中性粒细胞与淋巴细胞比值对新型冠状病毒感染患者心肌损伤高危人群的识别有效性分析  

Analysis of the effectiveness of neutrophil to lymphocyte ratio in identifying high-risk groups of myocardial injury in patients with Corona Virus Disease 2019 infection

作　　者：纪荣庄 雷元国 张艳芳[2] 李斌 李克乐 刘阳阳 JI Rong-zhuang;LEI Yuan-guo;ZHANG Yan-fang(Department of Cardiology,Zhongshan Huangpu People's Hospital,Zhongshan 528429,China)

机构地区：[1]中山市黄圃人民医院心血管内科,528429 [2]中山市黄圃人民医院检验科,528429 [3]松滋市人民医院医务科,434299

出　　处：《中国实用医药》2023年第5期11-15,共5页China Practical Medicine

基　　金：2020年度中山市第一批社会公益与基础研究项目(医疗卫生)(项目编号:2020B1009)。

摘　　要：目的评估中性粒细胞与淋巴细胞比值(NLR)是否可以作为感染新型冠状病毒(COVID-19)住院患者心肌损伤的预测指标。方法连续选取141例确诊的感染COVID-19住院患者,依据肌钙蛋白是否升高分为心肌损伤组(21例)和非心肌损伤组(120例)。收集患者临床、实验室检查等资料,通过多元Logistic回归模型评估感染COVID-19住院患者心肌损伤的危险因素,绘制受试者工作特征曲线(ROC),评估COVID-19感染患者预后的独立预测因子。结果本研究最终共入选141例COVID-19感染患者,男75例(53.2%);平均年龄(56.1±17.8)岁;发生心肌损伤21例(14.9%),构成心肌损伤组,其余120例(85.1%)构成非心肌损伤组。心肌损伤组患者年龄(70.6±19.7)岁显著高于非心肌损伤组的(53.5±16.3)岁,差异有统计学意义(P<0.05)。心肌损伤组白细胞计数为8.45(4.96,11.96)×10^(9)/L、中性粒细胞计数为6.95(5.03,9.20)×10^(9)/L、NLR为6.38(5.12,8.33)、C反应蛋白(CRP)水平为63.7(21.6,98.5)mg/L、脑钠肽(BNP)水平为786.8(302.1,1238.4)pg/ml、肌酸激酶(CK)水平为122.7(105.8,135.1)mmol/L、肌酸激酶同工酶(CK-MB)水平为54.3(50.2,80.1)mmol/L、肾小球滤过率(GFR)<60 ml/min比例为14.3%,显著高于非心肌损伤组的4.76(3.66,6.37)×10^(9)/L、3.88(2.65,5.37)×10^(9)/L、2.08(1.25,3.25)、31.5(12.2,71.2)mg/L、343.7(279.7,408.3)pg/ml、25.6(11.1,37.7)mmol/L、16.3(9.7,21.4)mmol/L、1.7%,血红蛋白水平(116.1±2.5)g/L显著低于非心肌损伤组的(120.4±2.7)g/L,差异有统计学意义(P<0.05)。两组患者性别、糖尿病、高血压、高血脂、吸烟及既往脑血管疾病(CVD)、Ⅰ型呼吸衰竭、Ⅱ型呼吸衰竭比例比较,差异无统计学意义(P>0.05)。两组患者肌酐、淋巴细胞计数、血小板计数、甘油三酯(TC)、总胆固醇(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平比较,差异无统计学意义(P>0.05)。两组患者使用血管紧张素Ⅱ受体拮抗剂(ARB)、二氢吡啶Objective To evaluate whether neutrophil-to-lymphocyte ratio(NLR)can be used as a predictor of myocardial injury in hospitalized patients with Corona Virus Disease 2019(COVID-19)infection.Methods A total of 141 hospitalized patients diagnosed with COVID-19 infection were divided into myocardial injury group(21 cases)and non-myocardial injury group(120 cases)according to whether troponin was elevated.The clinical and laboratory data of the patients were collected,and risk factors for myocardial injury in hospitalized patients with COVID-19 infection were evaluated by multivariate Logistic regression models,and the receiving operating characteristic curves(ROCs)were drawn to assess independent predictors of prognosis of patients with COVID-19 infection.Results A total of 141 patients with COVID-19 infection were finally enrolled in this study,75 cases(53.2%)were male;the mean age was(56.1±17.8)years;21 cases(14.9%)had myocardial injury and were included as the myocardial injury group,and the remaining 120 cases(85.1%)were included in the non-myocardial injury group.The age of patients in the myocardial injury group was(70.6±19.7)years,which was significantly higher than(53.5±16.3)years in the non-myocardial injury group,and the difference was statistically significant(P<0.05).In the myocardial injury group,the leukocyte count was 8.45(4.96,11.96)×10^(9)/L,neutrophil count was 6.95(5.03,9.20)×10^(9)/L,NLR was 6.38(5.12,8.33),C-reactive protein(CRP)level was 63.7(21.6,98.5)mg/L,brain natriuretic peptide(BNP)level was 786.8(302.1,1238.4)pg/ml,creatine kinase(CK)level was 122.7(105.8,135.1)mmol/L,creatine kinase isoenzyme(CK-MB)level was 54.3(50.2,80.1)mmol/L and the proportion of estimated glomerular filtration rate(GFR)<60 ml/min was 14.3%,which were significantly higher than(4.76(3.66,6.37)×10^(9)/L,3.88(2.65,5.37)×10^(9)/L,2.08(1.25,3.25),31.5(12.2,71.2)mg/L,343.7(279.7,408.3)pg/ml,25.6(11.1,37.7)mmol/L,16.3(9.7,21.4)mmol/L,1.7%in non-myocardial injury group;the hemoglobin level of myocardial injury group wa

关 键 词：新型冠状病毒 心肌损伤 中性粒细胞与淋巴细胞比值 肌钙蛋白 预测因子 

分 类 号：R511[医药卫生—内科学]