中性粒细胞与淋巴细胞比值对急性ST段抬高型心肌梗死患者介入治疗预后的影响

Predictive value of neutrophil to lymphocyte ratio in patients with acute ST-segment elevation myocardial infarction after percutaneous coronary intervention

目的探究中性粒细胞与淋巴细胞比值（NLR）对急性ST段抬高型心肌梗死（STEMI）患者急诊介入治疗预后的影响。方法选取徐州医科大学第二附属医院2014年1月至2016年10月来心血管内科就诊并行急诊经皮冠状动脉介入治疗（PCI）的STEMI患者405例，根据NLR水平将患者分为高NLR组（NLR≥3．40）和低NLR组（NLR〈3．40），平均随访12．2（中位数）个月，应用SPSS16．0软件进行统计分析。结果高NLR组患者的年龄（P=O．078）、血糖水平（P〈0．01）、白细胞（WBC）计数（P〈0．01）、尿素氮（BUN）水平（P=0．005）高于低NLR组，左心射血分数（LVEF）（P=0．002）低于NLR组；住院期间急性心力衰竭（P=0．017）及心室颤动（P=0．027）的发生率显著大于低NLR组；在院外，全因死亡率（P=0．037）、非致死性心肌梗死（P=0．020）、支架内狭窄（P=0．022）、主要心血管事件（MACE）的发生率显著大于低NLR组。二分类Logistic回归分析显示，高血压、血脂异常、LVEF和NLR为患者住院期间及院外发生MACE的独立危险因素（P均〈0．05）；ROC曲线下面积为0．649（95％C10．540-0．759）。结论NLR是STEMI行急诊介入治疗患者住院期间及远期预后的一个较好的独立预测指标。

Objective To investigate the value of neutrophil to lymphocyte ratio （NLR） to predict the prognosis of patients with ST-segment elevation myocardial infarction （STEMI） after percutaneous coronary inter- vention （PCI）. Methods A total of 405 patients with STEMI were included in the study. According to the NLR level, patients were divided into high NLR group （NLR≥3.40） and low NLR group （NLR〈3.40）. Results The age （P=0.078）, glucose （P〈0.01）, white blood cell （ WBC ） count （P〈0.01） and blood urea nitrogen （ BUN ） （P= 0.005 ） in the high NLR group were higher than those in the low NLR group, and the left ventricular ejection frac- tion（LVEF ）（P=0.002） was lower. The incidence of acute heart failure （P=0.017） and ventricular fibrillation （P= 0.027） was significantly higher than that of low NLR group during hospitalization. Mortality （P=0.037）, nonfatal myocardial infarction（P=0.020）, narrow in-stent（P=0.022）, the incidence of MACE was significantly higher than the low NLR group during the long-term. Binary logistic regression analysis showed that hypertension, dyslipidemi- a, LVEF and NLR were independent risk factors of MACE in-hospital and long-term, all of them were P〈0.05; ROC curve showed AUC 0.649 （95%CI 0.540-0.759）. Conclusion NLR is an independent predictor for in-hos- pital and long-term prognosis of patients with STEMI.