【摘要】 目的急性心肌梗死较高的住院死亡率需要寻找准确、简便的预测指标,以利尽早进行干预,改善AMI患者预后。该研究旨在探讨中性粒细胞/淋巴细胞比率(NLR)对急性心肌梗死(AMI)患者住院死亡率的预测价值。方法入选2010年1月~2011年12月河北大学附属医院急性心肌梗死患者528例,记录所有患者入院即刻白细胞分类计数,按中性粒细胞/淋巴细胞比率(NLR)以四分位法分为四组,分别统计比较各组的基础资料及住院死亡率,并确定住院死亡率与不同NLR水平间的相关关系。结果随着NLR的增加,心率(次/份)、白细胞计数(×109/L)、中性粒细胞百分比(%)、CK-MB峰值(u/L)显著增加,Killip分级Ⅲ~Ⅳ级患者比例(是/否)逐渐增多,差异有显著性([75.5±21.5)v(s76.2±15.4)vs(81.1±20.7)v(s86.3±19.6),P=0.000;(7.34±2.14)v(s8.50±2.84)v(s10.07±3.51)v(s13.23±7.04),P=0.000;(53.87±5.85)v(s67.30±4.64)v(s77.71±3.74)vs(86.61±3.70),P=0.000;(43.29±52.15)vs(71.46±106.18)vs(81.44±91.89)vs(119.99±204.90),P=0.000;14/118 vs 33/99 vs 34/98 vs 45/87,P=0.000]。与其他各组相比,最高四分位数患者的平均年龄较高,平均舒张压水平较低,并且血肌酐异常(>2 mg/dL)者所占比例较高([62.9±11.6)v(s63.1±12.3)v(s64.5±13.2)v(s69.0±12.7),P=0.000;(78.8±8.9)v(s74.9±13.9)v(s76.8±13.3)v(s73.7±12.9),P=0.024;1/131 vs 2/130 vs5/127 vs 12/120,P=0.002]。NLR与住院死亡率呈显著的正相关关系(r=0.231,P=0.04),最高四分位数患者的住院死亡率是最低四分位数患者的6倍以上,差异有显著性(3.79 vs 6.82 vs 11.36 vs 24.214,P=0.000)。死亡组患者的WBC计数、NLR较存活组显著升高([13.36±5.87)vs(9.33±4.49),P=0.000;(10.49±7.89)vs(6.17±12.63),P=0.009]。Logistic回归分析显示NLR与AMI患者住院死亡率有显著的相关性[P=0.005,OR=1.802,95%可信区间为(1.242~2.066)]。结论 AMI后NLR与住院死亡率之间存在显著的正相关,是急性心肌梗死患者住院死亡率的可靠预测指标。更多还原

【Abstract】 【Objective】To investigate the relationship between neutrophil/lymphocyte ratio(NLR) and the in hospital mortality in acute myocardial infarction(AMI).【Methods】 528 consecutive AMI patients in affiliated hospital of Hebei University were analyzed.Patients were stratified according to quartiles of the mean neutrophil/lymphocyte ratio.【Results】Relative to patients in the other three lower N/L ratio quartiles,patients in the highest quartile were more than six times more likely to die during hospitalization(P =0.000).By multivariate regression analysis including baseline demographic and clinical,the N/L ratio in the highest quartile remained an independent predictor of mortality(odds ratio 1.802,95% confidence interval(CI) 1.242 to 2.066;P =0.005).【Conclusion】NLR is a strong independent predictor of in-hospital mortality in acute myocardial infarction.更多还原