在老年慢性心力衰竭合并心房颤动患者中的临床意义及预后价值  

Clinical significance and prognostic value of peripheral blood neutrophil lymphocyte ratio in elderly patients with chronic heart failure and atrial fibrillation

作　　者：孙越红[1] 张丽敏[1] 李虓[1] 王丹[1] 吴静[1] 李玉文[1] 张国军[1] SUN Yuehong;ZHANG Limin;LI Xiao;WANG Dan;WU Jing;LI Yuwen;ZHANG Guojun(Experimental Diagnostic Center,Beijing Tiantan Hospital Affiliated to Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院实验诊断中心,北京100070

出　　处：《国际检验医学杂志》2020年第24期3015-3019,共5页International Journal of Laboratory Medicine

摘　　要：目的探讨外周血中性粒细胞/淋巴细胞比值(NLR)在老年慢性心力衰竭(CHF)合并心房颤动(简称房颤)患者中的临床意义及对预后的预测价值。方法选取248例CHF合并房颤患者作为研究对象,所有患者随访5年,根据是否发生主要不良心血管事件(MACE)将患者分为MACE组和非MACE组,多因素Logistics回归分析患者预后发生MACE的独立预测因素;再根据NLR四分位水平分为4组,即NLR<1.92组(A组)、1.92≤NLR<2.95组(B组)、2.95≤NLR<4.68组(C组)和NLR≥4.68组(D组);Kaplan-Meier生存曲线分析4组MACE的发生时间;采用受试者工作特征(ROC)曲线评价NLR对MACE的预测价值。结果多因素Logistic回归分析结果显示,年龄、低密度脂蛋白胆固醇(LDL-C)、NLR越大,左心室射血分数(LVEF)越小,伴有糖尿病及纽约心脏病协会(NYHA)心功能分级(Ⅲ级+Ⅳ级)是发生MACE的独立预测因素;不同NLR分组患者中,MACE发生率随NLR的升高而增加,4组患者急性心肌梗死、严重心律失常和心源性死亡发生率比较,差异均有统计学意义(P<0.05),其他MACE发生率比较,差异无统计学意义(P>0.05);患者发生MACE的平均时间分别为A组49.31个月,B组45.27个月,C组43.63个月,D组40.34个月,组间比较差异有统计学意义(P<0.05);NLR对预测CHF合并房颤患者发生MACE的最佳截断值为3.12,灵敏度为72.39%,特异度为86.18%。结论NLR水平可作为老年CHF合并房颤患者预后发生MACE的独立预测因素。Objective To investigate the clinical diagnosis and prognostic value of peripheral blood neutrophilic lymphocyte ratio(NLR)in elderly patients with chronic heart failure(CHF)and atrial fibrillation.Methods A total of 248 patients with CHF combined with atrial fibrillation were selected as the study objects.All patients were followed up for 5 years.According to the occurrence of major adverse cardiovascular events(MACE),the patients were divided into MACE group and non-MACE group.Then,according to the quartile level of NLR,they were divided into four groups,namely,NLR<1.92 group(group A),1.92≤NLR<2.95 group(group B),2.95≤NLR<4.68 group(group C)and NLR≥4.68 group(group D).Kaplan-meier survival curve was used to analyze the occurrence time of MACE in four groups.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of NLR in prognostic MACE.Results The results of multivariate logistic regression analysis showed that older age,higher levels of LDL-C,NLR,lower LVEF,diabetes and NYHA heart function grade(Ⅲ+Ⅳ)were independent predictors of MACE.As for patients in different groups of different NLR value,the incidence of MACE increased with the increase of NLR,among which,the differences in the incidence rates of acute myocardial infarction,serious arrhythmia and cardiac death in four groups were statistically significant(P<0.05),and the differences in the incidence rates of other MACE were not statistically significant(P>0.05).The mean time for MACE in the four groups was 49.31 months in group A,45.27 months in group B,43.63 months in group C and 40.34 months in group D,respectively,and the differences among groups were statistically significant(P<0.05).The optimal threshold value of NLR for the occurrence of MACE in CHF patients with atrial fibrillation was 3.12,the sensitivity was 72.39%,and the specificity was 86.18%.Conclusion NLR level can be used as an independent predictor of mace in elderly patients with CHF and atrial fibrillation.

关 键 词：中性粒细胞/淋巴细胞比值 慢性心力衰竭 心房颤动 预后 

分 类 号：R541[医药卫生—心血管疾病]