外周血中性粒细胞/淋巴细胞比值与急性ST段抬高型心肌梗死患者急性肾损伤的关系研究

Relationship between Neutrophilia/lymphocyte Ratio and Acute Kidney Injury in Patients with Acute ST-Segment Elevation Myocardial Infarction

目的探讨外周血中性粒细胞/淋巴细胞比值(NLR)与急性ST段抬高型心肌梗死(ASTEMI)患者急性肾损伤(AKI)的关系。方法选取2014年10月—2017年2月黄冈市红安县人民医院收治的ASTEMI患者225例,根据住院期间AKI发生情况分为AKI组45例与非AKI组180例。比较两组患者临床特征及实验室检查指标,外周血NLR与ASTEMI患者AKI的关系采用Pearson相关性分析及多因素Logistic回归分析,绘制ROC曲线以评价NLR对ASTEMI患者AKI的预测价值。结果两组患者性别、年龄、体质指数(BMI)、舒张压(DBP)、糖尿病病史阳性率、高脂血症病史阳性率及广泛前壁梗死者所占比例比较,差异无统计学意义(P>0.05);AKI组患者心率(HR)、Killip分级评分、氨基末端脑钠肽前体(NT-pro BNP)、C反应蛋白(CRP)、血肌酐(Scr)、肌钙蛋白I、白细胞计数(WBC)、中性粒细胞计数、NLR高于非AKI组,收缩压(SBP)、高血压病史阳性率、左心室射血分数(LVEF)、估算肾小球滤过率(e GFR)、淋巴细胞计数低于非AKI组(P<0.05)。Pearson相关性分析结果显示,NLR与ASTEMI并AKI患者HR、SBP、Killip分级评分、NT-pro BNP、CRP、Scr、肌钙蛋白I呈正相关(P<0.05),与LVEF、e GFR呈负相关(P<0.05)。多因素Logistic回归分析结果显示,HR[OR=2.758,95%CI(1.845,4.371)]、SBP[OR=0.638,95%CI(0.445,0.874)]、Killip分级评分[OR=3.175,95%CI(1.754,7.403)]、NT-pro BNP[OR=2.955,95%CI(1.674,4.163)]、CRP[OR=1.810,95%CI(1.572,3.235)]、e GFR[OR=2.420,95%CI(1.517,3.483)]、NLR[OR=2.218,95%CI(1.339,3.752)]是ASTEMI患者AKI的影响因素(P<0.05)。受试者工作特征(ROC)曲线显示,NLR预测ASTEMI患者AKI的曲线下面积为0.840,最佳截断值为7.482,灵敏度为89.8%,特异度为62.8%。结论外周血NLR升高是ASTEMI患者AKI的危险因素,其对ASTEMI患者AKI的预测价值较高,故应密切监测NLR以早期评估患者预后。

Objective To explore the relationship between neutrophilia/lymphocyte ratio（ NLR） and acute kidney injury（ AKI） in patients with acute ST-segment elevation myocardial infarction（ ASTEMI）. Methods From October 2014 to February 2017,a total of 225 patients with ASTEMI were selected in the People＇s Hospital of Hongan County,Huanggang,and they were divided into AKI group（ n = 45） and non-AKI group（ n = 180） according to the incidence of AKI during hospitalization. Clinical features and laboratory examination results were compared between the two groups,relationship between NLR and AKI in patients with ASTEMI was analyzed by Pearson correlation analysis and multivariate Logistic regression analysis,and ROC curve was drawn to evaluate the predictive value of NLR on AKI in patients with ASTEMI. Results No statistically significant differences of gender,age,BMI,DBP,positive rate of diabetes history or hyperlipidaemia history,or proportion of patients with extensive anterior myocardial infarction was found between the two groups（ P〉0. 05）; HR,Killip grade score,NT-pro BNP,CRP,Scr,c Tn I,WBC,neutrophil count and NLR in AKI group were statistically significantly higher than that in non-AKI group,while SBP,positive rate of hypertension history,LVEF,e GFR and lymphocyte count in AKI group were statistically significantly lower than those in non-AKI group（ P〈0. 05）. Pearson correlation analysis showed that,NLR was positively correlated with HR,SBP,Killip grade,NT-pro BNP,CRP,Scr and c Tn I in patients with ASTEMI,was negatively correlated with LVEF and e GFR（ P〈0. 05）. Multivariate Logistic regression analysis results showed that,HR [OR = 2. 758,95% CI（ 1. 845,4. 371） ], SBP [OR = 0. 638,95% CI（ 0. 445,0. 874） ], Killip grade score [OR = 3. 175,95% CI（ 1. 754,7. 403） ], NT-pro BNP [OR = 2. 955,95% CI（ 1. 674,4. 163） ], CRP [OR = 1. 810,95% CI（ 1. 572,3. 235） ],e GFR [OR = 2. 420,95% CI（ 1. 517,3. 483） ] and NLR [OR = 2. 218,95% CI（ 1. 339,3. 752） ] were influencing factors of AKI in patients with ASTEMI（ P〈0. 05）. ROC curve showed that,AUC of NLR in predicting AKI in patients with ASTEMI was 0. 840,the optimum truncation value was 7. 482,the sensitivity was 89. 8%, the specificity was62. 8%. Conclusion Elevated NLR is one of risk factors of AKI in patients with ASTEMI,it has relatively high predictive value on AKI,we should closely monitor NLR to early evaluate the prognosis.