中性粒细胞/淋巴细胞比值与心力衰竭患者的相关性研究  

Correlation of Neutrophil to Lymphocyte Ratio and Heart Failure Patients

作　　者：曾文飞 陈清[1] 余鹏[1] 王丽满[2] 邱玲慧 余惠珍[1] 李力[3] ZENG Wen-fei;CHEN Qing;YU Peng;WANG Li-man;QIU Ling-hui;YU Hui-zhen;LI Li(Department of Cardiovascular Medicine,Jinshan Branch of Shengli Clinical Medical College of Fujian Medical University,Fuzhou 350001,China;Department of Pharmacy,Fujian Provincial Hospital,Fuzhou,350028,China;Department of Health Management,Fujian Provincial Hospital,Fuzhou,350028,China)

机构地区：[1]福建医科大学省立临床医学院金山院区心内科,福建省福州市350001 [2]福建省立医院药学部 [3]福建省立医院健康管理科

出　　处：《中国心血管病研究》2022年第8期685-691,共7页Chinese Journal of Cardiovascular Research

基　　金：国家自然科学基金项目(81873515);福建省自然科学基金面上项目(2020J011072);福建省卫健委创新基金(2021CXA008);福建省立医院“创双高”火石基金项目(2020HSJJ03)。

摘　　要：目的探讨血液中性粒细胞/淋巴细胞比值(NLR)对心力衰竭患者诊断及预后的临床意义。方法连续性纳入2015年7月1日至2020年7月1日福建省立医院金山院区心内科收治住院的258例心力衰竭患者和同期258例健康体检人群,入院后及时收集患者的临床资料和相关实验室指标,超声心动图测量左心室射血分数。采用受试者工作曲线,分析NLR对心力衰竭患者的诊断价值,多因素logistics回归分析对混杂因素进行调整。患者出院后随访,平均随访550(315,845)天,以心血管死亡作为终点事件,采用限制性立方样条图法分析NLR与心血管死亡率之间的非线性关系,Kaplan-Meier(K-M)生存曲线比较NLR对心力衰竭患者心血管死亡的预测价值。结果与健康人相比较,心力衰竭患者的NLR水平明显升高[lgNLR:(0.50±0.27)比(0.22±0.17),P<0.001]。NLR诊断心力衰竭的ROC曲线下面积为0.812,最佳截点值为2.355,敏感性为68.2%,特异性为84.5%。多因素logistics回归分析对混杂因素进行调整后提示NLR升高为心衰发生的独立危险因素(OR=2.108,95%CI 1.521~2.921,P<0.001)。对血红蛋白、血小板计数、血钠、NT-proBNP及肌酐进一步调整后,限制性立方样条图分析,心力衰竭患者NLR与心血管死亡率之间呈“J”形非线性效应关系。K-M生存分析发现,NLR升高心力衰竭患者的远期心血管死亡事件明显增加,其预后差(P=0.016)。结论中性粒细胞/淋巴细胞比值升高可能作为诊断心力衰竭的独立危险因素,NLR升高预示心力衰竭患者心血管死亡风险升高。Objective To investigate the role of neutrophil to lymphocyte ratio(NLR)in the diagnosis and prognosis of heart failure(HF)patients.Methods 258 patients who were admitted for heart failure were consecutively enrolled from July 1,2015 to July 1,2020.And 258 healthy subjects were included as control.The clinical data,laboratory markers and left ejection fraction measured by echocardiography were collected.ROC and multiple logistics analysis were used to explore the value of NLR in the diagnosis of HF.The patients were followed average 550(315,845)days after discharge.The endpoint was cardiovascular death.Restricted cubic spline plot was used to analysis the nonlinear relationship between NLR and the cardiovascular mortality.Kaplan Meier(K-M)survival curve was used to compare the difference of mortality between the high NLR group and low NLR group.Results Compared with the healthy subjects,the level of NLR was significantly higher in the patients with HF[lgNLR:(0.50±0.27)vs.(0.22±0.17),P<0.001].The area under the ROC curve of NLR in the diagnosis of HF was 0.812 and the best cut-off point was 2.355,with a sensitivity of 68.2%and a specificity of 84.5%.Multiple logistics regression analysis showed that the elevation of NLR was an independent risk factor for heart failure occurring(OR=2.108,95%CI 1.521~2.921,P<0.001).After adjusting for the confunding factors,restricted cubic spline plot suggested J-shap associations of NLR and cardiovascular mortality.K-M survival analysis showed that the cardiovascular death of the high NLR group was significantly increased than that of the low group(P=0.016).Conclusions NLR may be considered as a independently risk factor for HF.Elevation of NLR would predict the poor prognosis.

关 键 词：心力衰竭 中性粒细胞/淋巴细胞比值 心血管死亡 预后 

分 类 号：R541.6[医药卫生—心血管疾病]