中性粒–淋巴细胞比值在缺血性心肌病预后预测作用——预测价值研究  

The Forecasting Role of Neutrophil to Lymphocyte Ratio in Ischemic Cardiomyopathy Prognosis: The Research of Prediction Value

作　　者：努尔艾合麦提·加马力 单雪峰[1] 

机构地区：[1]新疆医科大学第一附属医院小儿心胸外科,新疆 乌鲁木齐

出　　处：《临床医学进展》2023年第6期10585-10600,共16页Advances in Clinical Medicine

摘　　要：目的:评估中性粒细胞–淋巴细胞比值(NLR)在缺血性心肌病(Ischemic cardiomyopathy, ICM)患者预后作用,找出预测缺血性心肌病预后的方法。方法:收集2014年1月至2020年11月因缺血性心肌病在新疆医科大学第一附属医院心血管中心住院患者。经筛选后2147例患者纳入本研究。收集患者基本信息及临床资料,包括但不限于血常规、心脏超声等。对纳入患者进行电话机门诊随访,并记录相关终点事件及发生时间。终点事件指严重的心脑血管不良事件(MACCE),包括全因死亡、心源性死亡、急性心肌梗死、慢性心力衰竭、缺血性卒中或短暂性脑缺血发作等。结果:平均随访时间为45 (24.5, 71)个月,在2147例患者中随访期间共589 (27.4%)例患者发生MACCE。对MACCE组和非MACCE组进行基线资料的比较,发现MACCE组NLR水平显著高于非MACCE组(P < 0.05)。ROC曲线显示NLR预测ICM患者发生MACCE的曲线下面积(AUC) = 0.66,P < 0.05,当截断为3.14时,其灵敏度为53.3%,特异度为75%,约登指数为0.283。将所有患者根据NLR的cut off值分为2组,高NLR水平组(≥3.14 mg/L),低NLR水平组(<3.14 mg/L)。NLR高值组患者发生MACCE,全因死亡率及心源性死亡率显著高于NLR低值组。单因素及多因素COX回归分析显示NLR是缺血性心肌病患者发生MACCE [HR = 2.65, 95% CI (2.24, 3.14), P < 0.001],全因死亡[HR = 3.71, 95% CI (2.94, 4.67), P < 0.001],心原性死亡[HR = 3.67, 95% CI (2.80, 4.86), P < 0.001。结论:NLR对缺血性心肌病患者预后有良好的预测价值。Objective: To evaluate the prognostic role of neutrophil-lymphocyte ratio (NLR) in patients with is-chemic cardiomyopathy (ICM) and identify methods to predict the prognosis of ischemic cardiomy-opathy. Methods: The prognosis of patients with ischemic cardiomyopathy (ICM) in the First Affili-ated Hospital of Xinjiang Medical University was collected from January 2014 to November 2020. After screening, 2147 patients were included in this study. Basic patient information and clinical information, including but not limited to blood count, cardiac ultrasound, etc., were collected. The included patients were followed up with telephone machine outpatient visits, and relevant end-point events and the time of occurrence were recorded. Endpoint events were defined as serious adverse cardiovascular and cerebrovascular events (MACCE), including all-cause death, cardiac death, acute myocardial infarction death, chronic heart failure, ischemic stroke, or transient is-chemic attack. Results: The mean follow-up time was 45 (24.5, 71) months, and among 2147 pa-tients, a total of 589 (27.4%) patients experienced MACCE during the follow-up period. Comparing the baseline data between the MACCE group and the non-MACCE group, it was found that the MACCE group had significantly higher NLR levels than the non-MACCE group (P < 0.05). The ROC curve showed that the NLR predicted the occurrence of MACCE in ICM patients with an area under the curve (AUC) of 0.66, P < 0.05. When the cutoff was set at 3.14, the sensitivity was 53.3%, the speci-ficity was 75%, and the Jorden index was 0.283. All patients were divided into two groups based on the cutoff value of NLR: the high NLR group (≥3.14 mg/L) and the low NLR group (<3.14 mg/L). Pa-tients in the high NLR group had a significantly higher incidence of MACCE, overall mortality rate, and cardiac death rate compared to the low NLR group. Univariate and multivariate COX regression analysis showed that NLR was associated with the occurrence of MACCE in patients with ischemic cardiomyopathy [HR

关 键 词：缺血性心肌病 中性粒–淋巴细胞比值 预后 

分 类 号：R54[医药卫生—心血管疾病]