中性粒细胞-淋巴细胞比值在冠心病经皮冠状动脉介入治疗中的临床意义

Clinical significance of neutrophil lymphocyte ratio in percutaneous coronary intervention for coronary heart disease

目的探讨中性粒细胞-淋巴细胞比值(NLR)对冠心病患者经皮冠状动脉介入治疗(PCI)后临床结局的影响及对预后的预测价值。方法回顾性分析6046例于新疆医科大学第一附属医院心脏中心经冠状动脉造影确诊为冠心病并行PCI治疗的患者临床资料,根据受试者工作特征曲线确定患者NLR的最佳截断值,并据此将患者分为低NLR组(1997例)、中NLR组(2025例)和高NLR组(2024例)。分析各组的一般资料、实验室检查指标及预后结局相关指标,多因素分析影响预后的危险因素。采用Kaplan-Meier法分析随访期间患者预后生存情况。结果各组患者年龄、心率、男性比例、高血压比例、服用氯吡格雷比例比较差异均有统计学意义(P<0.05),中NLR组和高NLR组上述指标明显高于低NLR组(P<0.05)。各组患者NLR、载脂蛋白A1、血糖、尿素氮、肌酐水平比较差异均有统计学意义(P<0.05),且中NLR组和高NLR组上述指标明显高于低NLR组(P<0.05),高NLR组高于中NLR组(P<0.05)。各组患者全因性死亡发生率比较差异具有统计学意义(P<0.05),高NLR组全因性死亡发生率明显高于中NLR组及低NLR组(P<0.05)。年龄越大、心率越快、尿素氮越高及服用氯吡格雷是主要不良心脑血管事件(MACCE)发生的独立危险因素(P<0.05)。Kaplan-Meier生存曲线显示,低NLR组患者的生存率高于中NLR组和高NLR组(P<0.001),中NLR组和高NLR组生存率比较差异无统计学意义(P>0.05);Log-rank检验显示,低NLR组MACCE发生率明显低于中NLR组及高NLR组(P<0.05)。结论NLR高、年龄大、心率快、尿素氮高及服用氯吡格雷的冠心病患者PCI后预后较差,其中NLR能够预测冠心病PCI后患者的临床结局。

Objective To investigate the effect of neutrophil to lymphocyte ratio(NLR)on clinical outcomes after percutaneous coro-nary intervention(PCI)in patients with coronary heart disease and its predictive value on prognosis.Methods The clinical data of 6,046 patients with coronary heart disease diagnosed by coronary angiography and treated by PCI in the Heart Center of First Affiliated Hospital of Xinjiang Medical University were analyzed retrospectively.The optimal cutoff value of NLR was determined by the receiver operating charac-teristic curve,and the patients were divided into the low NLR group(1,997 cases),middle NLR group(2,025 cases)and high NLR group(2,024 cases).The general data,laboratory examination indexes and prognosis related indexes of each group were analyzed,and the risk factors affecting prognosis were analyzed by multivariate analysis.The survival of patients during follow-up period was analyzed by Kaplan-Meier analysis.Results There were statistically significant differences in the age,heart rate,and the proportions of men,hypertension,and clopidogrel among groups(P<0.05),and the above indexes in the middle NLR group and high NLR group were significantly higher than those in the low NLR group(P<0.05).There were statistically significant differences in the levels of NLR,apolipoprotein A1,blood glucose,urea nitrogen and creatinine among groups(P<0.05),and the above indexes in the middle NLR group and high NLR group were significantly higher than those in the low NLR group(P<0.05),and the high NLR group was higher than the middle NLR group(P<0.05).There was statistically significant difference in the incidence of all-cause death among groups(P<0.05),and the incidence of all-cause mor-tality in the high NLR group was significantly higher than those in the middle NLR group and the low NLR group(P<0.05).Older age,faster heart rate,higher urea nitrogen,and taking clopidogrel were the independent risk factors for the occurrence of major adverse cardiovas-cular and cerebrovascular events(MACCE),with statistically significant differences(P<0.05).The Kaplan-Meier survival curve showed that the survival rate of patients in the low NLR group was higher than those in the middle NLR group and high NLR group(P<0.001),and there was no significant difference in the survival rate between middle NLR group and high NLR group(P>0.05).Log-rank test showed that the incidence of MACCE in the low NLR group was significantly lower than those in the middle NLR group and the high NLR group(P<0.05).Conclusion Patients with high NLR,old age,fast heart rate,high urea nitrogen and taking clopidogrel have poor prognosis after PCI,among which NLR can predict the clinical outcome after PCI of patients with coronary heart disease.