中性粒细胞与淋巴细胞比值对老年稳定型心绞痛病人择期PCI围术期心肌损伤的预测价值  

Predictive value of the neutrophil-to-lymphocyte ratio for perioperative myocardial injury of percutaneous coronary intervention in elderly patients with stable angina pectoris

作　　者：殷云杰 蒋建东[1] 徐亮[1] 孙俊翔 赵祥海[1] 杨松[1] 陈燕春 YIN Yun-Jie;JIANG Jian-dong;XU Liang;SUN Jun-xiang;ZHAO Xiang-hai;YANG Song;CHEN Yan-chun(Department of Cardiology,Yixing People’s Hospital,Wuxi 214200,China;Department of Internal Medicine,Yixing Tumor Hospital,Wuxi 214200,China)

机构地区：[1]宜兴市人民医院心内科,江苏省无锡市214200 [2]宜兴市肿瘤医院内科,江苏省无锡市214200

出　　处：《实用老年医学》2021年第9期943-947,共5页Practical Geriatrics

摘　　要：目的探讨中性粒细胞与淋巴细胞比值(NLR)与老年稳定型心绞痛病人择期经皮冠状动脉介入治疗(PCI)围术期心肌损伤(PMI)的关系及其预测价值。方法本研究为回顾性研究,选择2016年1月至2018年6月在我院心内科住院行PCI的老年稳定型心绞痛病人159例,收集基线资料以及术前术后心肌肌钙蛋白T(cTnT)、生化指标和炎症因子水平。采用ROC曲线确定NLR预测PMI的最佳截点,将病人分为高NLR组(NLR>2)和低NLR组(NLR≤2),比较2组间的一般资料及PMI发生率。采用多因素Logistic回归分析预测PMI的危险因素。结果ROC曲线确定NLR预测PMI的最佳截点为2,此时AUC为0.76,敏感性为78.95%,特异性为65.69%。高NLR组与低NLR组在年龄、支架个数、支架总长度以及PMI的发生率方面差异有统计学意义(P<0.05)。高NLR组的血清胱抑素(Cys C)、hs-CRP、中性粒细胞计数(N)、NLR以及血小板与淋巴细胞比值(PLR)水平明显高于低NLR组,淋巴细胞计数(L)明显低于低NLR组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示吸烟史(OR=2.699,95%CI 1.016~7.168)、NLR>2(OR=4.332,95%CI 1.641~11.433)为PMI的危险因素,而女性(OR=0.219,95%CI 0.073~0.656)、他汀类服用史(OR=0.210,95%CI 0.045~0.982)为PMI的保护因素。结论术前NLR升高是老年稳定型心绞痛PMI的危险因素之一,可用于预测老年稳定型心绞痛病人PMI的发生。Objective To investigate the relationship between the neutrophil-to-lymphocyte ratio(NLR)and perioperative myocardial injury(PMI)of percutaneous coronary intervention(PCI)in the elderly patients with stable angina pectoris(SAP).Methods A total of 159 elderly patients with SAP hospitalized in our hospital for PCI were retrospectively selected from January 2016 to June 2018.The baseline data were collected and the levels of cardiac troponin T(cTnT),biochemistry parameters and the inflammatory factors before and after operation were detected.The best cut-off value of NLR was determined by receiver operating characteristic(ROC)curve.The patients were divided into high NLR group(NLR>2)and low NLR group(NLR≤2).The baseline data and the incidence rate of PMI between the two groups were observed and compared.Logistic regression analysis was used to analyze the risk factors of PMI.Results The best cut-off value of NLR was 2,with a area under the curve(AUC)of 0.76,with a sensitivity of 78.95%,with a specificity of 65.69%.There were significant differences in age,number of stents,total length of stents and incidence rate of PMI between the high NLR group and the low NLR group(P<0.05).The levels of Cystatin C,high-sensitivity C-reactive protein(hs-CRP),neutrophil count,NLR and platelet-to-lymphocyte ratio were significantly higher and the level of lymphocyte count was significantly lower in the high NLR group than that in the low NLR group(P<0.05).Multivariate Logistic regression analysis showed that smoking history(OR=2.699,95%CI 1.016-7.168)and NLR>2(OR=4.332,95%CI 1.641-11.433)were risk factors of PMI,while female(OR=0.219,95%CI0.073-0.656)and statins history(OR=0.210,95%CI 0.045-0.982)were protective factors of PMI.Conclusions Preoperative high level of NLR is one of the risk factors for elderly patients with SAP,which can predict the occurrence of PMI in the elderly patients with SAP.

关 键 词：老年人 稳定型心绞痛 中性粒细胞与淋巴细胞比值 经皮冠状动脉介入治疗 围术期心肌损伤 

分 类 号：R541.4[医药卫生—心血管疾病]