C反应蛋白、中性粒细胞淋巴细胞比值和白细胞计数与房颤的关联性研究

Associations of C-reactive protein,neutrophil to lymphocyte ratio and white blood cell count with atrial fibrillation

目的分析C反应蛋白（C-reactive protein,CRP）、中性粒细胞淋巴细胞比值（neutrophil to lymphocyte ratio,NLR）和白细胞计数（white blood cell,WBC）3种炎性标志物与心脏结构变化及房颤发生的相关性。方法运用病例对照研究设计,收集自2002年11月至2013年12月在某三甲医院心内科的住院患者病历资料,分为房颤组和非房颤对照组,提取两组外周血中CRP、NLR和WBC检测水平信息,采用多元Logistic回归分析3种炎性因子与左心室内径、左心房内径、左心室后壁厚度、右心室内径和右心房内径五种心脏结构指标的相关性,以及与房颤发生的关联性和关联强度。结果房颤组CRP和NLR水平显著高于对照组（P〈0.001）,且高水平的CRP和NLR与房颤发生显著相关[OR=2.25,95%CI=1.13-4.47,P=0.02;OR=1.41,95%CI=1.06-1.89,P=0.02]。WBC水平在房颤组和对照组之间的差异无统计学意义（P=0.054）,且与房颤发生无显著相关性。房颤组中,NLR水平在高左房内径组和高左室后壁厚度组中均较高（P〈0.05）。但多元logistic回归分析未发现CRP、NLR、WBC与心脏结构指标之间有显著关联。结论外周血中高水平的CRP和NLR水平与房颤发生有显著关联,可能是房颤发生的独立危险因素,而CRP、NLR、WBC与心脏结构重塑之间无显著关联。

Objective To explore the associations of C-reactive protein（ CRP）,neutrophil to lymphocyte ratio（ NLR） and white blood cell（ WBC） count with atrial fibrillation occurrence and cardiac structure indexes（ left ventricular diameter,left atrial diameter,left ventricular posterior wall thickness,right ventricular diameter,and right atrial diameter）. Methods A case-control study was performed. Medical records were collected from the department of cardiology of a grade Ⅲ class A hospital during November 2012 to December 2013. Subjects were divided into atrial fibrillation group and control group without atrial fibrillation. A multivariate logistic regression model was used to analyze the associations of the circulating levels of CRP,NLR and WBC with atrial fibrillation occurrence and cardiac structure indexes. Results The levels of CRP and NLR in the atrial fibrillation group were significantly higher than those in the control group（ P〈0. 001）,and high levels of CRP and NLR were significantly associated with atrial fibrillation（ OR =2. 25,95% CI = 1. 13 - 4. 47,P = 0. 020,OR = 1. 41,95% CI： 1. 06 - 1. 89,P = 0. 020）. The WBC count had no significant difference between the 2 groups（ P = 0. 054）,and it was not significantly associated with atrial fibrillation. In the atrial fibrillation group,higher NLR level appeared in the high left atrial diameter group and high left ventricular posterior wall thickness group（ P〈0. 05）. The multivariate analysis failed to identify the significant association between the CRP,NLR or WBC and the heart structure indexes. Conclusion High circulating levels of CRP and NLR have significant associations with atrial fibrillation,and may be independent risk factors for atrial fibrillation occurrence. However,there is no significant association of CRP,NLR or WBC with cardiac remodeling.