中性粒细胞百分比/白蛋白比值与非瓣膜性心房颤动患者缺血性脑卒中发生风险的关联

Association Between Neutrophil Percentage-to-Albumin Ratio and Ischemic Stroke Risk in Patients With Non-valvular Atrial Fibrillation

目的:评估中性粒细胞百分比/白蛋白比值(NPAR)与非瓣膜性心房颤动(NVAF)患者缺血性脑卒中发生风险的关联。方法:连续入选2010年1月1日至2021年10月31日期间就诊于新疆医科大学第一附属医院的NVAF患者6243例,根据NPAR四分位数将其分为四组:Q1组(n=1565)、Q2组(n=1558)、Q3组(n=1562)、Q4组(n=1558);高NPAR被定义为最高四分位数(≥1.94)。采用二元Logistic回归分析评估NPAR与NVAF患者缺血性脑卒中发生风险的关联,应用限制性立方样条图(RCS)评估NPAR与缺血性脑卒中发生风险之间的剂量-反应关系,同时进行亚组分析和敏感性分析来检验结果的稳健性。结果:研究期间共357例(5.7%)患者发生急性缺血性脑卒中。校正CHA2DS2-VASc评分和其他潜在混杂因素后,NPAR的对数值每增加1个单位,NVAF患者的缺血性脑卒中发生风险增加2.33倍(OR=3.33,95%CI:1.28~8.65,P=0.014)。与Q1组相比,Q4组NVAF患者的缺血性脑卒中发生风险增加67%(OR=1.67,95%CI:1.17~2.37,P=0.004)。RCS显示,NPAR与缺血性脑卒中发生风险之间存在正线性关系(P_(nonlinear)=0.196)。亚组分析提示,性别与NPAR在缺血性脑卒中发生风险上存在相乘交互作用(P_(interaction)=0.014)。在阵发性心房颤动患者中,高NPAR仍与缺血性脑卒中发生风险增加有关(OR=1.71,95%CI:1.16~2.53,P=0.007)。结论:在NVAF患者中,NPAR升高与缺血性脑卒中发生风险增加有关,提示NPAR可能是识别缺血性脑卒中高风险房颤患者的新兴生物标志物。

Objectives:The purpose of this study was to evaluate the association between high neutrophil percentage-to-albumin ratio(NPAR)and ischemic stroke risk in patients with non-valvular atrial fibrillation(NVAF).Methods:A total of 6243 NVAF patients,who were admitted in the First Affiliated Hospital of Xinjiang Medical University between January 1,2010 and October 31,2021,were enrolled in this study.The subjects were divided into four groups according to the quartile of NPAR:Q1 group(n=1565),Q2 group(n=1558),Q3 group(n=1562),Q4 group(n=1558).High NPAR was defined as the highest quartile(≥1.94).Binary logistic regression was used to analyze the association between NPAR and ischemic stroke risk in patients with NVAF.The dose-response relationship between NPAR and ischemic stroke risk was evaluated by restricted cubic spline(RCS).In addition,subgroup analysis and sensitivity analysis were performed to test the robustness of the results.Results:A total of 357 patients(5.7%)experienced acute ischemic stroke during the study period.After adjusting for CHA2DS2-VASc scores and other potential confounding factors,each additional unit of the logarithm of NPAR(log-NPAR)was associated with increased ischemic stroke risk of NVAF patients by 2.33 times(OR=3.33,95%CI:1.28-8.65,P=0.014).Compared with group Q1,patients with NVAF in group Q4 had 67%higher risk of ischemic stroke(OR=1.67,95%CI:1.17-2.37,P=0.004).RCS showed a positive linear relationship between NPAR and ischemic stroke risk(P_(nonlinear)=0.196).Subgroup analysis showed that there was a multiplicative interaction between sex and NPAR in ischemic stroke risk(P_(interaction)=0.014).In addition,high NPAR was still associated with an increased risk of ischemic stroke in patients with paroxysmal NVAF(OR=1.71,95%CI:1.16-2.53,P=0.007).Conclusions:In NVAF population,the increase of NPAR is associated with an increased risk of ischemic stroke,suggesting that NPAR may be used as an emerging biomarker for identifying atrial fibrillation populations with high risk of ischemic stroke.