NLR、PLR、LAD与非瓣膜持续性房颤患者发生缺血性脑卒中的关系研究  

Relationship Between NLR,PLR,LAD and Ischemic Stroke in Patients with Non-valvular Persistent Atrial Fibrillation

作　　者：杨楠 陈华 白小峰 杨帆 YANG Nan;CHEN Hua;BAI Xiaofeng;YANG Fan(Graduate School of Baotou Medical College,Baotou 014040 China;Department of Cardiology,Inner Mongolia Autonomous Region People's Hospital,Hohhot 010017 China;Ningcheng County,Inner Mongolia Center Hospital,Ningcheng 024200 China)

机构地区：[1]内蒙古科技大学包头医学院研究生院,内蒙古包头014040 [2]内蒙古自治区人民医院心血管内科,呼和浩特010017 [3]内蒙古宁城县中心医院,内蒙古宁城024200

出　　处：《内蒙古医学杂志》2023年第3期268-273,278,F0002,共8页Inner Mongolia Medical Journal

摘　　要：目的探讨中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞计数比值(PLR)和左心房内径(LAD)与非瓣膜持续性房颤患者发生缺血性脑卒中的关系。方法选择2019年1月至2022年10月于内蒙古自治区人民医院住院的非瓣膜持续性房颤患者198例,按照是否并发急性缺血性脑卒中分为单纯持续性房颤组(124例)和并发缺血性脑卒中组(74例),比较两组临床资料,多因素Logistic回归分析探讨非瓣膜持续性房颤患者发生缺血性脑卒中的危险因素,绘制受试者工作特征(ROC)曲线,评价相关指标对非瓣膜持续性房颤患者发生缺血性脑卒中的预测价值。结果并发缺血性脑卒中组的年龄、吸烟史、合并高血压、缺血性脑卒中及心力衰竭比例及NLR、PLR、LAD、CHA2DS2-VASc评分均高于单纯持续性房颤组,左心室射血分数(LVEF)低于对照组(P<0.05)。多因素Logistic分析结果显示,NLR、PLR、LAD是非瓣膜持续性房颤患者发生缺血性脑卒中的独立危险因素(OR=1.327,95%CI:1.071~1.645,P=0.010;OR=1.198,95%CI:1.032~1.364,P=0.022;OR=1.164,95%CI:1.043~1.285,P=0.001)。ROC曲线分析结果显示,NLR、PLR、LAD、CHA2DS2-VASc评分预测非瓣膜持续性房颤患者卒中风险的ROC曲线下面积分别为0.712、0.727、0.731、0.764,分别将NLR、PLR、LAD与CHA2DS2-VASc评分联合以及将上述4个指标联合,与CHA2DS2-VASc评分比较,AUC分别增加0.015、0.048、0.062、0.116,其中4项指标联合构建的ROC曲线下面积增加量最大,面积为0.880(P<0.05)。结论NLR、PLR、LAD是非瓣膜持续性房颤患者发生缺血性脑卒中的独立危险因素,三者联合CHA2DS2-VASc评分可以更好地预测非瓣膜持续性房颤患者缺血性脑卒中发生风险。Objective To investigate the relationship between neutrophil-to-lymphocyte ratio(NLR), platelet-to-lymphocyte ratio(PLR) and left atrial diameter(LAD) and ischemic stroke in patients with non-valvular persistent atrial fibrillation.Methods A total of 198 patients with non-valvular persistent atrial fibrillation hospitalized in Inner Mongolia People's Hospital from January 2019 to October 2022 were selected. According to whether they were complicated with acute ischemic stroke, they were divided into the simple persistent atrial fibrillation group(124 cases) and the ischemic stroke group(74 cases). The clinical data of the two groups were compared. Multivariate Logistic regression analysis was used to explore the risk factors of ischemic stroke in patients with non-valvular persistent atrial fibrillation. The receiver operating characteristic(ROC) curve was drawn to evaluate the predictive value of related indicators for ischemic stroke in patients with non-valvular persistent atrial fibrillation.Results The age, smoking history, ratio of hypertension, ischemic stroke and heart failure, NLR, PLR, LAD and CHA2DS2-VASc score in the ischemic stroke group were higher than those in the persistent atrial fibrillation group, and the left ventricular ejection fraction(LVEF) was lower than that in the control group(P<0.05).Multivariate Logistic analysis showed that NLR, PLR and LAD were independent risk factors for ischemic stroke in patients with non-valvular persistent atrial fibrillation(OR=1.327, 95%CI:1.071-1.645;OR=1.198,95%CI:1.032-1.364;OR=1.164,95%CI:1.043-1.285,P<0.05).ROC curve analysis showed that the area under the ROC curve of NLR, PLR,LAD and CHA2DS2-VASc score for predicting stroke risk in patients with non-valvular persistent atrial fibrillation was 0.712,0.727,0.731 and 0.764, respectively. Compared with the CHA2DS2-VASc score, the AUC of NLR, PLR, LAD combined with CHA2DS2-VASc score and the combination of the above four indicators increased by 0.015,0.048,0.062,0.116,respectively, and the area under the

关 键 词：房颤 缺血性脑卒中 左心房内径 

分 类 号：R541[医药卫生—心血管疾病]