NLR与急性心肌梗死患者左室射血分数和预后的关系  

Relationship between neutrophil-to-lymphocyte ratio level and left ventricular ejection fraction and prognosis in patients with acute myocardial infarction

作　　者：余航 闫斌 肖懿慧 田刚[1] 雷新军[1] YU Hang;YAN Bin;XIAO Yi-hui;TIAN Gang;LEI Xin-jun(Department of Cardiology,First Affiliated Hospital,Xi’an Jiaotong University,Xi’an 710061,Shaanxi,China;Department of Clinical Research Center,First Affiliated Hospital,Xi’an Jiaotong University,Xi’an 710061,Shaanxi,China)

机构地区：[1]西安交通大学第一附属医院心血管内科,陕西西安710061 [2]西安交通大学第一附属医院临床研究中心,陕西西安710061

出　　处：《心脏杂志》2025年第1期19-23,29,共6页Chinese Heart Journal

基　　金：国家自然科学基金项目(82000414);陕西省重点研发计划项目(2018SF-079,2021SF-319)。

摘　　要：目的探讨急性心肌梗死(AMI)患者血清中性粒细胞/淋巴细胞比值(NLR)与左室射血分数及预后的关系。方法纳入813例急性心肌梗死患者,根据其左室射血分数(LVEF)分为两组:LVEF降低组(LVEF<50%,n=390)和对照组(LVEF正常组,LVEF≥50%,n=423)。按照血清NLR水平的三分位数将研究对象分为3组,低NLR组(NLR≤3.94)、中NLR组(3.94<NLR≤7.34)、高NLR组(NLR>7.34),比较各组间临床资料、生化指标的差异,多因素及多因素线性回归分析有统计学差异指标与患者LVEF的相关性。比较随访12个月心血管不良事件的发生率。结果LVEF降低组AMI患者NLR水平和其它项目如心率(HR)、白细胞计数、血肌酐、血清D-二聚体、超敏C-反应蛋白、GRACE评分、Gensini积分显著高于LVEF正常组的AMI患者,差异具有统计学意义(均P<0.05)。LVEF降低组AMI患者收缩压低于LVEF正常组的AMI患者,差异具有统计学意义(P<0.05)。NLR水平3分位组对比:3组的入院心率(HR)、白细胞计数、血肌酐、GRACE评分均随着NLR三分位数的增加而增加,多数项目邻组和跨组间均P<0.01,D-二聚体的中NLR组与高NLR组均高于低NLR组(均P<0.01),但中NLR组与高NLR组间无差异。同时,糖尿病史(邻组和跨组间均P<0.01)、入院收缩压(邻组和跨组间均P<0.05)、LVEF(邻组和跨组间均P<0.01)随着NLR三分位数的增加而减低,糖化血红蛋白高NLR组低于中NLR组和低NLR组(均P<0.01),但中NLR组和低NLR组之间无差异。线性回归分析提示,NLR水平与LVEF呈显著负相关性。进一步进行多因素线性回归分析,结果显示NLR(β=−0.248,P<0.01)和其它项目心率(β=−0.121,P<0.01)、GRACE评分(β=−0.043,P<0.05)、Gensini评分(β=−0.036,P<0.01)与LVEF呈负相关,收缩压(β=0.088,P<0.01)与LVEF呈正相关。在12个月的随访观察中,高NLR高组患者的心力衰竭发生率高于低NLR组患者(6.88%vs.3.69%,P<0.05),高NLR高组患者的恶性心律失常发生率高于低NLR组患者(5.65%vAIM To investigate the relationship between serum neutrophil-to-lymphocyte ratio(NLR)level and left ventricular ejection fraction(LVEF),as well as prognosis in patients with acute myocardial infarction(AMI).METHODS A total of 813 patients diagnosed with AMI who had undergone coronary angiography in our hospital from July 2017 to December 2018 were enrolled in this study and their data were analyzed retrospectively.The patients were divided into 3 groups based on serum NLR levels and the differences in baseline data and clinical biochemical indicators were compared between the groups.Regression analysis was conducted to examine the relationship between serum NLR and left ventricular ejection fraction(LVEF).A 12-month follow-up was performed and the occurrence rate of cardiovascular events was compared.RESULTS The NLR levels and other indicators such as heart rate(HR),white blood cell count,blood creatinine,serum D-dimer,hypersensitive C-reactive protein,GRACE score,and Gensini score of AMI patients in the LVEF reduced group were significantly higher than those in the LVEF normal group,and the differences were statistically significant(all P<0.05).The systolic blood pressure of AMI patients in the LVEF reduced group was lower than that of AMI patients in the LVEF normal group,and the difference was statistically significant(P<0.05).Comparison of the NLR level in the three quantile group:LVEF(both adjacent and cross group P<0.01)and other items of diabetes history(both adjacent and cross group P<0.01),admission systolic pressure(both adjacent and cross group P<0.05)decreased with the increase of the NLR triple,and glycosylated hemoglobin HIGH NLR group was lower than LOW NLR GROUP and MIDDLE NLR groups(both P<0.01),but there was no difference between LOW NLR GROUP and MIDDLE NLR groups.At the same time,the admission heart rate(HR),white blood cell count,blood creatinine,and GRACE score of the three groups all increased with the increase of NLR interquartile,and most items were P<0.01 between adjacent and cross group

关 键 词：急性心肌梗死 中性粒细胞淋巴细胞比值 左室射血分数 预后 

分 类 号：R541.4[医药卫生—心血管疾病]