【摘要】 目的 探讨高龄急性心力衰竭(AHF)患者入院早期中性粒细胞/淋巴细胞比值(NLR)与近期心血管不良事件的相关性。方法 选取2011-03~2014-09我院收治的78例高龄AHF患者为研究对象,以住院期间是否发生心血管不良事件分为不良事件组(n=31)和非事件组(n=47);比较两组入院时一般临床资料,血常规[白细胞计数(WBC)、中性粒细胞(NEU)计数及淋巴细胞(LYM)计数并计算两者间比值(NLR)]、高敏C-反应蛋白(hs-CRP),心功能相关指标等,并绘制受试者工作特征(ROC)曲线,分析NLR预测患者发生心血管不良事件的临床价值。结果 与非事件组比较,不良事件组患者心率偏快(P<0.05),WBC、NEU计数、NLR、NTproBNP、hs-CRP偏高(P<0.05),而LYM计数、LVEF偏低(P<0.05);Pearson相关分析显示,NLR与WBC、NT-proBNP及hs-CRP呈正相关(P<0.05),而与LVEF呈负相关(P<0.05);多因素Logistic回归分析显示,高水平NLR与高龄AHF患者心血管不良事件呈独立正相关(P<0.05);ROC曲线分析显示,NLR预测高龄AHF患者心血管不良事件发生的曲线下面积(AUC)为0.795(95%CI 0.536~0.927,P<0.05),最佳的诊断截点值为7.49,敏感度和特异度分别为77.1%和82.0%;以NLR的截点值7.49为分界将患者分为两组(NLR≥7.49组及NLR<7.49组),NLR≥7.49组患者心血管不良事件发生率高于NLR<7.49组(P<0.05)。结论 高水平NLR、炎症反应和心功能降低密切相关,且是高龄AHF患者发生近期心血管不良事件的高危因素,早期评估NLR水平对于判断高龄AHF患者近期预后具有一定的临床意义。更多还原

【Abstract】 Objective To investigate the correlation between adverse cardiovascular events and neutrophil and lymphocyte ratio(NLR) in aged patients with acute heart failure(AHF).Methods Seventy- eight cases of aged patients with AHF in our hospital from March 2011 to September 2014 were selected as the research subjects,all cases were divided into adverse event group(n = 31 cases) and non- event group(n = 47) according to adverse cardiovascular events;general clinical data on admission,routine blood[white blood cell count(WBC),the number of neutrophils(NEU) and lymphocyte count(LYM) and calculate the ratio between(NLR),high-sensitivity c-reactive protein(hs- CRP) and cardiac function related indicators were compared among two groups;and the receiver-operating characteristic curve(ROC curve) was drawn to analyze the clinical value of NLR predict the adverse cardiovascular events.Results Compared with the non- event group,heart rate in adverse events group was rapid,WBC counts,NEU,NLR,NT-proBNP,hs- CRP were higher(P<0.05),while LYM,LVEF were lower(P < 0.05);Pearson correlation analysis showed that NLR were positively correlated with WBC,NT- proBNP and hs- CRP(P < 0.05),while was negatively correlated with LVEF(P < 0.05);Multiariable Logistic regression analysis showed that high level of NLR was independently correlated with cardiovascular adverse events in elderly patients with AHF(P <0.05);ROC curve analysis showed that:the NLR prediction for older patients with AHF area under the curve of cardiovascular adverse events(ROCAUC) was 0.795(95%CI = 0.536-0.927,P <0.05),die best diagnostic cut- off value was 7.49,the sensitivity and specificity were 77.1%and 82.0%respectively;cut- off value of NLR with 7.49 for boundary divided the patients into two groups(NLR acuity 7.49 group and NLR <7.49),NLR acuity 7.49 higher incidence of adverse cardiovascular events in patients with NLR < 7.49 group(P < 0.05).Conclusion NLR is closely related to the inflammatory reaction and a decreased cardiac function.It is a risk factor for cardiovascular adverse events in elderly patients with AHF,therefore early detecting of NLR has certain clinical significance in judging the prognosis of elderly patients with AHF.更多还原