【摘要】 目的探讨中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)对心房颤动(房颤)患者射频消融术(radiofrequency catheter ablation,RFCA)后复发的临床意义。方法回顾性分析2018年1月至2019年1月在我院接受RFCA的166例房颤患者的临床资料,按照RFCA后6个月房颤是否复发,将其分为复发组(48例)和未复发组(118例)。分析两组患者的一般临床资料,采用Logistic回归方程分析RFCA后房颤复发的相关因素,使用受试者工作特征(ROC)曲线评价NLR预测RFCA后房颤复发的价值。结果与未复发组相比,复发组基线资料中的血肌酐水平较高[(95.1±20.6)mmol/L比(84.6±19.7)mmol/L,P<0.05];两组患者RFCA前左心房内径(LAD)、左心室射血分数(LVEF)、中性粒细胞计数、淋巴细胞计数和NLR之间的差异无统计学意义(P>0.05);RFCA后复发组LAD、中性粒细胞计数、NLR均高于未复发组[(38.6±2.6)mm比(35.0±3.4)mm、(5.2±0.6)×10~9/L比(4.8±0.5)×10~9/L、2.9±0.5比2.3±0.5,P均<0.05],淋巴细胞计数低于未复发组[(1.8±0.3)×10~9/L比(2.3±0.3)×10~9/L,P<0.05],两组患者LVEF无明显差异(P>0.05)。多元Logist ic回归方程显示,NLR是RFCA后房颤复发的独立危险因素(P<0.001)。ROC曲线结果显示,RFCA后NLR预测房颤复发的曲线下面积(AUC)为0.802(95%CI0.725~0.880,P<0.05),高于RFCA后6个月时中性粒细胞计数的面积0.671 (95%CI0.580~0.762,P<0.05)和患者血肌酐水平的面积0.635 (95%CI0.543~0.727,P<0.05)。结论房颤患者RFCA后NLR水平升高可能是预测房颤复发的早期预警信号,可通过加强对NLR的监测以评估患者的预后。更多还原

【Abstract】 Objective To investigate the clinical significance of neutrophil-lymphocyte ratio(NLR) in the evaluation of the recurrence after radiofrequency catheter ablation(RFCA) in patients with atrial fibrillation.Methods A retrospective analysis of clinical data of 166 patients with atrial fibrillation who underwent RFCA in our hospital from January 2018 to January 2019 were done.According to whether AF recurred at 6 months after RFCA,the patients were divided into recurrent group(n=48) and non-recurrent group(n=118).The general clinical data of the two groups were analyzed.Logistic regression equation was used to analyze the factors related to the recurrence of AF after RFCA.The receiver operating characteristic(ROC) curve was used to evaluate the value of NLR in predicting the recurrence of AF after RFCA.Results Compared with the non-recurrent group,the serum creatinine level in the baseline data of the recurrence group was higher[(95.1±20.6)mmol/L vs.(84.6±19.7) mmol/L,P<0.05].There were no significant differences in the left atrial internal diameter(LAD),left ventricular ejection fraction(LVEF),neutrophil count,lymphocyte count and NLR between the two groups of patients before RFCA(P>0.05).After RFCA,the LAD,neutrophil count and NLR in the recurrent group were higher than those in the non-recurrent group [(38.6±2.6)mm vs.(35.0±3.4)mm,(5.2±0.6)×10~9/L vs.(4.8±0.5)×10~9/L,2.9±0.5 vs.2.3±0.5,all P<0.05] and the lymphocyte counts were lower than those in the non-relapse group [(1.8±0.3) × 10~9/L vs.(2.3±0.3) × 10~9/L,P<0.05];there were no significant differences in LVEF between the two groups(P>0.05).Multivariate Logistic regression equations showed that NLR was an independent risk factor for recurrence of AF after RFCA.The ROC curve showed that the area under the curve(AUC) of NLR in predicting the recurrence of AF after RFCA was 0.802(95%CI 0.725-0.880,P<0.05),which was longer than the area of neutrophil count 0.671(95%CI 0.580-0.762,P<0.05) and the area of serum creatinine 0.635(95%CI0.543-0.727,P<0.05) at 6 months after RFCA.Conclusion An elevated level of NLR after RFCA in patients with atrial fibrillation may be an early warning signal for predicting recurrence of atrial fibrillation,which can be assessed by enhancing NLR monitoring.更多还原