中性粒细胞/淋巴细胞比值与急性心肌梗死患者再灌注对左心功能的影响

Influence of neutrophile granulocyte-to-lymphocyte ratio and reperfusion on left heart function in patients with acute myocardial infarction

目的探讨中性粒细胞与淋巴细胞的比值(NLR)与急性心肌梗死患者心肌损害及心脏功能相关参数的关系。方法收集急性心肌梗死且12 h内接受再灌注治疗的患者186例,采集外周静脉血进行中性粒细胞和淋巴细胞计数,计算NLR。分析NLR与心肌损伤及功能障碍参数之间的关联强度。结果在所有患者中NLR与血清肌酸激酶同工酶(CK-MB)呈正线性回归(r=0.238,P<0.0001),NLR与左室射血分数(LVEF)(r=-0.216,P<0.0001)或左心室短轴缩短率(FS)呈负线性回归(r=-0.223,P<0.0001)。当NLR>2.74时CK-MB、谷草转氨酶(AST)和肌酐(CREA)明显升高,LVEF和FS明显降低(P均<0.05),NLR与CK-MB间无相关性(r=0.076,P=0.234),与LVEF和FS仍显著相关(r=-0.125,P=0.037;r=-0.227,P=0.001)。Logisti回归分析仍提示NLR为EF、FS降低的危险因素(OR=3.13,95%CI:2.78~8.85,P<0.001;OR=2.58,95%CI:1.78~9.58,P<0.001)。结论NLR可能是评估急性心肌梗死后心肌损伤和心脏功能障碍程度的有效预测指标。

Objective To investigate the relationship among granulocyte-to-lymphocyte ratio(NLR),myocardial damage and parameters related to heart function in patients with acute myocardial infarction(AMI).Methods AMI patients(n=186)received reperfusion treatment within 12 h were chosen,and samples of peripheral venous blood were collected for counting neutrophile granulocyte and lymphocyte and calculating NLR.The strength of correlation among NLR,myocardial damage and dysfunction parameters was analyzed.Results In all patients,NLR and serum CK-MB showed a positive linear regression(r=0.238,P<0.0001),and NLR and LVEF(r=-0.216,P<0.0001),NLR and left ventricular fraction shortening(LVFS,r=-0.223,P<0.0001)showed a negative linear regression.When NLR>2.74,CK-MB,AST and CREA increased significantly,and LVEF and LVFS decreased significantly(all P<0.05).NLR was no correlated to CK-MB(r=0.076,P=0.234),but greatly correlated to LVEF(r=-0.125,P=0.037)and LVFS(r=-0.227,P=0.001).The results of Logisti regression analysis showed that NLR was the risk factor of LVEF decrease(OR=3.13,95%CI:2.78~8.85,P<0.001)and LVFS decrease(OR=2.58,95%CI:1.78~9.58,P<0.001).Conclusion NLR may be an effective index for predicting severity of myocardial damage and heart dysfunction after AMI.