中性粒细胞与淋巴细胞比值对老年重度主动脉瓣狭窄患者经导管主动脉瓣置换术后跨瓣压差升高的预测价值  

Predictive Value of Neutrophil to Lymphocyte Ratio on Elevated Transvalvular Pressure Gradient after Transcatheter Aortic Valve Replacement in Older Patients with Severe Aortic Stenosis

作　　者：李无为 邵一兵[1] 李吉和 毕晓磊 Li Wuwei;Shao Yibing;Li Jihe;Bi Xiaolei(Department of Cardiology,Qingdao Municipal Hospital,Qingdao 266000)

机构地区：[1]青岛市市立医院心内科,青岛266000

出　　处：《国际老年医学杂志》2023年第3期313-317,共5页International Journal of Geriatrics

基　　金：山东省医药卫生科技发展计划项目(2019WS223)。

摘　　要：目的探讨中性粒细胞与淋巴细胞比值(NLR)对老年重度主动脉瓣狭窄患者经导管主动脉瓣置换术(TAVR)后跨瓣压差升高的预测价值。方法选取青岛市市立医院2019年3月~2021年12月收治的99例老年重度主动脉瓣狭窄患者作为研究对象,根据3个月内是否发生跨瓣压差升高将其分为非跨瓣压差升高组(68例)和跨瓣压差升高组(31例)。收集两组临床资料、术前实验室指标和超声指标,采用ROC曲线评价不同时间点的NLR对老年重度主动脉瓣狭窄患者TAVR后跨瓣压差升高的预测价值,采用logistic回归分析老年重度主动脉瓣狭窄患者TAVR后跨瓣压差升高的影响因素。结果跨瓣压差升高组脑钠肽、D-二聚体水平高于与非跨瓣压差升高组(P<0.05);在术后3 d和术后1周,跨瓣压差升高组NLR高于非跨瓣压差升高组(P<0.05);跨瓣压差升高组术前、术后3 d、术后1周NLR依次升高,组间比较差异均有统计学意义(P<0.05);用ROC曲线分析显示,术前、术后3 d、术后1周的NLR预测老年重度主动脉瓣狭窄患者TAVR后跨瓣压差升高的曲线下面积分别为0.463、0.864、0.957;logistic回归分析显示,术后3 d NLR和术后1周NLR是老年重度主动脉瓣狭窄患者TAVR后发生跨瓣压差升高的独立危险因素(P<0.05)。结论术后3 d和术后1周NLR检测对老年重度主动脉瓣狭窄患者TAVR后跨瓣压差升高可能有重要预测价值。Objective To investigate the value of neutrophil to lymphocyte ratio(NLR)in predicting the elevated transvalvular pressure gradient(TPG)after transcatheter aortic valve replacement(TAVR)in older patients with severe aortic stenosis.Methods A total of 99 older patients with severe aortic stenosis who were admitted to Qingdao Municipal Hospital from March 2019 to December 2021 were enrolled in this study.The patients were divided into a non-elevated TPG group(68 cases)and an elevated TPG group(31 cases)according to TPG within 3 months.Clinical data,preoperative laboratory indicators and ultrasound indicators were collected.Receiver operating characteristic(ROC)curve was performed to evaluate the predictive value of NLR at different time points on elevated TPG after TAVR.Logistic regression was performed to analyze the influential factors of elevated TPG after TAVR.Results The levels of brain natriuretic peptide and D-dimer in the elevated TPG group were higher than those in the non-elevated TPG group(P<0.05).At 3 days and 1 week after operation,NLR in the elevated TPG group was higher than that in the non-elevated TPG group(P<0.05).NLR increased gradually before operation,3 days and 1 week after operation in the elevated TPG group,the difference between the groups was statistically significant(P<0.05).ROC curve analysis showed that the area under the curve of NLR in predicting the elevated TPG before operation,3 days and 1 week after operation were 0.463,0.864 and 0.957,respectively.Logistic regression analysis showed that NLR at 3 days and 1 week after operation were independent risk factors for increased TPG after TAVR in older patients with severe aortic stenosis(P<0.05).Conclusion NLR at 3 days and 1 week after operation may have important predictive value on elevated TPG after TAVR in older patients with severe aortic stenosis.

关 键 词：中性粒细胞与淋巴细胞比值 重度主动脉瓣狭窄 经导管主动脉瓣置换术 跨瓣压差 

分 类 号：R654.2[医药卫生—外科学]