中性粒细胞/淋巴细胞比值与非瓣膜性心房颤动患者左心耳血栓状态的相关性  

Relationship Between Neutrophil/lymphocyte Ratio and Left Atrial Appendage Thrombogenic Milieu in Patients With Nonvalvular Atrial Fibrillation

作　　者：何长健 张艳[1] 马建帅 刘倩[1] 杨婧[1] 侯倩[1] 王连霞 张媛媛[1] 尤玲[1] 谢瑞芹 HE Changjian;ZHANG Yan;MA Jianshuai;LIU Qian;YANG Jing;HOU Qian;WANG Lianxia;ZHANG Yuanyuan;YOU Ling;XIE Ruiqin(Department of Cardiology,The Second Hospital of Hebei Medical University,Shijiazhuang(050000),Hebei,China)

机构地区：[1]河北医科大学第二医院心内一科,河北省石家庄市050000

出　　处：《中国循环杂志》2021年第9期891-896,共6页Chinese Circulation Journal

基　　金：河北省政府资助专科能力建设和专科带头人培养项目(361004)。

摘　　要：目的:探讨中性粒细胞/淋巴细胞比值(NLR)与非瓣膜性心房颤动(NVAF)患者左心耳血栓状态(LAATM)的相关性。方法:回顾性分析2017年1月至2019年12月在河北医科大学第二医院接受经食道超声心动图(TEE)检查、拟行导管消融或左心耳封堵治疗的494例NVAF患者资料。根据超声心动图检查结果,将患者分为LAATM组(n=62)和无LAATM组(n=432)。采用多因素Logistic回归分析评估NLR是否为NVAF患者LAATM的独立危险因素,通过ROC曲线评估NLR对NVAF患者LAATM的预测价值。结果:与无LAATM组相比,LAATM组患者的年龄较大,心力衰竭患者比例、CHA2SD2-VASc评分、左心房内径、左心室收缩末期容积、白细胞计数、NLR(1.99±0.67 vs.2.31±0.71)均较高,左心室射血分数较低,差异均有统计学意义(P均<0.05)。多因素回归分析显示,NLR(OR=1.631,95%CI:1.049~2.534,P=0.030)、左心房内径(OR=1.159,95%CI:1.091~1.231,P<0.001)、心力衰竭病史(OR=1.979,95%CI:1.013~3.866,P=0.046)是NVAF患者LAATM的独立危险因素。ROC曲线分析显示,NLR预测NVAF患者LAATM的AUC为0.629(95%CI:0.559~0.699,P=0.001);NLR=2.22时,患者可能存在LAATM(敏感度为53.2%,特异度为69.0%)。结论:NLR可能是NVAF患者LAATM的危险因素。Objectives:To explore the relationship between neutrophil/lymphocyte ratio(NLR)and left atrial appendage thrombogenic milieu(LAATM)in patients with nonvalvular atrial fibrillation(NVAF).Methods:We retrospectively analyzed the data of 494 patients with NVAF who underwent catheter ablation or left atrial appendage occlusion in the Second Hospital of Hebei Medical University from January 2017 to December 2019.According to the results of transesophageal echocardiography,patients were divided into LAATM group(n=62)and non-LAATM group(n=432).Multivariate logistic regression was used to analyze whether NLR was an independent risk factor of LAATM in NVAF patients,and the value of NLR in judging the presence or absence of LAATM was evaluated through the ROC curve.Results:Compared with the non-LAATM group,patients in the LAATM group were older,and the proportion of patients with heart failure,CHA2SD2-VASc score,left atrial diameter,left ventricular end-systolic volume,white blood cell count,NLR(1.99±0.67 vs.2.31±0.71)were significantly higher,the left ventricular ejection fraction was significantly lower(all P<0.05).Multivariate regression analysis showed that NLR(OR=1.631,95%CI:1.049-2.534,P=0.030),left atrial diameter(OR=1.159,95%CI:1.091-1.231,P<0.001),and history of heart failure(OR=1.979,95%CI:1.013-3.866,P=0.046)were independent risk factors for LAATM.The AUC of NLR for predicting LAATM from the ROC curve is 0.629(95%CI:0.559-0.699,P=0.001).The sensitivity was 53.2%,specificity was 69.0%with NLR=2.22 for predicting LAATM in this patient cohort.Conclusions:NLR is a risk factor of LAATM in patients with non-valvular atrial fibrillation.

关 键 词：非瓣膜性心房颤动 中性粒细胞/淋巴细胞比值 左心耳血栓 经食道超声心动图 

分 类 号：R54[医药卫生—心血管疾病]