中性粒细胞/淋巴细胞比值对急性心肌梗死患者预后的价值

Prognostic value of Neutrophil-to-Lymphocyte ratio in patients with ST-segment elevation myocardial infarction

目的：探讨中性粒细胞/淋巴细胞比值（NLR）对急性ST段抬高型心肌梗死（STIMI）并行经皮冠状动脉介入（PCI）治疗患者发生不良事件的预测价值。方法选取我院326例STIMI患者，根据NLR分为T1组（≤3.46）、T2组（3.47-6.75）和T3组（〈6.75）。收集患者一般临床资料、实验室指标、冠脉造影结果、术后TIMI分级及左室射血分数（LVEF），记录患者住院期间心力衰竭、支架内血栓再形成、室速/室颤、房颤、房室传导阻滞、心源性休克等不良事件的发生情况以及随访6个月主要心血管不良（MACE）事件如非致命性心梗、死亡、心衰再入院、缺血性卒中的发生情况。结果 T3组住院期间心衰、房颤、室速/室颤及心源性休克的发生率明显高于其余两组（P〈0.05），冠脉多支病变发生率明显高于T1组（54.1%vs 37.0%），且术后梗死相关动脉TIMI 3级的患者比例明显低于T1组（83.5%vs 94.4%），住院期间LVEF明显低于T1组（0.48±0.10 vs 0.52±0.10）。随访6个月，3组非致命性心梗、死亡、缺血性卒中的发生率差异无统计学意义，而T3组的因心力衰竭再入院率明显高于T1组（P〈0.05）。结论 NLR可能会作为急性心肌梗死患者心衰发生的预测指标。

Objective To investigate the clinical prognostic value of neutrophils to lymphocyte ratio（NLR）in patients with ST-segment elevation myocardial infarction（STIMI）who underwent percutaneous coronary intervention（PCI）. Methods A total of 326 patients with acute ST segment elevation myocardial infarction were enrolled. According to the neutrophils to lymphocyte ratio, patients were divided into group T1（≤3.46）, group T2（3.47-6.75）and group T3（〈6.75）. Basic clinical data,laboratory indexes,coronary angiography results, TIMI grading and left ventricular ejection fraction（LVEF） were collected in all groups. Incidence of adverse events in hospital such as acute heart failure, thrombosis, ventricular tachycardia and ventricular fibrillation, atrial fibrillation, atrioventricular block and cardiogenic shock, were recorded. Major adverse cardiac events（MACE）, death of all causes, non-fatal MI, ischemic stroke and readmission due to heart failure at the 6-month follow-up were also noted. Results The incidence of heart failure, atrial fibrillation, ventricular tachycardia/ventricular fibrillation and cardiogenic shock was higher in group T3 than those in the other two groups（P 〈 0.05）.The incidence of multivessel coronary artery disease was significantly higher in group T3 than that in group T1 （54.1% vs 37.0%, P〈0.05）. The percentage of TIMI grade 3 in post-operative infracted artery was significantly lower than that in group T1 （83.5%vs 94.4%）. Left ventricular ejection fraction was significantly lower in group T3 than that of group T1 during hospitalization （0.48± 0.10 vs 0.52± 0.10）. There was no significant difference in the incidences of death, non-fatal MI, ischemic stroke at 6 month follow up. But the rate of readmission due to heart failure was significantly higher in group T3 than that in the group T1（P〈0.05）. Conclusion Neutrophils to lymphocyte ratio may be a useful marker to predict the prognosis of patients with heart failure due to acute myocardial infarction.