中性粒细胞/淋巴细胞比值与急性心肌梗死患者行急诊经皮冠状动脉介入治疗术后对比剂肾病发生的相关性

The correlation between neutrophil/lymphocyte ratio and contrast-induced nephropathy after primary percutaneous coronary intervention in patients with acute myocardial infraction

目的 探讨中性粒细胞/淋巴细胞比值（neutrophil/lymphocyte ratio,NLR）与急性ST段抬高心肌梗死（STEMI）患者行急诊经皮冠状动脉介入治疗（PCI）术后发生对比剂肾病（contrastinduced nephropathy,CIN）的相关性.方法 入选500例行急诊PCI的患者,CIN定义为使用对比剂后48～72 h内血肌酸酐（肌酐）值较基线值升高超过44.2 μmol/L或者较原基础值升高25％以上.比较CIN组与非CIN组之间的基线资料及院内不良临床事件发生率.采用受试者工作特征（ROC）曲线及Logistics回归分析评估NLR与CIN风险的相关性.结果 500例患者中,85例（17％）患者发生CIN.CIN组在院内死亡、需要肾脏替代治疗、需使用主动脉内球囊反搏、围术期低血压、急性心力衰竭、新发心律失常等院内不良事件的发生率均较非CIN组明显升高,差异有统计学意义.ROC曲线显示：NLR界值为6.03时,其预测CIN的敏感度为80.1％,特异度为73.7％,曲线下面积0.764.单因素Logistics回归分析显示,NLR水平与CIN发病率明显相关（OR 1.2,95％ CI 1.1～1.3,P＜ 0,01）.多因素Logistic回归分析显示,NLR＞6.03是CIN的独立危险因素（OR 1.3,95％ CI1.2～1.3,P＜0.001）；此外,女性、基础肾功能不全及围术期低血压也是CIN的独立危险因素（P＜0.05）.结论 急性STEMI患者行急诊PCI术前NLR水平与CIN相关,NLR升高的患者发生CIN的风险明显增高.

Objective To explore the correlation between neutrophil/lymphocyte ratio （NLR） and contrast-induced nephropathy （CIN） in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. Methods 500 patients undergoing primary PCI from Guangdong general hospital were enrolled. C1N was defined as an increase in serum creatinine more than 44.2μmol/L or 25% from baseline within 48-72 h after contrast exposure. Baseline data and in-hospital clinical adverse events were compared among two groups. Receiver operator characteristics （ROC） curves and multivariate logistic regression was used to assessed the correlation between NLR and CIN. Results CIN occurred in 85 （17%） patients. The incidence of in-hospital death （4.8% vs 1.2%,χ^2=4.951, P=0.026）, required renal replacetherapy （2.4% vs 0.2%, χ^2=5.322, P=0.021）, required IABP （15.3% vs 4.6%, χ^2=13.706, P 〈 0.001）, peri- procedural hypotension （16.5% vs 5.3%, χ^2=13.174, P 〈 0.001）, acute heart failure （9.4% vs 3.9%, χ^2 = 4.848, P=0.028） and arrhythmia （11.8% vs 5.1%, χ^2=5.551, P=0.018） in CIN group were significant higher than Non-CIN group. ROC analysis revealed that the optimal cutoff value of NLR to predict the onset of C1N was 6.03, and sensitivity was 80.1%, specificity was 73.7%, AUC was 0.764. Univariate logistic analysis showed that NLR was strongly related with CIN incidence （OR 1.2, 95% CI 1.1 ~ 1.3, P 〈 0.01）. Multivariate logistic regression analysis found that after adjusting other traditional risk factors including female gender, age 〉 75 years, diabetes, anemia, basic renal dysfunction, LVEF 〈 40%, ACEI/ARB usage, IABP support, NLR 〉 6.03 was still a significant independent predictor of CIN in patients with STEMI undergoing primary PCI. Additionally, female gender, basic renal dysfunction and peri-procedural hypotension were also significant associated with CIN. Conclusions NLR was strongly related with CIN incidence. Patients with high NLR level might be in high risk of CIN.