中性粒细胞/淋巴细胞与老老年男性高血压患者90d非致死性心血管事件发生率的关系

The relationship between neutrophil to lymphocyte ratio and incidence rate of non-fatal cardiovascular events in a 90-day follow-up period in the very elderly male hypertensive patients

目的探讨老老年高血压患者中性粒细胞/淋巴细胞(NLR)水平对近期非致死性心血管事件(NFCE)发生率的影响。方法采用前瞻性队列研究方法,选取2011年1月至2013年12月期间在解放军总医院老年心血管内科住院治疗的年龄≥80岁的男性高血压患者328例,根据入选对象入院时NLR的四分位数将患者分为4组(第1~4组),随访不同组研究对象入院后7、14、30、90d的NFCE发生情况并进行分析,通过多因素分析研究NLR与NFCE的关系。结果 90d随访结果显示,发生NFCE患者入院时NLR的水平明显高于不发生NFCE者[4.5(2.5,9.0)比2.9(1.9,5.6),P<0.05]。第1组~第4组NFCE发生率分别为8.5%、15.9%、18.3%和29.3%(χ~2=11.96,P=0.008),Kaplan-Meier风险累积分析结果显示,随着NLR水平增高,NFCE发生率明显增高。NLR水平预测NFCE的受试者工作特征(ROC)曲线下面积(AUC)为0.648(95%CI 0.574~0.723,P=0.001),截断界值点为NLR=2.16,敏感度88.3%,特异度47.1%。Cox回归分析显示NLR>2.16(HR=3.102,P=0.032)、C反应蛋白水平(HR=1.065,P=0.023)及入院时的呼吸频率(HR=1.044,P=0.032)是男性老老年高血压患者90dNFCE的独立危险因素。结论男性老老年高血压患者入院时NLR>2.16是90dNFCE的独立预测因子,监测NLR这个简单快捷的指标能够对高血压患者进行进行初步的危险性分层。

Objective To explore the impact of neutrophil to lymphocyte ratio （NLR） on recent incidence rate of non-fatal cardiovascular events （NFCE） in the very elderly male hypertensive patients. Methods A total of 328 male hypertensive patients aged 80 years and older who admitted to the geriatric cardiovascular department of PLA general hospital between Jan 2011 and Dec 2013 were enrolled in this prospective cohort study. According to the quartile of NLR on admission, the patients were divided into 4 groups, and the occurrence of NFCE in these groups were followed up at 7 （D7）, at 14 （D14）, at 30 （D30） and at 90 days （D90） after admission. The relationship between NLR and NFCE was studied with multivariate analysis. Results 90-day follow-up results showed that the NLR levels in the patients with NFCE were significantly higher than those in the patients without NFCE[4.5 {2. 5, 9.0） vs 2.9（1.9, 5.6）, P〈 0.05]. The incidence rates of NFCE in group 1 to group 4 were 8.5 %, 15.90%, 18.3% and 29.3%, respectively （χ^2 = 11.96, P=0. 008）, and Kaplan-Meier cumulative risk analysis showed that the incidence rate of NFCE was significantly increased with the increase in the NLR level. The area under the receiver operating characteristic（ROC） curve （AUC） was 0. 648 （95% CI： 0. 574-0. 723, P=0. 001）, and the cut-off point of NLR was 2.16, and the sensitivity was 88. 3 % and the specificity was 47.1%. Cox regression analysis showed that NLR 〉2. 16 （HR=3. 102, P=0. 032）, C-reactive protein level （HR=1. 065, P=0. 023） and respiratory rate on admission （HR= 1. 044, P=0. 032 } were independent risk factors for 90-day NFCE in the very elderly male hypertensive patients. Conclusion NLR〉2.16 on admission was an independent risk factor for 90-day NFCE in the very elderly male hypertensive patients. NLR could be useful for initial risk stratification in patients with hypertension.