NLR及左房内径预测急性心肌梗死后新发心房颤动的价值

Value of NLR and Left Atrial Distance in Predicting New Onset Atrial Fibrillation after Acute Myocardial Infarction

目的:探讨血小板平均体积/淋巴细胞比值(Neutrophils to lymphocyte ratio, MPVLR)及左心房内径(Left atrial distance, LAD)预测急性心肌梗死(acute myocardial infarction, AMI)后新发心房颤动(new onset atrial fibrillation, NOAF)的价值。方法:选取符合条件的AMI患者共413名作为研究对象,收集患者一般资料及检验检查结果;分组依据为AMI急性期内是否发生心房颤动,分为新发房颤组(NOAF组)及无新发房颤组(非NOAF组),采用Logistic回归分析NLR及LAD对AMI后NOAF发病的影响;应用受试者工作特征(ROC)曲线分析NLR及LAD对NOAF的预测价值。结果:413名AMI患者中,发生NOAF的患者96例(NOAF组,23.2%),未发生NOAF的患者317例(非NOAF组,76.8%)。多变量Logistic回归分析表明,NLR (OR = 1.555, 95% CI: 1.205~2.009, p < 0.005)是AMI患者发生NOAF的独立预测因素。预测NOAF的最佳临界值为3.86,预测的灵敏度和特异度分别为78.1%和57.7%,曲线下面积为0.765 (95% CI 0.712~0.817, p < 0.001);同时联合NLR及LA (left atrium)前后径时能取得更好的预测效果,其ROC曲线下面积为0.841,灵敏度为90.6%,特异度为61.8%。结论:MPVLR是AMI后NOAF的独立危险因素,且MPVLR联合LA前后径可有更好的预测效果。

Objective: To investigate the value of mean platelet volume/lymphocyte ratio (MPVLR) and left atrial diameter (LAD) in predicting new onset atrial fibrillation (NOAF) after acute myocardial in-farction (AMI). Methods: A total of 413 eligible AMI patients were selected as the research objects, and the general information and inspection results of the patients were collected;the grouping was based on whether atrial fibrillation occurred during the acute period of AMI, and was divided into new onset atrial fibrillation group (NOAF group) and non-new onset atrial fibrillation group (non-NOAF group). In the atrial fibrillation group (non-NOAF group), Logistic regression was used to analyze the influence of NLR and LAD on the incidence of NOAF after AMI;receiver operating char-acteristic (ROC) curve was used to analyze the predictive value of NLR and LAD on NOAF. Results: Among the 413 AMI patients, 96 patients developed NOAF (NOAF group, 23.2%), and 317 patients did not develop NOAF (non-NOAF group, 76.8%). Multivariate Logistic regression analysis showed that NLR (OR = 1.555, 95% CI: 1.205~2.009, p < 0.005) was an independent predictor of NOAF in AMI patients. The optimal cut-off value for predicting NOAF was 3.86, the predictive sensitivity and specificity were 78.1% and 57.7%, respectively, and the area under the curve was 0.765 (95% CI 0.712~0.817, p < 0.001);while combining NLR and LA (Left atrium) can achieve better prediction results, the area under the ROC curve is 0.841, the sensitivity is 90.6%, and the specificity is 61.8%. Conclusion: MPVLR is an independent risk factor for NOAF after AMI, and MPVLR combined with LA anteroposterior diameter can have a better predictive effect.