NLR与PLR对急性冠脉综合征左室收缩功能障碍的预测价值  

Predictive value of neutrophils/lymphocytes and platelets/lymphocytes for left ventricular systolic dysfunction in acute coronary syndrome

作　　者：杨莉军[1] 周婉明[1] 梁万添 梁爱群[1] 陈锦峰[1] YANG Lijun;ZHOU Wanming;LIANG Wantian;LIANG Aiqun;CHEN Jinfeng(Department of Cardiovascular Medicine,Yuebei People′s Hospital,Shaoguan Guangdong 512026,China)

机构地区：[1]粤北人民医院心血管内科,广东韶关512026

出　　处：《中国急救复苏与灾害医学杂志》2023年第9期1194-1198,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：韶关市卫生计生科研项目(Y16036)。

摘　　要：目的探讨中性粒细胞/淋巴细胞比率(NLR)和血小板/淋巴细胞比率(PLR)对非ST段抬高急性冠状动脉综合征(NSTACS)患者左心室收缩功能障碍(LVSD)的预测价值。方法本研究为回顾性研究,评估了2018年6月—2020年6月粤北人民医院收治的NSTACS患者,应用Logistic回归分析NLR、PLR与NSTACS患者LVSD事件的相关性,通过受试者工作特征(ROC)曲线分析PLR、NLR对LVSD的预测价值,并比较预测价值大小。结果最终纳入100例NSTACS患者,其中LVSD组31例,无LVSD组69例,两组年龄、糖尿病占比、非ST段抬高型心肌梗死(NSTEMI)占比、既往心肌梗死(MI)占比、PLR水平、NLR水平具有统计学差异(P<0.05);单因素分析表明糖尿病、年龄≥65岁、NLR水平、PLR水平、既往MI、既往NSTEMI为NSTACS患者发生LVSD的独立危险因素(P<0.05);多因素分析表明调整混杂因素后,年龄≥65岁、NLR水平、PLR水平、既往MI、既往NSTEMI为LVSD发生的独立危险因素(P<0.05)。根据对LVSD最大预测价值的PLR值分为两组:A组(PLR>135.6)收缩压、内生肌酐清除率(Ccr)显著低于B组(PLR≤135.6)(P<0.05),肌酐急性心力衰竭及非致死性心肌梗死发生率高于B组(P<0.05)。根据对LVSD最大预测价值的NLR值分为两组:C组(NLR>3.02)总胆红素、三酰甘油、NLR、肌酐较D组(NLR≤3.02)显著增高(P<0.05),急性HF及非致死性MI的发生率高于D组(P<0.05)。前壁心梗组的左室收缩末容量(ESV)、左心室的射血分数(EF)、最小收缩末期容积时间的标准差(Tmsv16-SD)和最大时间差(Tmsv-DIF)均高于下壁MI组(P<0.05)。PLR和NLR两者联合预测的敏感度及特异度分别为81.25%及86.67%,较单独预测升高,有统计学差异(P<0.05)。结论发生LVSD的NSTACS患者其NLR、PLR水平更高;NLR及PLR为NSTACS患者发生LVSD的独立预测因子,曲线下面积分别为0.803及0.799,二者联合预测价值更强。Objective To investigate the predictive value of neutrophil/lymphocyte ratio(NLR)and platelet/lymphocyte ratio(PLR)on left ventricular systolic dysfunction(LVSD)in patients with non ST segment elevation acute coronary syndrome(NSTACS).Methods Retrospective evaluation was conducted on NSTACS patients admitted to our hospital from June 2018 to June 2020.Logistic regression was used to analyze the correlation between NLR,PLR and LVSD events in NSTACS patients.The predictive value of PLR and NLR to LVSD was analyzed through the receiver work characteristic(ROC)curve,and the predictive value was compared.Results 100 patients with NSTACS were included,31 patients in LVSD group and 69 patients in without LVSD group.Age,diabetes mellitus,NSTEMI,previous myocardial infarction(MI),PLR level and NLR level were statistically different between the two groups(P<0.05).Univariate analysis showed that diabetes,male,age≥65 years old,NLR level,PLR level,previous MI,previous NSTEMI were independent risk factors for LVSD in NSTACS patients(P<0.05).Multivariate analysis showed that after adjusting confounding factors,age≥65 years old,NLR level,PLR level,previous MI and previous NSTEMI were independent risk factors for LVSD(P<0.05).According the PLR value of the maximum predictive value of LVSD the patients were divided into two groups,and the systolic blood pressure and endogenous creatinine clearance(Ccr)of group A(PLR>135.6)were significantly lower than those of group B(PLR≤135.6)(P<0.05),the incidence of acute heart failure and non-fatal myocardial infarction was higher than that in group B(P<0.05).According the NLR value of the maximum predictive value of LVSD the patients were divided into two groups,and group C(NLR>3.02)had significantly higher total bilirubin,NLR and creatinine than group D(NLR≤3.02)(P<0.05),the incidence of heart failure and non-fatal myocardial infarction in group C was higher than that in group D(P<0.05).Left ventricular endsystolic volume(ESV),left ventricular ejection fraction(EF),standard deviatio

关 键 词：中性粒细胞/淋巴细胞比率 血小板/淋巴细胞比率 非ST段抬高急性冠脉综合征 左心室收缩功能障碍 

分 类 号：R541[医药卫生—心血管疾病]