中性粒细胞/淋巴细胞比值与非瓣膜性心房颤动患者左心房血栓的相关性研究  

Correlation between neutrophil/lymphocyte ratio and left atrial thrombosis in patients with nonvalvular atrial fibrillation

作　　者：张智文 王雪莹 郭权 杨海涛 李牧蔚 Zhang Zhiwen;Wang Xueying;Guo Quan;Yang Haitao;Li Muwei(Department of Cardiology,People's Hospital,Zhengzhou University,Zhengzhou 450003,China;不详)

机构地区：[1]郑州大学人民医院心内科河南省人民医院心脏中心阜外华中心血管病医院,郑州450003 [2]新乡医学院附属河南省人民医院,郑州450003

出　　处：《中国循证心血管医学杂志》2024年第1期39-44,共6页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：国家自然科学基金面上项目(82270474)。

摘　　要：目的探讨中性粒细胞/淋巴细胞比值(NLR)与非瓣膜性心房颤动(房颤)患者左心房血栓的相关性,以及使用NLR预测非瓣膜性房颤患者合并左心房血栓的临床价值。方法回顾性分析2012年1月至2018年1月于河南省人民医院接受经食道超声心动图(TEE)检查的387例非瓣膜性房颤患者的临床资料,根据TEE检查患者左心房是否存在血栓,将患者分为血栓组(n=46)和非血栓组(n=341)。比较两组患者之间的一般临床资料、实验室检查指标及超声心动图检查指标是否存在差异,采用单因素及多因素Logistic回归方程分析非瓣膜性房颤患者发生左心房血栓的相关危险因素,使用受试者工作特征(ROC)曲线及曲线下面积(AUC)评价NLR预测非瓣膜性房颤患者合并左心房血栓的临床价值。结果一般临床资料方面比较,血栓组患者年龄、房颤病程、非阵发性房颤比例、心力衰竭、卒中史和CHA2DS2-VASc评分均高于非血栓组,差异有统计学意义(P<0.05);实验室检查指标方面比较,血栓组中性粒细胞、NLR、C反应蛋白(CRP)和N末端脑钠肽前体(NT-proBNP)均高于非血栓组,而淋巴细胞低于非血栓组,差异均有统计学意义(P<0.05);超声心动图检查指标方面比较,血栓组左心房内径高于非血栓组,而左心室射血分数低于非血栓组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,非阵发性房颤、卒中史、高CHA2DS2-VASc评分、NLR升高、C反应蛋白升高、左心房内径增大是非瓣膜性房颤患者合并左心房血栓的独立危险因素(P<0.05),而左心室射血分数则是其独立保护因素(P<0.05)。ROC曲线结果显示,NLR预测非瓣膜性房颤患者合并左心房血栓的AUC为0.733(95%CI:0.686~0.776,P<0.001),NLR联合CHA2DS2-VASc评分的AUC为0.771(95%CI:0.726~0.812,P<0.001)。结论高NLR是非瓣膜性房颤患者合并左心房血栓的独立危险因素,使用CHA2DS2-VASc评分联合NLR预测非瓣膜性房颤患�Objective To discuss the correlation between neutrophil/lymphocyte ratio(NLR)and left atrial thrombosis in patients with non-valvular atrial fibrillation(NVAF),and clinical value of NLR in predicting NVAF complicated by left atrial thrombosis.Methods The clinical materials were retrospectively analyzed in NVAF patients(n=387)received examination of transesophageal echocardiography(TEE)in People’s Hospital of Henan Province from Jan.2012 to Jan.2018.According to TEE results,all patients were divided into thrombosis group(n=46)and non-thrombosis group(n=341).The general clinical materials and indexes of laboratory examination and echocardiogram were compared between 2 groups.The risk factors related to left atrial thrombosis were analyzed by using single-factor and multi-factor Logistic regressions in NVAF patients.The clinical value of NLR in predicting NVAF complicated by left atrial thrombosis was reviewed by using ROC curve and AUC analyses.Results The comparison in general clinical materials showed that age,AF course,percentage of non-paroxysmal atrial fibrillation(PAF),heart failure,stroke history and CHA2DS2-VASc score were all higher in thrombosis group than those in non-thrombosis group(P<0.05).The comparison in indexes of laboratory examination showed that levels of neutrophile granulocyte,NLR,C-reactive protein(CRP)and N-terminal pro-brain natriuretic peptide(NT-proBNP)were higher,and lymphocyte was lower in thrombosis group than those in non-thrombosis group(P<0.05).The comparison in indexes of echocardiogram showed that left atrial diameter(LAD)was higher,and left ventricular ejection fraction(LVEF)was lower in thrombosis group than those in non-thrombosis group(P<0.05).The multi-factor Logistic regression analysis showed that non-PAF,stroke history,high CHA2DS2-VASc score,increased NLR,CRP and LAD were independent risk factor(P<0.05),and LVEF was an independent protective factor(P<0.05)of NVAF complicated by left atrial thrombosis.The results of ROC curve analysis showed that AUC of NLR in predictin

关 键 词：心房颤动 中性粒细胞/淋巴细胞比值 左心房血栓 

分 类 号：R541.75[医药卫生—心血管疾病]