中性粒细胞与淋巴细胞比值对STEMI再灌注损伤后微血管阻塞的预测价值

Predictive Value of Neutrophil-to-Lymphocyte Ratio for MVO After STEMI Reperfusion Injury

目的探讨中性粒细胞与淋巴细胞比值(NLR)与急性ST段抬高心肌梗死(STEMI)的再灌注损伤后微血管阻塞的关系。方法收集2018年10月—2020年12月在南京大学医学院附属鼓楼医院首次行急诊经皮冠状动脉介入治疗(PCI)的86例STEMI患者的资料,术后1周行心脏磁共振检查,分析微血管阻塞(MVO)面积及MVO与左心室的比值,分成轻中度、重度MVO两组,比较两组之间的NLR、C反应蛋白以及低密度脂蛋白胆固醇等指标的差异,分析NLR与MVO严重程度的关联。以NLR为自变量,MVO为因变量,计算ROC曲线下面积。结果重度MVO组的术前白细胞计数、中性粒细胞百分率和NLR均显著高于轻中度MVO组。多因素逻辑回归分析显示,NLR是MVO严重程度的危险因素(P<0.05)。NLR对MVO的截断值是4.2103,NLR对重度MVO的敏感性是76.3%,特异性是66.7%。结论NLR可预测STEMI患者PCI后MVO的严重程度,NLR升高的STEMI患者的MVO面积显著增加。

Objective To investigate the association of neutrophil-to-lymphocyte ratio(NLR)with microvascular obstruction after reperfusion injury in acute ST segment elevation myocardial infarction(STEMI).Methods 86 STEMI patients who underwent emergency percutaneous coronary intervention(PCI)in Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School from October 2018 to December 2020 were enrolled.Cardiac magnetic resonance examination was performed one week after the operation,and microvascular obstruction(MVO)area and ratio of MVO to left ventricle were analysed.Then patients were divided into two groups:mild to moderate MVO and severe MVO.NLR,C-reactive protein,low-density lipoprotein cholesterol and other related indicators between the two groups were compared,and the correlation between NLR and MVO severity was analyzed.The area under the ROC curve was calculated with NLR as the independent variable and MVO as the dependent variable.Results The preoperative white blood cell count,neutrophil percentage and NLR in severe MVO group were significantly higher than those in mild to moderate MVO group.Multivariate logistic regression analysis showed that NLR is a risk factor for MVO severity(P<0.05).The cut-off value of NLR to MVO was 4.2103,and the sensitivity and specificity of NLR to severe MVO were 76.3%and 66.7%respectively.Conclusion NLR can predict the severity of MVO in STEMI patients after PCI,and the area of MVO in STEMI patients with elevated NLR is significantly increased.