中性粒细胞/淋巴细胞比值对下肢动脉硬化闭塞症患者预后预测作用的meta分析  

Prognostic value of neutrophil to lymphocyte ratio in patients with lower extremity peripheral arterial disease:a meta-analysis

作　　者：梁新雨 徐洪涛 许永城 王御震 赵诚 曹烨民 LIANG Xin-yu;XU Hong-tao;XU Yong-cheng;WANG Yu-zhen;ZHAO Cheng;CAO Ye-min(Department of Vasculature,Shanghai Traditional Chinese Medicine-Integrated Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 200082,China;Clinical Faculty of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)

机构地区：[1]上海中医药大学附属上海市中西医结合医院脉管科,上海200082 [2]上海中医药大学市中西医结合临床医学院,上海201203

出　　处：《海军军医大学学报》2023年第2期188-196,共9页Academic Journal of Naval Medical University

基　　金：国家科技重大专项(2019ZX09201004-002-091);国家自然科学基金(82174382);上海市2020年度科技创新行动计划(20Z21900200)。

摘　　要：目的系统评价中性粒细胞/淋巴细胞比值(NLR)与下肢动脉硬化闭塞症(PAD)患者预后的关系。方法检索Pub Med、Scopus、Web of Science、中国知网、万方数据知识服务平台、维普网、中国生物医学文献服务系统建库至2021年12月31日发表的NLR、下肢PAD相关研究。收集研究的第一作者、发表年份、国家、研究类型、样本量及研究对象的性别、年龄、吸烟状况、合并疾病、NLR平均数、NLR临界值、结局指标、随访时间。运用纽卡斯尔-渥太华量表对纳入文献进行质量评估。使用Stata 16.0软件采用随机效应模型计算下肢PAD患者高、低NLR组间不同结局的效应量。结果共纳入17篇文献(n=4554)。meta分析结果显示,高NLR与全因死亡、截肢和介入后再狭窄关系密切,合并后效应量分别为HR=1.93(95%CI 1.21~3.10)、HR=1.92(95%CI 1.43~2.59)、OR=1.76(95%CI 1.13~2.75)。亚组分析结果提示,在介入治疗后的下肢PAD患者中,高NLR患者1年内发生全因死亡、截肢和再狭窄的效应量分别为HR=3.24(95%CI 1.96~5.35)、HR=2.64(95%CI 2.10~3.31)和OR=2.44(95%CI1.09~5.43);在保守治疗下肢PAD患者中,高NLR患者发生全因死亡的HR为2.82(95%CI 2.08~3.84),但高NLR与截肢的发生关系不密切。结论高NLR与全因死亡、截肢、介入后再狭窄的关系密切,可作为下肢PAD患者介入治疗后1年发生截肢、全因死亡和支架内再狭窄的预测指标。Objective To systematically evaluate the relationship between neutrophil to lymphocyte ratio(NLR)and prognosis of patients with lower extremity peripheral arterial disease(PAD).Methods Studies on NLR and lower extremity PAD were retrieved from PubMed,Scopus,Web of Science,CNKI,Wanfang data,VIP and SinoMed till Dec.31,2021.First author,publication year,country,study type,sample size,gender,age,smoking,comorbidity,average NLR,NLR threshold,outcome and follow-up time were collected.The quality of the included studies was evaluated with Newcastle-Ottawa scale.Stata 16.0 software was used to calculate the effect size of different outcomes in lower extremity PAD patients with high or low NLR by random-effect model.Results A total of 17 articles were included(n=4554).Meta analysis showed that allcause death,amputation and restenosis were closely associated with high NLR and the combined effect sizes were hazard ratio(HR)=1.93(95%confidence interval[CI]1.21-3.10),HR=1.92(95%CI 1.43-2.59)and odds ratio(OR)=1.76(95%CI 1.13-2.75),respectively.Subgroup analysis suggested that high NLR was predictive of all-cause death,amputation and restenosis in lower extremity PAD patients within 1 year after intervention,with HR being 3.24(95%CI 1.96-5.35),HR being 2.64(95%CI 2.10-3.31)and with OR being 2.44(95%CI 1.09-5.43),respectively.HR of all-cause death in lower extremity PAD patients with high NLR treated conservatively was 2.82(95%CI 2.08-3.84),while high NLR was not associated with amputation.Conclusion High NLR is closely associated with all-cause death,amputation and restenosis after intervention,which can be used as a predictor of amputation,all-cause death and in-stent restenosis in lower extremity PAD patients 1 year after intervention.

关 键 词：外周动脉疾病 闭塞性硬化 中性粒细胞/淋巴细胞比值 截肢术 全因死亡 再狭窄 危险因素 队列研究 

分 类 号：R543.5[医药卫生—心血管疾病]