中性粒细胞与淋巴细胞比值对ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗后微循环障碍的预测价值

Predictive value of neutrophil-to-lymphocyte ratio on microcirculatory disturbance in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention

目的基于微循环阻力指数(IMR)探讨ST段抬高型心肌梗死(STEMI)患者中性粒细胞与淋巴细胞比值(NLR)和直接经皮冠状动脉介入治疗(PCI)术后微循环障碍的关系。方法选择2016年1月至2018年12月期间苏北人民医院收治的50例急性STEMI患者为研究对象,将患者分为低NLR组(NLR≤6.17,25例)和高NLR组(NLR>6.17,25例)。比较两组患者的临床资料、冠状动脉病变情况、介入治疗方案及直接PCI术后IMR值,并采用Pearson相关分析NLR与直接PCI术后IMR的相关性。结果低NLR组和高NLR组患者糖尿病病史(7/25 vs.15/25,χ^2=5.195,P=0.023)、高血脂病史(7/25 vs.14/25,χ^2=4.023,P=0.045)、中性粒细胞计数[6.33(4.04,6.66)×10^9/L vs.7.90(7.23,12.09)×10^9/L,H=18716.000,P<0.001]、淋巴细胞计数[1.85(1.37,2.56)×10^9/L vs.0.87(0.78,1.03)×10^9/L,H=29710.000,P<0.001]、发病-球囊扩张时间[227.00(180.00,390.00)min vs.360.00(270.00,435.00),H=25199.500,P<0.001]及直接PCI术后IMR值[(29.9±2.7)vs.(40.4±1.7),t=16.307,P<0.001]比较,差异均有统计学意义。Pearson相关分析显示,NLR与IMR具有正相关性(r=0.676,P<0.001)。进一步简单线性回归分析示,患者NLR与直接PCI术后微循环障碍的发生有关(R2=0.457,P<0.001)。结论STEMI患者入院时,较高的NLR水平与直接PCI术后严重的微循环障碍密切相关,对预测STEMI患者直接PCI术后微循环状态有一定的参考价值。

Objective To explore the relationship between the neutrophil-to-lymphocyte ratio(NLR)and microcirculatory disturbance in patients with ST-segment elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary intervention(PCI)based on the index of microcirculatory resistance(IMR).Methods Fifty patients with acute STEMI from January 2016 to December 2018 were selected from Northern Jiangsu People's Hospital and divided into a low NLR group(NLR≤6.17,n=25)and a high NLR group(NLR>6.17,n=25).The clinical data,coronary artery disease,interventional treatment and IMR after primary PCI were compared between the two groups.Meanwhile,the correlation between the NLR and IMR after primary PCI was analyzed by Pearson correlation analysis.Results The diabetes history(7/25 vs.15/25,χ^2=5.195,P=0.023),hyperlipidemia history(7/25 vs.14/25,χ^2=4.023,P=0.045),neutrophil count[6.33(4.04,6.66)×10^9/L vs.7.90(7.23,12.09)×10^9/L,H=18716.000,P<0.001],lymphocyte count[1.85(1.37,2.56)×10^9/L vs.0.87(0.78,1.03)×10^9/L,H=29710.000,P<0.001],onset-balloon dilation time[227.00(180.00,390.00)min vs.360.00(270.00,435.00)min,H=25199.500,P<0.001]and IMR after primary PCI[(29.9±2.7)vs.(40.4±1.7),t=16.307,P<0.001]were statistically significantly different between the low NLR group and high NLR group.Pearson correlation analysis showed a positive correlation between the NLR and IMR(r=0.676,P<0.001).Further simple linear regression analysis showed that the NLR was associated with the occurrence of microcirculatory disturbance after primary PCI(R2=0.457,P<0.001).Conclusion The higher NLR of STEMI patients at admission is closely related to their severe microcirculatory disturbance after primary PCI,and it has certain reference value for predicting their microcirculation status.