中性粒细胞与淋巴细胞比值、单核细胞与高密度脂蛋白比值对急性非ST段抬高型心肌梗死预后的预测价值研究

Predictive value of neutrophil-to-lymphocyte ratio and monocyte-to-high-density lipoprotein ratio on the prognosis of acute non-ST-segment elevation myocardial infarction

目的探讨中性粒细胞与淋巴细胞比值(NLR)、单核细胞与高密度脂蛋白比值(MHR)对急性非ST段抬高型心肌梗死(NSTEMI)预后的预测价值。方法回顾性队列研究2020年1月至2022年12月武汉市第四医院急诊科入院并最终确诊为NSTEMI患者144例的临床资料。根据患者出院后6个月内是否出现不良心血管事件(MACE),将其分为MACE组(49例)和非MACE组(95例)。比较两组患者临床资料,采用多因素logistic回归分析NLR、MHR与NSTEMI患者出现MACE的关系,并绘制受试者工作特征(ROC)曲线,分析NLR、MHR预测NSTEMI患者预后的价值。结果单因素分析中,与非MACE组比较,MACE组左心室射血分数较低,入院时Killip分级>Ⅱ级比例、白细胞计数、肌酐、NLR、B型钠尿肽前体、高敏肌钙蛋白均较高,差异均有统计学意义(P<0.05);两组MHR比较,差异无统计学意义(P=0.916);多因素logistic回归结果显示,NLR是NSTEMI患者发生MACE的独立危险因素(OR=1.261,95%CI 1.048~1.517,P<0.05);ROC曲线显示,NLR预测MACE的曲线下面积为0.793,灵敏度为83.7%,特异度为66.3%,最佳截断值为3.12(95%CI 0.72~0.87,P<0.001)。结论NLR是NSTEMI患者发生MACE的独立危险因素,具有良好的预测价值;该研究暂未发现MHR与NSTEMI患者出现MACE具有相关性。

Objective To investigate the predictive value of neutrophil-to-lymphocyte ratio(NLR)and monocyte-to-high-density lipoprotein ratio(MHR)on the prognosis of acute non-ST-segment elevation myocardial infarction(NSTEMI).Methods A retrospective cohort study was conducted to collect clinical data from 144 patients admitted to the emergency department of Wuhan Fourth Hospital from January 2020 to December 2022 and finally diagnosed with NSTEMI.The patients were divided into the MACE group(49 cases)and the non-MACE group(95 cases)according to whether they had the major adverse cardiovascular events(MACE)within six months after discharge.The clinical data of the two groups were compared,and the relationship between NLR,MHR and MACE in the NSTEMI patients was analyzed by multivariate logistic regression,and the predictive value of NLR and MHR in predicting the prognosis of NSTEMI patients was analyzed by the receiver operating characteristic(ROC)curve.Results In univariate analysis,compared with the non-MACE group,left ventricular ejection fraction was lower in the MACE group,and the proportion of Killip grade>Ⅱ,white blood cell count,creatinine,NLR,B-type natriuretic peptide precursor and high-sensitivity troponin were higher at admission,with statistical significance(P<0.05).The difference in MHR between the two groups was not statistically significant(P=0.916).Multivariate logistic regression showed that NLR was an independent risk factor for MACE in the NSTEMI pat ients(OR=1.261,95%CI 1.048-1.517,P<0.05).The ROC curve showed that the area under the curve of NLR was 0.793,the sensitivity was 83.7%,the specificity was 66.3%,and the best cut-off value was 3.12(95%CI 0.72-0.87,P<0.001).Conclusion NLR is an independent risk factor for the development of MACE in patients with NSTEMI and has good predictive value.This study did not find a correlation between MHR and the development of MACE in patients with NSTEMI for the time being.