中性粒细胞与淋巴细胞比值对介入治疗后ST段抬高型心肌梗死患者预后预测价值的荟萃分析

Value of neutrophils/lymphocytes ratio on predicting the prognosis of patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention： a meta-analysis

目的 荟萃分析中性粒细胞与淋巴细胞比值（NLR）对经皮冠状动脉介入治疗（PCI）后ST段抬高型心肌梗死（STEMI）患者近、远期预后的预测价值.方法 检索PubMed、EMBASE和万方数据库中自建库至2014年6月发表的NLR与STEMI患者预后相关的文献,并追踪获取文献的参考文献.按照文献纳入标准,用标准表格提取纳入文献的相关资料.应用RevMan 5.2软件进行荟萃分析.结果 荟萃分析共纳入6篇临床试验文献,1 953例患者.与NLR＞ 3.30患者相比,NLR≤3.30患者PCI术后住院期间和远期（≥12个月）全因死亡（住院期间RR：0.29,95％ CI：0.19 ～ 0.46,P＜0.001;远期RR：0.33,95％ CI：0.23 ～0.45,P＜0.001）、主要不良心血管事件（住院期间RR：0.38,95％ CI：0.31 ～0.46,P＜0.001;远期RR：0.27,95％ CI：0.20 ～0.35,P＜0.001）的风险均较低;此外,NLR≤3.30患者在住院期间发生非致命性心肌梗死（RR：0.43,95％ CI：0.28 ～0.67,P＜0.001）、支架内血栓形成（RR：0.32,95％ CI：0.19 ～0.53,P＜0.001）和术后冠状动脉血流＜TIMI 3级（RR：0.34,95％ CI：0.14 ～0.86,P=0.020）的风险亦较低.结论 荟萃分析表明,NLR对PCI术后STEMI患者近、远期预后有预测价值,但需要大规模随机临床试验的进一步证实.

Objective To analyze the value of neutrophils/lymphocytes ratio （NLR） on predicting the cardiovascular events at hospital discharge and ≥ 12 months follow-up for patients with ST-segment elevation myocardial infarction （STEMI） undergoing percutaneous coronary intervention （PCI） by meta-analysis.Methods Both English and Chinese databases,including PubMed,EMBASE,Wanfang database from their reception to June 2014 were searched to identify randomized controlled studies or non-randomized controlled studies that reported relationship between NLR and the prognosis of patients with STEMI undergoing PCI.The Newcastle-OttawaScale （NOS） system was employed to assess the quality of literatures enrolled in this study.Two reviewers assessed the quality of each trial and extracted data independently.A standardized form and RevMan 5.2 software were used to extract information,and perform quantitative analysis,respectively.Results A total of 1 953 patients from 6 clinical trials were included in this meta-analysis.The risks of all-cause mortality （RR：0.29,95％ CI：0.19-0.46,P ＜ 0.001）,major adverse cardiac events （RR：0.38,95％ CI：0.31-0.46,P ＜ 0.001）,nonfatal myocardial infarction （RR：0.43,95 ％ CI：0.28-0.67,P ＜ 0.001）,stent thrombosis （RR：0.32,95 ％ CI：0.19-0.53,P ＜ 0.001）,and TIMI flow after PCI procedure ＜ 3 grade （RR：0.34,95％ CI：0.14-0.86,P =0.020） were significantly lower in patients with NLR ≤3.30 compared patients with NLR ＞ 3.30 at hospital discharge.During ≥ 12 months follow-up,the risks of death （RR：0.33,95％ CI：0.23-0.45,P ＜ 0.001）,major adverse cardiac events （RR：0.27,95 ％ CI：0.20-0.35,P ＜ 0.001） were significantly lower.Whereas nonfatal myocardial infarction was not significantly different （RR：0.42,95％ CI：0.05-3.45,P =0.420） in patients with NLR≤3.30 compared patients with NLR ＞ 3.30.Conclusions Results from this meta-analysis show that the NLR could predict short-and long-term prognosis in patients with STEMI undergoing PCI.This finding needs to be validated by large-scale clinical trials in the future.