中性粒细胞/淋巴细胞比值与PCI术后AMI患者死亡的关系及其预测价值

Relationship between neutrophil/lymphocyte ratio and death of AMI patients after PCI and its predictive value

目的:研究中性粒细胞/淋巴细胞比值(NLR)与经皮冠状动脉介入治疗(PCI)术后急性心肌梗死(AMI)患者死亡的关系及其预测价值。方法:依据NLR值,于我院行PCI术的AMI患者811例被分为低NLR组(383例,NLR<3.25)和高NLR组(428例,NLR≥3.25),比较两组基线资料,分析两组36个月生存曲线,并分析NLR与PCI术后死亡风险的关系及其预测价值。结果:与低NLR组比较,高NLR组年龄、入院时心率、糖尿病患病率、中性粒细胞计数、血脂指标:TC、LDL-C、non-HDL-C水平,ALT、空腹血糖、肌酐、NT-proBNP水平、GRACE危险评分(GRS)均显著升高,HDL-C水平、溶栓、应用他汀类药物、β受体阻滞剂、ACEI比例、淋巴细胞计数、LVEF均显著降低,P<0.05或<0.01。随访中,低NLR组死亡率为2.6%,高NLR组死亡率为9.1%。ROC曲线显示,NLR、GRS及两者联合预测36个月全因死亡风险的曲线下面积分别为0.666、0.755及0.762,NLR的最佳截断值为3.25,敏感度为79.6%,特异度为51.9%。Kaplan-Meier生存曲线提示高NLR组死亡风险显著增加(P均=0.001);COX比例风险模型提示,高NLR是此类患者长期死亡风险的独立危险因素(HR=1.031,P=0009)。结论:高NLR与PCI术后AMI患者的长期死亡风险关系密切,且其具有显著预测价值。

Objective:To study relationship between neutrophil/lymphocyte ratio(NLR)and death of patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI)and its predictive value.Methods:According to NLR value,a total of 811 AMI patients undergoing PCI in our hospital were divided into low NLR group(n=383,NLR<3.25)and high NLR group(n=428,NLR≥3.25).Baseline data were compared and 36-month survival curve were analyzed between two groups.And relationship between NLR and death risk after PCI and its predictive value were analyzed.Results:Compared with low NLR group,there were significant rise in age,heart rate at hospitalization,prevalence rate of diabetes mellitus,neutrophil count,blood lipid indexes:levels of TC,LDL-C and non-HDL-C,levels of ALT,fasting blood glucose,creatinine and NT-proBNP and GRACE risk score(GRS),and significant reductions in level of HDL-C,percentages of thrombolysis,statin,β-receptor blocker and ACEI application,lymphocyte count and LVEF in high NLR group,P<0.05 or<0.01.During follow-up,mortality rate of low NLR group was 2.6%,and that of high NLR group was 9.1%.ROC curve analysis indicated that AUCs of NLR,GRS and combined detection were 0.666,0.755 and 0.762 respectively for predicting 36-month all-cause mortality.The optimal cutoff point of NLR was 3.25,sensitivity was 79.6%,and specificity was 51.9%.Kaplan-Meier survival curve indicated that death risk of high NLR group significantly increased(P=0.001 all).COX proportional hazard model indicated that high NLR was independent risk factor for long-term death risk in these patients(HR=1.031,P=0.009).Conclusion:High NLR is closely associated with long-term death risk in AMI patients after PCI,and it possesses significant predictive value.