中性粒细胞／淋巴细胞比值对于糖尿病合并急性心肌梗死患者近期预后的预测价值

Predictive value of neutrophil to lymphocyte ratio for in-hospital mortality in type 2 diabetic patients with acute myocardial infarction

目的旨在揭示中性粒细胞/淋巴细胞比值（neutrophil to lymphocyte ratio, NLR）对于2型糖尿病合并急性心肌梗死（acute myocardial infarction，AMI）患者近期预后的预测价值。方法AMI患者707例，分为2型糖尿病组（DM-AMI组）、糖耐量异常组（IGT-AMI组）、糖耐量正常组（NGT-AMI组）。临床特征和实验室检查数据来自于对医疗病历的回顾性分析，NLR和全球急性冠状动脉事件注册（Global Registry of Acute Coronary Events, GRACE）评分由计算得来。结果3组患者中IGT-AMI组和NGT-AMI组的NLR、GRACE评分均显著低于DM-AMI组（P〈0.01或P〈0.05）。在DM-AMI组中，老年组的NLR和GRACE评分均显著高于非老年组（均P〈0.01），住院期间死亡组的NLR和GRACE评分均明显高于存活组（均P〈0.01），基于GRACE评分的低危组和中危组NLR均较高危组显著低下（均P〈0.01），NLR与GRACE评分呈显著正相关（r＝0.425, P〈0.01）。受试者工作特征曲线显示，NLR和GRACE评分切值分别为9.36（敏感性80.8%,特异性69.6%；曲线下面积0. 787）和166（敏感性76.9%,特异性76.4%；曲线下面积0. 778）对住院期死亡诊断效率最高。结论NLR可以作为预测2型糖尿病合并AMI患者住院期间死亡的良好指标，为临床医生迅速识别高危患者、制定合适的治疗策略提供可靠的依据。

ObjectiveTo explore the prognostic value of biomarkers in type 2 diabetic patients with acute myocardial infarction （AMI）, this study was to investigate the associations between the neutrophil to lymphocyte ratio （NLR）, the Global Registry of Acute Coronary Events （GRACE） score and in-hospital mortality.MethodsSeven hundred and seven consecutive AMI patients were divided into diabetic group （DM-AMI group）, impaired glucose tolerance group （IGT-AMI group）, and normal glycemic group （NGT-AMI group）. The laboratory and clinical characteristics were assessed retrospectively from the medical records. The NLR and GRACE score were calculated.ResultsIn AMI patients, the DM-AMI group had significantly higher NLR and GRACE scores compared with those from the IGT-AMI group and NGT-AMI group （P〈0.01 or P〈0.05）. In DM-AMI group, the NLR and GRACE score were considerably elevated in the elderly DM-AMI group compared with their younger counterparts （both P〈0.01）. Furthermore, the NLR was considerably higher in the high-risk group than those in both the low- and medium-risk groups based on the GRACE score （both P〈0.01）. The NLR was positively correlated with the GRACE score in DM-AMI group（r=0.425, P〈0.01）. Based on the receiver operating characteristic curve, when to predict death in-hospital, the best cutoff value of NLR was 9.36 （sensitivity 80.8%, specificity 69.6%; area under curve 0.787）, and the best cutoff value of GRACE score was 166 （sensitivity 76.9%, specificity 76.4%; area under curve 0.778）.ConclusionAn elevated NLR is a potential predictor of in-hospital mortality in type 2 diabetic patients with AMI, which could help clinicians indentify high-risk patients and determine appropriate treatment strategies.