中性粒细胞/淋巴细胞比值对射血分数保留的心力衰竭患者远期预后的影响

Impact of Neutrophil to Lymphocyte Ratio at Admission on Long-term Prognosis of Patients With Heart Failure With Preserved Ejection Fraction

目的:探讨中性粒细胞/淋巴细胞比值(NLR)对射血分数保留的心力衰竭(HFpEF)患者远期预后的影响。方法:回顾性分析2013年1月至2018年12月在中国医科大学附属盛京医院心内科因心力衰竭入院治疗的3 608例HFpEF患者的临床资料,同时根据入院NLR水平分为三组:NLR低值组(NLR≤2.47,n=1 204)、NLR中值组(NLR 2.48~4.12,n=1 203)、NLR高值组(NLR≥4.13,n=1 201)。采用Cox回归及Kaplan-Meier生存曲线分析NLR对HFpEF患者远期预后的影响,同时应用ROC曲线分析NLR评估HFpEF患者全因死亡及心血管死亡的价值。结果:平均随访(3.20±2.01)年期间,NLR低值组、中值组、高值组心血管死亡分别为163例(13.5%)、257例(21.4%)、408例(34.0%),全因死亡分别为273例(22.7%)、403例(33.5%)、617例(51.4%),组间比较差异均有统计学意义(P均<0.001)。多因素Cox回归分析显示,NLR是HFpEF患者预后的危险因素,NLR每增加1,心血管死亡风险增加1.3%(HR=1.013,95%CI:1.005~1.022,P=0.002),全因死亡风险增加1.2%(HR=1.012,95%CI:1.005~1.019,P<0.001)。Kaplan-Meier生存分析显示,NLR越高,全因死亡及心血管死亡率越高,累积生存率越低。ROC曲线显示,NLR联合N末端B型利钠肽原(NT-proBNP)预测HFpEF患者全因死亡(AUC=0.732,灵敏度62.3%,特异度71.6%)、心血管死亡(AUC=0.702,灵敏度65.1%,特异度61.9%)的能力优于单用NLR或NT-proBNP。结论:HFpEF患者的远期死亡率随着NLR的升高而上升,NLR与HFpEF患者远期预后独立相关。

Objectives:To investigate the impact of neutrophil to lymphocyte ratio(NLR)on the long-term prognosis of patients with heart failure with preserved ejection fraction(HFpEF).Methods:The clinical data of 3608 patients with HFpEF admitted to the Department of Cardiology,Shengjing Hospital Affiliated to China Medical University from January 2013 to December 2018 due to heart failure were retrospectively analyzed.Patients were divided into three groups according to the admission NLR level:low NLR group(NLR≤2.47,n=1204),median NLR group(NLR 2.48-4.12,n=1203),and high NLR group(NLR≥4.13,n=1201).Kaplan-Meier survival curve and Cox regression analysis were used to analyze the impact of different NLRs on the long-term prognosis of HFpEF patients.At the same time,ROC curve was used to analyze the value of NLR in predicting all-cause death and cardiovascular death in HFpEF patients.Results:During the mean follow-up of(3.20±2.01)years,all-cause mortality(low NLR group vs.median NLR group vs.high NLR group:22.7%vs.33.5%vs.51.4%,P<0.001)and cardiovascular mortality(low NLR group vs.median NLR group vs.high NLR group:13.5%vs.21.4%vs.34.0%,P<0.001)increased proportionally with the increase of NLR.Multivariate Cox regression analysis showed that NLR remained an independent risk factor for the prognosis of HFpEF patients after adjusting confounding factors.Each increase of one in NLR increased the risk of cardiovascular death by 1.3%(HR=1.013,95%CI:1.005-1.022,P=0.002),and the risk of all-cause death by 1.2%(HR=1.012,95%CI:1.005-1.019,P<0.001).Kaplan-Meier survival analysis showed that the higher the NLR is,the lower the cumulative survival rate of all-cause death and cardiovascular death is in the cohort.The ROC curve showed that the combined use of NLR and N-terminal pro-brain natriuretic peptide(NT-proBNP)is superior to the use of NLR or NT-proBNP alone in predicting all-cause death(AUC 0.732,sensitivity 62.3%,specificity 71.6%)and cardiovascular death(AUC 0.702,sensitivity 65.1%,specificity 61.9%)in enrolled HFpEF patients.Conclusions:NLR is independently associated with long-term prognosis in patients with HFpEF.The higher the NLR at admission,the higher the long-term mortality of HFpEF patients.