【摘要】 目的探讨中性粒细胞与淋巴细胞比值(NLR)对ST段抬高型心肌梗死(STEMI)患者行经皮冠状动脉介入治疗(PCI)术后7 d内发生主要不良心血管事件(MACE)的预测价值。方法选择2014年1月~2016年1月于四川省乐山市人民医院心内科行PCI的STEMI患者136例,其中男性71例,女性65例,平均年龄(64.58±11.72)岁。依据NLR水平分为高NLR组(>2.43,69例)和低NLR组(≤2.43,67例)。根据整体风险分层(GRC)评分将患者分为:低危组(41例)、中危组(67例)、高危组(28例)。收集所有患者病史、吸烟史、家族史等资料。入院后检测C反应蛋白(CRP)等指标,术后检测白细胞计数、淋巴细胞计数和N末端脑钠肽前体(NT-pro BNP)水平,并计算出NLR。PCI术后观察7 d,记录MACE及其发生时间。结果与低NLR组比较,高NLR组糖尿病病史比例、NT-pro BNP、CRP、中性粒细胞、NLR、MACE发生率升高,淋巴细胞减少,差异有统计学意义(P均<0.05)。低危组NLR为(1.52±0.48),中危组为(2.41±0.52),高危组为(4.28±0.87),MACE发生率分别9.76%、19.4%、53.57%,随着GRC风险分层的上升MACE发生率增加,NLR升高,差异有统计学意义(P均<0.05)。ROC曲线分析NLR、GRC评分、GRC评分+NLR对发生MACE的预测价值,曲线下面积(AUC)分别为:0.862(95%CI:0.791~0.974)、0.907(95%CI:0.855~0.967)、0.938(95%CI:0.886~0.989)。多因素分析结果提示,NLR(OR=2.794,95%CI:1.655~5.404)、年龄(OR=1.451,95%CI:1.602~1.842)、NT-pro BNP(OR=1.326,95%CI:1.063~1.814)、糖尿病病史(OR=2.473,95%CI:1.571~3.679)、高血压病史(OR=1.305,95%CI:1.041~3.816)均是STEMI患者PCI术后7 d内发生MACE的独立危险因素。结论中性粒细胞/淋巴细胞比值与年龄、NT-pro BNP、糖尿病病史、高血压病史是STEMI患者PCI术后7 d内发生MACE的独立危险因素,同时联合GRC评分可高效预测STEMI患者PCI术后7 d内MACE的发生,可辅助细化此类患者危险分层管理。更多还原

【Abstract】 Objective To investigate the predictive value of neutrophil-lymphocyte ratio(NLR) to major adverse cardiovascular events(MACE) in patients with ST-segment elevation myocardial infarction(STEMI) within 7 d after percutaneous coronary intervention(PCI). Methods STEMI patients undergone PCI(n=136, male 71, female 65 and average age=64.58±11.72) were chosen from the Department of Cardiology of People’s Hospital of Leshan City from Jan. 2014 to Jan. 2016. All patients were divided, according to NLR level, into high-NLR group(>2.43, n=69) and low-NLR group(≤2.43, n=67). According to scores of global risk classification(GRC), the patients were divided into low-risk group(n=41), mid-risk group(n=67) and high-risk group(n=28). The materials including medical history, smoking history and family history were collected from the patients. The index of C-reactive protein(CRP) was detected after hospitalization, levels of white blood cell count(WBC), lymphocyte count and N-terminal pro-brain natriuretic peptide(NT-pro BNP) were detected after PCI, and NLR level was calculated. The patients were observed for 7 d after PCI, and the occurrence of MACE was recorded. Results Compared with low-NLR group, the percentage of diabetic cases, levels of NT-pro BNP, CRP, neutrophile granulocyte, NLR and MACE incidence increased, and lymphocytes decreased in high-NLR group(all P<0.05). NLR level was(1.52±0.48) in low-risk group,(2.41±0.52) in mid-risk group and(4.28±0.87) in high-risk group, and MACE incidence was 9.76% in low-risk group, 19.4% in mid-risk group and 53.57% in high-risk group. As GRC increased, MACE incidence and NLR level increased(all P<0.05). The results of receiver operating curve(ROC) analyzing on predictive values of NLR, GRC scores and GRC scores+NLR to MACE showed AUC was, respectively, 0.862(95%CI: 0.791-0.974), 0.907(95%CI: 0.855-0.967) and 0.938(95%CI: 0.886~0.989). The results of multi-factor analysis showed that NLR(OR=2.794, 95%CI: 1.655~5.404), age(OR=1.451, 95%CI: 1.602~1.842), NT-pro BNP(OR=1.326, 95%CI: 1.063~1.814), diabetic history(OR=2.473, 95%CI: 1.571~3.679) and hypertensive history(OR=1.305, 95%CI: 1.041~3.816) were independent risk factors of MACE within 7 d after PCI in STEMI patients. Conclusion NLR, age, NT-pro BNP, diabetic history and hypertensive history are independent risk factors of MACE within 7 d after PCI in STEMI patients. NLR combining GRC scores can effectively predict the incidence of MACE within 7 d after PCI in STEMI patients, which can assist refining the management of risk stratification in these patients.更多还原