NLR和NT-proBNP及MPV联合检测对急性心肌梗死后发生急性肾损伤预测价值探讨

Predictive value of combined detection of NLR,NT-proBNP and MPV for acute kidney injury after acute myocardial infarction

目的 探讨中性粒细胞淋巴细胞比值(NLR)、N末端B型脑钠肽前体(NT-proBNP)、血小板平均体积(MPV)联合检测对急性心肌梗死后发生急性肾损伤(AKI)的预测价值。方法 选取2020-06-01-2022-06-01巨野县人民医院收治的210例急性心肌梗死患者为研究对象,将急性心肌梗死后发生AKI的60例患者作为观察组(AKI组),急性心肌梗死后未发生AKI的150例患者作为对照组(非AKI组)。收集2组患者的临床资料;采用全自动生化分析仪检测血细胞计数,计算NLR和MPV;采用荧光免疫分析法检测NT-proBNP。采用多因素logistic回归分析急性心肌梗死后发生AKI的影响因素,采用受试者工作特征(ROC)曲线分析NLR、NT-proBNP、MPV联合检测对急性心肌梗死后发生AKI的预测价值。结果 AKI组使用利尿剂占比为45.00%,高于非AKI组的20.00%,χ^(2)=23.482,P<0.001;NLR、NT-proBNP、MPV分别为8.77±2.55、(808.25±43.84) pg/L、(10.23±0.89) fL,均高于非AKI组的6.01±2.08、(450.58±17.46) pg/L、(9.47±0.55) fL,t值分别为8.126、84.740和7.489,均P<0.001。多因素logistic回归分析结果显示,NLR(OR=3.466,95%CI为2.075~7.486,P=0.003)、NT-proBNP(OR=7.925,95%CI为4.628~13.571,P<0.001)、MPV(OR=3.617,95%CI为1.162~11.259,P=0.026)为急性心肌梗死后发生AKI的独立影响因素。NLR、NT-proBNP、MPV联合检测预测急性心肌梗死后发生AKI的ROC曲线下面积、准确率、敏感度、特异度均大于各单独检测。结论 NLR、NT-proBNP、MPV及三者联合检测对急性心肌梗死后发生AKI均有预测价值,其中NLR、NT-proBNP、MPV三者联合检测可进一步提升对急性心肌梗死后发生AKI的预测价值。

Objective To investigate the predictive value of neutrophil lymphocyte ratio(NLR),N terminal b-type brain natriuretic peptide precursor(NT-proBNP),average blood platelet volume(MPV)joint detection in acute kidney injury(AKI)after acute myocardial infarction.Methods Totally 210 patients with acute myocardial infarction admitted to Juye County People's Hospital from June 1,2020 to June 1,2022 were selected as the study subjects.Sixty patients with AKI after acute myocardial infarction were selected as the observation group(AKI group),and 150 patients without AKI after acute myocardial infarction were selected as the control group(non AKI group).The clinical data from 2 groups of patients were collected.A fully automated biochemical analyzer was used to detect blood cell count,calculate NLR and mean platelet volume(MPV);Fluorescence immunoassay was used to detect NT-proBNP.Multiple logistic regression analysis was used to analyze the influencing factors of acute kidney injury after acute myocardial infarction,and the combined detection of NLR,NT-proBNP,and MPV was analyzed using the receiver operating characteristic(ROC)curve to predict the predictive value of acute kidney injury after acute myocardial infarction.Results The proportion of diuretics used in the AKI group was 45.00%,which was higher than the 20.00%in the non AKI group(χ^(2)=23.482,P<0.001);NLR,NTproBNP and MPV were 8.77±2.55,(808.25±43.84)pg/L and(10.23±0.89)fl,respectively,higher than those in the non AKI group 6.01±2.08,(450.58±17.46)pg/L and(9.47±0.55)fl,with t-values of 8.126,84.740 and 7.489,respectively,all P<0.001.The results of multivariate logistic regression analysis showed that NLR(OR=3.466,95%CI:2.075-7.486,P=0.003),NT-proBNP(OR=7.925,95%CI:4.628—13.571,P<0.001)and MPV(OR=3.617,95%CI:1.162-11.259,P=0.026)were independent influencing factors for the occurrence of AKI after acute myocardial infarction.The combined detection of NLR,NT-proBNP and MPV has a greater area under ROC curve,accuracy,sensitivity and specificity for predicting AKI after acute myocardial infarction compared to individual tests.ConclusionNI LR,NTproBNP,MPV and their combined detection have predictive value for AKI after acute myocardial infarction.Among them,the combined detection of NLR,NT-proBNP and MPV can further enhance the predictive value for AKI after acute myocardial infarction.