中性粒细胞/高密度脂蛋白胆固醇比值对低危心房颤动并发无症状脑梗死患者的临床意义

Clinical Significance of Neutrophil to High-density Lipoprotein Cholesterol Ratio in Patients with Low-risk Atrial Fibrillation Complicated with Silent Cerebral Infarction

目的 探讨中性粒细胞与高密度脂蛋白胆固醇比值(neutrophil to high-density lipoprotein cholesterol ratio,NHR)对低危心房颤动(房颤)(CHA2DS2-VA评分≤1分)并发无症状脑梗死(silent cerebral infarction,SCI)患者的临床意义。方法 回顾性分析2017年1月至2021年2月在徐州市中心医院就诊的低危房颤患者255例,根据头颅核磁共振成像(magnetc resonance imagng,MRI)检查结果,分为SCI组(n=99)和无SCI组(n=156),同时记录患者相关临床资料。NHR等指标与SCI的关系采用多因素Logistic回归分析,并绘制受试者工作特征曲线(receiver operating characteristic curve,ROC)评估NHR、CHA2DS2-VA评分及NHR联合CHA2DS2-VA评分对低危房颤患者并发SCI的风险评估价值。结果 SCI组患者的年龄、房颤病程>5年、CHA2DS2-VA评分=1、有原发性高血压(高血压)病史、吸烟史者均高于无SCI组,差异有统计学意义(P<0.05)。SCI组患者的估算肾小球滤过率(estimated glomerular filtration rate,e GFR)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)低于无SCI组(P<0.05),白细胞、中性粒细胞、超敏C反应蛋白、NHR高于无SCI组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示年龄、高血压病史、CHA2DS2-VA评分和NHR是SCI的独立危险因素。绘制ROC发现,NHR、CHA2DS2-VA评分的曲线下面积(area under the curve,AUC)分别为0.711、0.625,其中NHR的预测价值最大,灵敏度为66.7%,特异度为67.3%。NHR联合CHA2DS2-VA评分预测SCI的AUC为0.76,预测价值高于NHR、CHA2DS2-VA评分(P<0.05)。结论 NHR是低危房颤并发SCI患者的独立危险因素,可作为低危房颤发生SCI的风险评估参考指标。

Objectives To explore the clinical significance of neutrophil to high-density lipoprotein cholesterol ratio(NHR)on low-risk atrial fibrillation(AF)complicated with silent cerebral infarction(SCI).Methods A total of 255 low-risk AF inpatients(CHA2DS2-VA score≤1)were enrolled from January 2017 to February 2021 in the Xuzhou Central Hospital.According to the results of cerebral magnetc resonance imagng(MRI),the patients were divided into SCI group(n=99)and non-complicating SCI group(n=156).The clinical and laboratory data of all the subjects were collected.Univariate and multivariate Logistic regression analysis were used to analyze the influencing factors of low-risk AF patients complicated with SCI.In addition,receiver operating characteristic curve(ROC)was performed to assess the ability of influencing factors to predict SCI in patients with low-risk AF.Results Compared with non-SCI group,the age,course of AF,CHA2DS2-VA score,proportions of patients with history of hypertension and smoking history,white blood cells,neutrophils,high-sensitivity C-reactive protein and NHR were significantly higher and the estimated glomerular filtration rate(eGFR),high-density lipoprotein cholesterol(HDL-C)were significantly lower in SCI group(P<0.05).The multivariate Logistic regression showed that age,history of hypertension,CHA2DS2-VA score and NHR were inde-pendent risk factors for patients with low-risk AF complicated with SCI.The ROC showed that the area under curve(AUC)of NHR and CHA2DS2-VA score were 0.711 and 0.625,respectively(P<0.001).The predictive value of NHR was the highest,the sensitivity and specificity were 66.7%and 67.3%.AUC of NHR combined with CHA2DS2-VA score was 0.76,which was higher than that of NHR and CHA2DS2-VA score.Conclusions NHR is a positively independent influencing factor of patients with low-risk AF complicated with SCI,which may be the index for auxiliary risk assess-ment of SCI in low-risk AF patients.