联合中性粒细胞/淋巴细胞比值和C-反应蛋白与急性心肌梗死患者心血管不良事件发生关系的研究

Predictive value of combined use of neutrophil to lymphocyte ratio and c-reactive protein for adverse events in patients with acute myocardial infarction

目的:探讨联合中性粒细胞/淋巴细胞比值(NLR)和C-反应蛋白(CRP),在急性心肌梗死(AMI)患者经皮冠状动脉介入(PCI)术后24个月内出现心血管不良事件的预测价值。方法:回顾性分析了经PCI治疗的381例AMI患者的临床随访资料,以PCI术后24个月内出现全因死亡、主要心脑血管不良事件(MACCE)等作为终点事件,并根据ROC曲线确定的患者入院时NLR和CRP对全因死亡的诊断阈值,将患者进行分组比较。结果:高NLR(>6.30)且高CRP(>0.76mg/L)的患者在24个月内出现全因死亡和MACCE的风险显著高于NLR正常且(或)CRP正常的患者。在多因素Cox回归分析中,高NLR且高CRP是AMI患者在PCI术后24个月内出现全因死亡(HR=23.412,95%CI:9.241~45.214,P<0.001)和MACCE(HR=1.936,95%CI:1.366~3.278,P=0.003)的危险因素。结论:NLR和CRP水平的升高与AMI患者PCI术后远期不良事件发生的风险增加密切相关。

Objective： The aim of this study was designed to evaluate predictive value of the neutrophil to lymphocyte ratio（ NLR） and C-reactive protein（ CRP） for adverse events within 24 month after percutaneous coronary intervention（ PCI） in patients with acute myocardial infarction（ AMI）. Methods： A total of 381 cases of AMI patients treated with PCI was enrolled in this study,and all-cause death,major adverse cardiovascular events（ MACCE） within 24 month after PCI were determinaed as end point events. All patients were grouped according to the cut-off value of on admission NLR and CRP determinated by ROC analysis. Results：Patients with both higher NLR（ 6. 30） and higher CRP（ 0. 76 mg/L） had significantly higher risk of allcause death and MACCE at 24 months compared with those with normal NLR/CRP or with only one marker increased. In multivariate Cox regression analysis,higher NLR/higher CRP was an independent risk factor for allcause mortality（ HR = 23. 412,95% CI： 9. 241-45. 214,P〈0. 001） and MACCE（ HR = 1. 936,95% CI：1. 366-3. 278,P = 0. 003） within 24 months after PCI intervention in AMI patients. Conclusion： Elevated levels of both NLR and CRP are closely associated with increased risk of long-term adverse events after PCI in AMI patients.