【摘要】 目的 探讨患者术前中性粒细胞/淋巴细胞比值(NLR)对非体外循环下冠状动脉旁路移植术(OPCABG)后心肌损伤以及临床预后的影响。方法 选取2014年1月—2019年12月我院收治的314名行OPCABG的患者，依据患者术前NLR的三分位数分为高比值组(NLR>2.8,n=102)、中比值组(2.8≥NLR≥1.6,n=106)以及低比值组(NLR<1.6,n=106)。分别检测患者术前基线、术后8 h及术后24 h肌酸激酶同工酶(CKMB)及肌钙蛋白(CTnI)水平。结果 高比值组患者术后心肌损伤发生率显著高于中比值组及低比值组(P<0.05)。高比值组术后CKMB峰值显著高于中比值组[2.1(1.2～13.0) ng/mL vs 2.0(1.0～7.3) ng/mL,P=0.047]及低比值组[2.1(1.2～13.0) ng/mL vs 1.1(0.9～1.6) ng/mL,P<0.001]。且高比值组患者术后CTnI峰值同样显著高于中比值组[0.075(0.010～0.185) ng/mL vs 0.020(0.000～0.103) ng/mL,P=0.011],以及低比值组[0.075(0.010～0.185) ng/mL vs 0.010(0.000～0.030) ng/mL,P<0.001]。术前NLR较高是术后患者CTnI升高的独立危险因素(OR:2.809; 95%CI:1.326～5.954;P=0.007)。高比值组患者1年不良心血管事件发生率显著高于中比值组及低比值组(HR:1.80; 95%CI:1.16～2.79; Log Rank P=0.021)。结论 患者术前中性粒细胞/淋巴细胞比值升高是非体外循环冠状动脉旁路移植术后心肌损伤的独立危险因素，而且会增加患者不良心血管事件。更多还原

【Abstract】 Objective To evaluate the impact of preoperative neutrophil-lymphocyte ratio on myocardial injury after off-pump coronary artery bypass grafting and 1 year clinical outcomes. Methods Three hundred and fourteen consecutive patients who underwent off-pump coronary artery bypass grafting were enrolled in the study and divided into three groups in accordance with tertiles of neutrophil-lymphocyte ratio at baseline. Serum creatine kinase-MB and troponin I levels were measured at baseline and at 8 and 24 hours postoperatively, while clinical outcomes were followed up for 1 year. Results The occurrence of postprocedural myocardial injury was significantly higher in tertile 3. Postprocedural peak creatine kinase-MB values of patients in tertile 3 [2.1(1.2-13.0) ng/mL] were significantly higher than patients in tertile 2 [2.0(1.0-7.3) ng/mL, P=0.047] and tertile 1 [1.1(0.9-1.6) ng/mL, P<0.001]. Postprocedural troponin I levels in tertile 3 patients [0.075(0.010-0.185) ng/mL] were higher than those in tertile 2 [0.020(0.000-0.103) ng/mL, P=0.011] and tertile 1 [0.010(0.000-0.030) ng/mL, P<0.001]. Elevated neutrophil-lymphocyte ratio was an independent predictor of postprocedural troponin I elevation(OR 2.809; 95% CI:1.326-5.954; P=0.007). Event-free survival was significantly associated with neutrophil-lymphocyte ratio tertiles, with worse rate in tertile 3 than in tertile 2 and tertlie 1 patients(HR 1.80; 95%CI:1.16-2.79; Log Rank P=0.021).Conclusion Elevated preoperative neutrophil-lymphocyte ratio is an independent predictor of myocardial injury after off-pump coronary artery bypass grafting and is associated with worse clinical outcomes during 1 year follow-up.更多还原