中性粒细胞与淋巴细胞比值评估老年急性ST段抬高型心肌梗死患者冠状动脉病变程度及预后

Value of NLR for assessing severity and outcome of CAD in elderly STEMI patients

目的 探讨外周血中性粒细胞/淋巴细胞比值(NLR)对老年急性ST段抬高型心肌梗死(STEMI)患者冠状动脉病变严重程度及PCI术后预后评估价值。方法 纳入老年STEMI急诊PCI患者241例,根据Gensini积分三分位数值分为低分位组80例、中分位组81例、高分位组80例。根据PCI术后是否发生主要不良心脑血管事件(MACCE),分为无MACCE组214例和MACCE组27例。采用Spearman相关性分析、Cox分析和ROC曲线分析。结果 高分位组高敏C反应蛋白、白细胞计数和NLR水平较低分位组和中分位组明显升高(P<0.01);单核细胞和中性粒细胞计数较低分位组明显升高(P<0.01)。外周血NLR与Gensini积分呈正相关(r=0.192,P=0.003)。NLR(HR=1.168,95%CI:1.050~1.299),Gensini积分(HR=1.014,95%CI:1.004~1.025)是患者术后1年内发生MACCE的独立危险因素。ROC曲线分析,NLR预测MACCE的曲线下面积为0.649(95%CI:0.532~0.766),最佳临界值为4.645,敏感性77.8%,特异性为57.9%。结论 外周血NLR水平与老年STEMI患者Gensini积分呈正相关,辅助预测患者PCI术后发生MACCE的价值较高。

Objective To study the value of NLR for assessing the severity and outcome of CAD in elderly STEMI patients after PCI.Methods Two hundred and forty-one elderly STEMI patients who underwent PCI in our hospital were divided into low Gensini score group(n=80),medium Gensini score group(n=81) and high Gensini score group(n=80),and further divided into MACCE group(n=27) and MACCE-free group(n=214).Analyzed by Pearson correlation analysis, multivariate Cox analysis and ROC curve analysis respectively.Results The serum hs-CRP level and leukocyte count and NLR were significantly higher in high Gensini score group than in low and medium Gensini score groups(P<0.01).The number of monocytes and neutrophils was significantly larger in high Gensini score group than in low Gensini score group(P<0.01).That NLR was positively related with Gensini score in elderly STEMI patients(r=0.192,P=0.003).The NLR and Gensini score were independent risk factors for MACCE in elderly STEMI patients within 1 year after PCI(HR=1.168,95%CI:1.050-1.299;HR=1.014,95%CI:1.004-1.025).ROC curve analysis revealed that the AUC of NLR for assessing the MACCE in elderly STEMI patients after PCI was 0.649(95%CI:0.532-0.766) with an optimal cut-off value of 4.645,a sensitivity of 77.8% and a specificity of 57.9%.Conclusion NLR is positively related with the severity of CAD and the value of NLR is rather high for predicting MACCE in elderly STEMI patients.