【摘要】 目的 探讨中性粒细胞/淋巴细胞比值(NLR)联合乏氧诱导因子-1α(HIF-1α)检测在老年急性左心衰竭患者中的变化及临床意义。方法 选取2018年2月—2020年2月青海省西宁市第二人民医院收治的118例老年急性左心衰竭患者，另选取同期来院体检的110例健康者。比较两组入院时血清NLR、HIF-1α水平，随访28 d，统计老年急性左心衰竭患者死亡率，比较死亡患者与生存患者临床特征，采用Logistic回归分析判定影响老年急性左心衰竭患者死亡的因素，采用受试者工作曲线(ROC)分析血清NLR、HIF-1α水平预测老年急性左心衰竭患者死亡的价值。结果 急性左心衰竭患者血清NLR、HIF-1α水平均高于健康者(P<0.05)；随访28 d，老年急性左心衰竭患者死亡率为24.14%；死亡患者NYHA心功能分级Ⅲ级、合并多器官功能障碍发生率均高于存活患者(均P<0.05)，死亡患者血清NLR、HIF-1α均高于存活患者(均P<0.05);Logistic多因素回归分析显示NLR、HIF-1α水平、合并多器官功能障碍均是老年急性左心衰竭患者死亡的独立危险因素(P<0.05);ROC分析显示，血清NLR、HIF-1α水平预测老年急性左心衰竭患者死亡的最佳截断点分别为6.11、5.96 ng/L，灵敏度分别为71.43%、75.00%，特异度分别为84.09%、79.55%，曲线下面积(AUC)分别为0.726、0.760，二者联合的特异度、AUC分别为97.73%、0.825。结论 老年急性左心衰竭患者血清NLR、HIF-1α水平均异常升高，二者均是患者死亡的独立危险因素，临床联合监测血清NLR、HIF-1α水平预测老年急性左心衰竭患者死亡的价值更高。更多还原

【Abstract】 Objective To explore the changes and clinical significance of neutrophil/lymphocyte ratio(NLR) combined with hypoxia inducible factor-1α(HIF-1α) in elderly patients with acute left heart failure.Methods 118 patients with acute left heart failure, aged(60.72±9.44) were hospitalized and followed up for 28 days to record the mortality. 110 sex and aged-matched healthy physical examinees during the same period were used as control group. Peripheral fasting venous blood samples were collected from the 118 patients and the control group to test the levels of neutrophils and lymphocytes to calculate the NLR and to measure the serum HIF-1α by ELISA. Relevant clinical data were collected too. Multivariate logistic regression analysis was used to identify the independent risk factors for death of the patients.ROC analysis was conducted to analyze the values of NLR, HIF-1α, and combination of the 2 in predicting the death of the patients.Results During the 28-d follow-up 28 patients died with a mortality rate of 24.14%, and 2 patients were lost in touch. The levels of serum NLR and HIF-1α of the patients with acute left heart failure were both significantly higher than those of the healthy examinees(both P<0.05). The incidence of NYHA heart function classification Ⅲ and multiple organ dysfunction in the dead patients were higher than those in the surviving patients(all P<0.05), and the serum NLR and HIF-1α of the dead patients were higher than those in the surviving patients(all P<0.05). Logistic multivariate regression analysis showed that NLR level, HIF-1α level, and multiple organ dysfunction were independent risk factors for death in elderly patients with acute left heart failure(all P<0.05). ROC analysis showed that the best cut-off points for serum NLR and HIF-1α levels to predict death of the elderly patients with acute left heart failure were 6.11 and 25.96 ng/L the sensitivity were 71.43% and 75.00%, the specificity were84.09% and 79.55%, the area under the curve(AUC) were 0.726 and 0.76 respectively, and the combined specificity and AUC were 97.73% and 0.825 respectively.Conclusion Elderly patients with acute left heart failure have abnormally elevated serum NLR and HIF-1α levels, both of which are independent risk factors for patient death.Combined monitoring of serum NLR and HIF-1α levels is more valuable in predicting the death of elderly patients with acute left heart failure.更多还原