外周血NLR对急性ST段抬高型心肌梗死患者急性肾损伤的预测能效

Prediction efficiency of peripheral blood NLR for acute kidney injury in patients with acute ST-segment elevation myocardial infarction

目的研究外周血中性粒细胞/淋巴细胞比率(NLR)对急性ST段抬高型心肌梗死患者急性肾损伤的预测能效。方法将2016年2月至2018年2月于河北省人民医院收治的急性ST段抬高型心肌梗死患者98例为研究对象,将所有患者按照是否发生急性肾损伤分为急性肾损伤组37例与非急性肾损伤组61例。比较两组患者一般资料,各项生化指标水平及住院用药情况。并对急性ST段抬高型心肌梗死患者急性肾损伤与各项因素的关系予以多因素Logisitic回归分析。结果急性肾损伤组年龄、Killip分级为Ⅲ~Ⅳ级、使用利尿剂人数占比高于非急性肾损伤组,差异有统计学意义(P均<0.05);而性别、吸烟史、高血压史、糖尿病史、高脂血症、冠心病史相比不明显,差异无统计学意义(P均>0.05)。急性肾损伤组NLR、C反应蛋白(CRP)、氨基末端脑钠肽前体(NT-proBNP)、肌钙蛋白I水平高于非急性肾损伤组,而肾小球滤过率(eGFR)水平低于非急性肾损伤组,差异有统计学意义(P均<0.05)。经多因素Logisitic回归分析可得:NLR、使用利尿剂、CRP、eGFR、NT-proBNP、肌钙蛋白均是急性ST段抬高型心肌梗死患者急性肾损伤的影响因素(P均<0.05)。经ROC曲线分析发现,NLR预测急性肾损伤的曲线下面积为0.838,灵敏度为81.5%,特异度为74.2%。结论年龄、Killip分级、NLR、使用利尿剂、CRP、eGFR、NT-proBNP、肌钙蛋白均与急性ST段抬高型心肌梗死患者发生急性肾损伤密切相关,且NLR对急性ST段抬高型心肌梗死患者急性肾损伤的预测能效较高。

Objective To study the prediction efficiency of peripheral blood NLR for acute kidney injury in patients with acute ST-segment elevation myocardial infarction. Methods 98 patients with acute ST-segment elevation myocardial infarction admitted to Hebei General Hospital from February 2016 to February 2018 were as research objects. All patients were divided into acute kidney injury group (n=37) and non-acute kidney injury group (n=61) according to whether acute kidney injury occurred or not. The general data of the two groups, and the level of biochemical indexes and drug application was compared. The relationship between acute kidney injury and various factors in patients with acute ST-segment elevation myocardial infarction was analyzed by Multivariate logistic regression analysis. Results The age, the proportion of Killip grade was III to IV, and the number of diuretics used in acute kidney injury group was higher than those in non-acute kidney injury group (P<0.05). There was no significant difference in gender, smoking history, hypertension history, diabetes history, hyperlipidemia, coronary heart disease history (P>0.05). The level of NLR, CRP, NT-pro BNP and troponin I in acute kidney injury group was higher than that in non-acute kidney injury group, while the level of e GFR was lower than that in non-acute kidney injury group (P<0.05). Multivariate logistic regression analysis showed that NLR, the use of diuretics, CRP, e GFR, NT-pro BNP and troponin was the influencing factor of acute kidney injury in patients with acute ST-segment elevation myocardial infarction (all P<0.05).The ROC curve analysis showed that the area under the curve of NLR for predicting acute kidney injury was 0.838, the sensitivity was 81.5%, and the specificity was 74.2%. Conclusion Age, Killip grade, NLR, the use of diuretics, CRP, e GFR, NT - pro BNP, troponin was closely related to acute kidney injury in patients with acute ST-segment elevation myocardial infarction, and NLR is more effective in predicting acute kidney injury in patients with acute ST segment elevation myocardial infarction.