中性粒细胞与淋巴细胞比值与老年急性冠状动脉综合征患者近期预后的关系

Relationship between neutrophil-lymphocyte ratio and short-term prognosis of elderly patients with acute coronary syndrome

目的探讨中性粒细胞与淋巴细胞比值(NLR)与老年急性冠状动脉综合征(ACS)患者近期预后的关系。方法回顾性分析2015年1月至2017年10月东南大学附属中大医院心血管内科收治的老年ACS患者资料。所有患者均经冠状动脉造影检查,并结合临床症状、心肌坏死标志物及心电图进行确诊。根据入院后即时(4 h内)NLR,将最终纳入研究的500例老年ACS患者按NLR三分位数分为3组:NLR≤3.337组(n=169),NLR 3.338~6.166组(n=167),NLR≥6.167组(n=164)。研究的主要终点事件为住院期间和随访期间全因死亡,次要结果为住院期间发生的主要不良心脑血管事件(MACCE)、住院时间及左心室射血分数(LVEF)。结果NLR≤3.337组、NLR 3.338~6.166组和NLR≥6.167组患者住院时间分别为8(6,11)、9(7,11)、10(8,11)d,住院期间LVEF<50%发生率分别为8.9%(15/169)、14.4%(24/167)、18.3%(30/164),LVEF分别为(57.78±12.15)%、(54.71±11.73)%、(53.56±13.38)%,3组之间差异均有统计学意义(P均<0.05)。500例患者住院期间MACCE发生率为21.6%(108/500),出院后随访6个月共死亡6例,3组患者之间全因死亡率、MACCE发生率差异无统计学意义(P均>0.05)。多因素Cox比例风险回归模型未发现NLR与全因死亡、MACCE、心源性死亡、心肌梗死、卒中存在关联(P均>0.05);与NLR≤3.337组比较,NLR 3.338~6.166组[风险比(HR)=2.567,95%置信区间(CI)1.558~4.229,P<0.001]和NLR≥6.167组[HR=1.979,95%CI 1.629~3.524,P=0.019]住院期间发生LVEF<50%的风险增高。受试者工作特征曲线分析显示NLR评估住院期间LVEF<50%的曲线下面积为0.652(95%CI 0.603~0.700,P<0.001),最佳截断值为3.84,此时灵敏度为68.3%,特异度为65.3%。将NLR作为三分类变量纳入多元线性回归模型分析发现较高的NLR水平是住院时间延长的独立影响因素(β=0.181,P<0.001)。结论NLR是老年ACS患者住院期间发生LVEF<50%和住院时间延长的危险因素,而与全因死亡、MACCE无明显关联。

Objective To explore the relationship between neutrophil-lymphocyte ratio(NLR)and the short-term prognosis of elderly patients with acute coronary syndrome(ACS).Methods The clinical data of elderly ACS patients,who were hospitalized at Department of Cardiology of Zhongda Hospital Southeast University from Jan.2015 to Oct.2017,were retrospectively analyzed.All patients were diagnosed by coronary angiography in combination with clinical symptoms,myocardial necrosis markers and electrocardiogram.According to NLR detected immediately after admission(within 4 h),500 elderly ACS patients were divided into 3 groups:NLR≤3.337 group(n=169),NLR 3.338-6.166 group(n=167),and NLR≥6.167 group(n=164).The primary endpoints of the study were all-cause deaths during hospitalization and followup.The secondary outcomes were major adverse cardio-cerebrovascular events(MACCEs),hospital stay and left ventricular ejection fraction(LVEF).Results In NLR≤3.337 group,NLR 3.338-6.166 group and NLR≥6.167 group,the hospital stays were 8(6,11)d,9(7,11)d and 10(8,11)d,the incidence rates of LVEF<50%during hospitalization were 8.9%(15/169),14.4%(24/167)and 18.3%(30/164),and the LVEF values were(57.78±12.15)%,(54.71±11.73)%and(53.56±13.38)%,respectively,and the differences among three groups were significant(all P<0.05).The incidence of MACCEs was 21.6%(108/500)during hospitalization.Six patients died during a follow-up period of 6 months after discharge.There were no significant differences in all-cause mortality or MACCE incidence among three groups(both P>0.05).Multivariate Cox risk regression model showed that there was no association between NLR and all-cause death,MACCEs,cardiogenic death,myocardial infarction,or stroke(all P>0.05).Compared with the NLR≤3.337 group,the incidence rates of LVEF<50%during hospitalization were significantly increased in the NLR 3.338-6.166 group(hazard ratio[HR]=2.567,95%confidence interval[CI]1.558-4.229,P<0.001)and the NLR≥6.167 group(HR=1.979,95%CI 1.629-3.524,P=0.019).Reciever operating characteristic curve showed that area under curve of NLR in evaluating LVEF<50%during hospitalization was 0.652(95%CI 0.603-0.700,P<0.001).The optimal cut-off value of NLR was 3.84,and the sensitivity and specificity were 68.3%and 65.3%,respectively.The multiple linear regression model showed that high NLR was an independent influencing factor of prolonged hospital stay(β=0.181,P<0.001).Conclusion In elderly ACS patients,NLR is a risk factor of LVEF<50%during hospitalization and prolonged hospital stay,while it has no significant association with all-cause death and MACCEs.