急性心肌梗死患者中性粒细胞/淋巴细胞比值与介入术后冠状动脉血流的相关性研究

Relation of admission neutrophil/lymphocyte ratio to angiographic no-reflow phenomenon in patients with ST-elevated myocardial infarction undergoing primary coronary intervention

目的 探讨急性ST段抬高型心肌梗死（STEMI）患者中性粒细胞/淋巴细胞比值（NLR）与经皮冠状动脉介入治疗（PCI）后冠状动脉无复流的关系.方法 纳入2010-2013年接受急诊PCI的232例STEMI患者,将患者分为无复流组（TIMI血流≤2级）和正常血流组,采用受试者工作特征（ROC）曲线评价NLR预测无复流发生的最佳切点值,并进行logistic回归分析无复流的危险因素.数据分析使用SPSS 11.0统计软件.结果 无复流组的NLR高于正常血流组[4.1（2.4～ 6.5）vs.2.4（1.7 ～ 3.8）,P=0.001];ROC曲线计算NLR预测无复流的最佳切点值为3.2,其敏感度、特异度分别为80％和73％;高NLR组的无复流发生率明显大于低NLR组（34.8％vs.9.3％,P＜0.001）;NLR（＞3.2）是无复流的独立危险因素（OR=3.70,95％CI：1.39～9.80,P=0.009）.结论 NLR是STEMI患者急诊PCI后发生无复流现象的独立危险因素,对其早期危险分层有一定的参考价值.

Objective To investigate the relationship of the neutrophil/lymphocyte ratio （NLR） on admission and angiographic no-reflow phenomenon in patients with ST-segment elevation myocardial infarction （STEMI） who had undergone primary percutaneous coronary intervention （PCI）.Methods 232 patients who had undergone PCI between 2010 and 2013,were included and divided into two groups based upon the thrombolysis in myocardial infarction （TIMI） flow gradings.No-reflow was defined as post-PCI TIMI Grade 0,1 and 2 flows （group Ⅰ）.Normal-flow was defined as TIMI 3 flow （group Ⅱ）.Receiver operating characteristic curve （ROC） analysis was used to identify the predictive effect of NLR on no-reflow phenomenon.Relationship of NLR and no-reflow was assessed by multivariate logistic regression.All statistical calculations and analyses were performed using SPSS 11.0.Results NLR was significantly higher in group Ⅰ （n=45） compared with group Ⅱ （n=187） [4.1 （2.4-6.5） vs.2.4 （1.7-3.8）,P=0.001].In ROC analysis,NLR＞3.2 predicted no reflow with 80％ sensitivity and 73％ specificity.Patients with elevated NLR had a higher incidence of no-reflow phenomenon than those with non-elevated NLR （34.8％ vs.9.3％,P＜0.001）.Also,NLR （＞3.2） was an independent predictor of no-reflow development [odds ratio 3.70,95％ confidence interval （1.39-9.80）,P=0.009].Conclusion NLR was an independent predicator for no-reflow development in STEMI patients who had undergone PCI.This simple and low-cost parameter could provide useful information for the early risk evaluation on these patients.