基础白细胞计数及中性与淋巴细胞比值对于急性冠脉综合征患者的临床价值

The clinical value of basic white blood cell count and the ratio ofneutrophil to lymphocyte in patients with acute coronary syndrome

目的 该文通过分析白细胞计数水平（WBC）及淋巴细胞的比值（NLR）能否作为评价ACS患者危险分层的指标及发生心脏终点事件（MACE）的预测指标,并判断其有无统计学意义,论证WBC及NLR究竟有无临床价值。方法 选择237例ACS的患者,对所有患者行冠脉造影术（CAG）明确血管病变并植入支架1-3枚,患者出院后均予积极的药物治疗,包括抗血小板、血管紧张素转化酶抑制剂（ACEI）类、调脂类等药物,平均随访（6.32±1.21）个月,根据临床资料,比较心肌梗死（MI）组和不稳定型心绞痛（UAP）组之间WBC、NLR有无差异,且差异有无统计学意义;比较彩超提示室壁运动异常组与无室壁运动异常组之间WBC、NLR有无差异;分析WBC、NLR与MI标记物如肌钙蛋白T（cTnT）、肌酸激酶同工酶（CK-MB）和血管造影结果有无相关性;再根据出院半年内发生MACE的有无分为阳性组和阴性组,通过Logistic回归分析,判断WBC、NLR与MACE的发生有无相关性,且有无统计学意义。结果 MI组的WBC、NLR明显高于UAP组,且均有统计学意义;通过分析WBC、NLR与cTnT、CK-MB、血管造影结果的相关性,证实WBC与cTnT、CK-MB、血管造影结果呈明显的正相关,而NLR与cTnT、CK-MB正相关,与血管造影结果无显著相关;而去除其他因素干扰,出院后半年内MACE阳性组的WBC、NLR亦明显高于阴性组,也均有统计学意义。结论 WBC、NLR作为容易检测且价格便宜的炎性指标,对于ACS患者的危险分层有着重要的提示价值,为临床医生对于高危患者的识别提供依据;而其亦可作为判断ACS患者预后的独立指标,为临床医生针对高危患者可以选择合适的治疗方案进行早期干预。

Objective This article is aimed to analyze whether basic white blood cell count （WBC） and neutrophil to lymphocyte ratio （NLR） can be used as biomarkers to evaluate the risk stratification and predict the major adverse cardiac event （MACE） in patients with ACS,and to judge the statistical value to help clinician to identify the high -risk patients. Methods 237 patients with ACS were selcted,and all patients received angiography to identify pathological changes of the coronary and were implanted 1 to 3 stents. Every patient received standard therapeutic regimen, including anti - platelet, ACEIs, and statins drugs. Whether the WBC count and NLR have val：iances were recorded between the myocardial infarction （MI） group and the unstable angina （UAP） group,as well as between the ventricular muscle group showing abnormal activity and the one not showing. The correlation between WBC, NLR and cTnT, CK - MB and the results of angiography was analyzed. The patients were also divided into the positive and the negative group according to whether they had MACEs in half a year, analyzing whether the WBC count and NLR were related to the MACEs. Results The WBC and NLR in MI groups are higher than the UA group. WBC has direct correlation with cTnT,CK - MB and the results of angiography, while NLR has direct correlation with cTnT, CK- MB, but not with the results of angiography. The WBC count and NLR of the positive group are higher than the negative group. , Without other factors involved, the WBC count and NLR in the MACE positive group are higher than the negative group,and the results had statistical significance. Conclusions As universally available and low - cost in- flammatory factors, the WBC count and NLR have important value in risk stratification and can be used as independent predictors for the prognosis in patients with ACS, thereby helping clinicians to make suitable therapeutic schedule for high - risk patients.