中性粒细胞与淋巴细胞比值对急性主动脉夹层患者预后的预测价值

Prognostic value of neutrophil to lymphocyte ratio in patients with acute aortic dissection

目的:探讨中性粒细胞与淋巴细胞比值(NLR)对急性主动脉夹层(AAD)患者短期和长期死亡风险的预测价值.方法:回顾性分析141例AAD患者的临床资料,分组:①依据随访2周结果将患者分为死亡组(n=41)及存活组(n=100);②依据NLR 4分位数将患者分为NLR<4.33(Q1组,n=35),4.33≤NLR<7.26(Q2组,n=35),7.26≤NLR<11.78(Q3组,n=36),NLR≥11.78(Q4组,n=35).结果:短期内死亡组NLR显著高于存活组,死亡组NLR=9.67(6.81,13.07)、存活组NLR=6.18(3.63,11.10),死亡组的NLR水平比存活组的更高(P<0.05).KM生存曲线显示,Q4组的短期和长期死亡风险均明显高于其他3组.多因素Cox比例风险回归模型显示,与Q1组比较, Q4组增加短期死亡风险28倍,HR 28.403,95%CI 3.392(237.865),增加长期死亡风险3倍,HR 3.396,95%CI 1.596(7.228),有统计学差异(P<0.05).结论:入院NLR≥11.78可明显增加AAD患者的短期和长期死亡风险,NLR愈高,预后愈差.

Objective:To investigate the prognostic value of neutrophil to lymphocyte ratio(NLR)in short- and long-term mortality risk of patients with acute aortic dissection(AAD).Methods:A total of 141 patients diagnosed with AAD were collected for clinic data retrospectively.The Patients were divided into death group(n=41)and survival group(n=100)according to whether there was a death event in 2-week follow-up.According to the quartile count of NLR,the patients were divided into Q1 group(NLR<4.33,n=35),Q2 group(4.33≤NLR<7.26,n=35),Q3 group(7.26≤NLR<11.78,n=36)and Q4 group(NLR≥11.78,n=35).Results:The NLR was 9.67(6.81,13.07)in deceased patients,which was significantly higher than that(6.18(3.63,11.10))in in survived patients(P<0.05).Kaplan-Meier analysis showed that the cumulative short- and long-term mortality risk was greatly higher in patients with elevated admission Q4 levels when compared with those with low admission NLR in the other 3 groups.In multivariate Cox regression analysis,it showed that elevated admission NLR(≥11.28)in Q4 group remained an independent predictor of short-term mortality of AAD(HR to 28.403,95% CI 3.392~237.865)and long-term mortality(HR to 3.396,95% CI 1.596~7.228)(all P<0.05).Conclusion:Admission NLR is an independent predictor of short- and long-term mortality risk in patients with AAD.The higher NLR,the poorer prognosis.