中性粒细胞/淋巴细胞与急性冠状动脉综合征及其预后的关系

The association of the neutrophils/lymphocytes ratio and patients suspected of acute coronary syndrome and its prognosis

目的探讨中性粒细胞/淋巴细胞(NLR)与急性冠状动脉综合征(ACS)及其预后的关系。方法入选我院经冠状动脉造影检查的160例可疑冠心病患者,其中不稳定型心绞痛组(UA组)50例,急性心肌梗死(AMI)组60例,正常对照组50例,对照组为冠状动脉造影阴性的非冠心病患者。检测各组的白细胞计数(WBCC)、中性粒细胞计数(NC)、淋巴细胞计数(LC)、超敏C反应蛋白(hs-CRP),并计算NLR。比较各组之间各项指标水平的差异,并进行Logistic回归分析。另对行PCI术的48例AMI患者按NLR大小均分为两组,分别进行为期一年的随访,记录或计算各组的死亡率、死亡原因、再住院率及左心室重构率。结果 (1)随着病情严重程度的升高WBCC、NC、hs-CRP、NLR水平逐渐升高(P<0.05或P<0.01),AMI组的LC水平较对照组明显升高[(1.7±0.7)×109/Lvs.(1.2±0.4)×109/L,P<0.05]。(2)多因素Logistic回归分析WBCC(OR5.960,95%CI5.278～6.729,P<0.01),hs-CRP(OR10.827,95%CI7.498～15.632,P<0.001)、NLR(OR9.915,95%CI7.958～12.351,P<0.001)均为ACS的独立危险因素,NLR与hs-CRP预测ACS的价值相当。(3)随访结果:NLR较高组的PCI术患者一年全因死亡率(25.0%vs.4.2%,P<0.05)、左心室重构率(37.5%vs.12.5%,P<0.05)较低NLR组明显偏高。结论 NLR是ACS的独立危险因素,其预测价值较WBCC高,与hs-CRP相当。NLR与PCI术患者术后一年全因死亡率、左心室重构率密切相关。

Objective To investigate the relationship between the neutrophil to lymphocyte ratio（ NLR） and patients suspected of acute coronary syndrome（ ACS） and its prognosis. Methods A total of 160 patients treated in our hospital who were doubted coronary heart disease and examined by coronary angiography（CAG） were studied. The patients were divided into 3 groups as unstable angina（UA） group, n = 50 ;acute myocardial infarction（AMI） group, n = 60;and control group, n = 50, the patients CAG showed no evidence of coronary artery disease. White blood cell count （WBCC）, neutrophil count （NC）, lymphocyte count （LC）and hs-CRP were measured, N/L ratio were calculated. Multivariate logistic regression analysis were performed. Results （1）The more severe the disease, the higher of levels of WBCC, NC, hs-CRP and NLR （ P 〈 0. 05 or P 〈 0. 01 ）. The values of LC in AMI group were significantly higher than control group[ （ 1.7 ± 0. 7 ） × 10^9/L vs. （ 1.2 ± 0. 4） × 10^9/L, P 〈 0. 05 ]. （2） Multivariate logistic regression analysis（forward method）indicated that WBCC（ OR 5.960,95% C1 5.278-6. 729 ,P 〈0. 01 ）, hs- CRP（ OR 10. 827,95% C1 7. 498-15. 632 ,P 〈 0. 001 ）, NLR （ OR 9. 915,95% CI 7. 958-12. 351, P 〈 0. 001 ） were interrelated with ACS. （3）The results as followed： The all cause mortality （4. 2% vs. 25.0%, P 〈 0. 05 ）and left ventricular（LV） remodeling rate of the high NLR group significantly higher than low group（ 12. 5% vs. 37.5% ,P 〈 0. 05）. Conduslons NLR is a powerful independent risk factor for ACS. Its predictive value is more important than that of WBCC, equivalent to hs-CRP. The NLR is closely to the 1 year all cause mortality and LV remodeling of the patients undergoing PCI.