中性粒细胞与淋巴细胞比率和血小板与淋巴细胞比率对经导管主动脉瓣置换术的预测价值

Predictive Value of Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio in Transcatheter Aortic Valve Replacement

目的:本研究作为回顾性研究,探讨中性粒细胞与淋巴细胞比率(NLR)和血小板与淋巴细胞比率(PLR)对经导管主动脉瓣置换术(transcatheter aortic valve replacement, TAVR)的预测价值。方法:选取2017年11月至2022年7月在我中心接受经导管主动脉瓣置换术的103例患者作为研究对象,收集其基线资料、术前用药、术前和术后NLR、PLR化验检查、术中相关资料、术后植入永久起搏器、再入院、死亡等数据并使用ROC曲线、独立样本t检验、卡方检验、Cox回归、生存曲线进行回顾性分析,所有患者随访满1年。根据不同时间NLR、PLR等对1年预后的预测作用使用ROC曲线分析曲线下面积(AUC)及最佳截断值,并根据最佳截断值分组,通过Cox回归模型和生存曲线继续进行预后分析,以风险比(Hazard Ratio, HR)表示死亡风险及再入院风险大小;以Log-Rank p表示再入院率和死亡率的差异,p < 0.05时考虑存在统计学意义。结果:在本研究中共入选103例患者,经导管主动脉瓣置换术1年永久起搏器植入率21.4%,1年再入院率14.6%,1年死亡率5.8%。ROC曲线:1年植入永久起搏器:术前NLR (AUC:0.755,最佳截断值:2.98,p < 0.0001)、术后NLR (AUC:0.732,最佳截断值:6.82,p = 0.001)。术前PLR (AUC:0.650,最佳截断值:112.45,p = 0.031)、术后PLR (AUC:0.663,最佳截断值:179.66,p = 0.020)。1年再入院术前NLR (AUC:0.759,最佳截断值:2.35,p = 0.001)、术后NLR (AUC:0.594,最佳截断值:10.37,p = 0.246)。术前PLR (AUC:0.663,最佳截断值:116.97,p = 0.044)、术后PLR (AUC:0.479,最佳截断值:495.52,p = 0.793)。术前NLR (AUC: 0.848, p < 0.0001)。1年死亡:术前NLR (AUC:0.790,最佳截断值:2.75,p = 0.017)、术后NLR (AUC:0.840,最佳截断值:9.22,p = 0.005)。术前PLR (AUC:0.675,最佳截断值:181.27,p = 0.151)、术后PLR (AUC:0.409,最佳截断值:659.25,p = 0.456)。Cox回归:高术前NLR组术后1年再入院风险增加(HR: 9.56, p = 0.003),高术前NLR组术后1年再入院率29.3%,低术前NLR组术后1年再入院率3.6% (Log-Rank p = 0.0003)。高术前NLR组术后1年死亡风险增加(HR: 11.68, p = 0.025),高术前NLR组1年生存率84.4%,低术前NLR组1年生存率98.6% (Log-Rank p = 0.0044)。结论:在本研究中术前NLR可以较好的预测TAVR术后1年植入起搏器、再入院及死亡,术后NLR预测能力次之,术前PLR和术后PLR的预测能力较差。高术前NLR显著增加1年再入院的风险以及死亡的风险,高NLR组具有更高的再入院率及死亡率。

Objective: To investigate the predictive value of neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in transcatheter aortic valve replacement (TAVR). Methods: We selected 105 patients who underwent transcatheter aortic valve replacement in our hospital as the study objects and collected data of baseline data, preoperative medication, preoperative and postoperative NLR, PLR test, intraoperative relevant data, postoperative permanent pacemaker implantation, readmission, death and other data were collected, and ROC curve, independent sample t test, Chi-square test, Cox regression, and survival curve were retrospectively analyzed. All patients were followed up for 1 year. ROC curve was used to analyze the area under the curve (AUC) and the best cutoff value according to the prediction effect of NLR and PLR on 1-year prognosis at different times, and the groups were grouped according to the best cutoff value. Prognostic analysis was continued through Cox regression model and survival curve, and Hazard Ratio (HR) was used to represent the risk of death and readmission. Log-Rank p was used to represent the difference between readmission rate and mortality, with statistical significance considered when p < 0.05. Results: A total of 103 patients were enrolled in this study. The 1-year permanent pacemaker implantation rate was 21.4%, the 1-year readmission rate was 14.6%, and the 1-year mortality rate was 5.8%. ROC curve: 1 year permanent pacemaker implantation: preoperative NLR (AUC: 0.755, best cutoff: 2.98, p < 0.0001), postoperative NLR (AUC: 0.732, best cutoff: 6.82, p = 0.001). Preoperative PLR (AUC: 0.650, best cutoff value: 112.45, p = 0.031), postoperative PLR (AUC: 0.663, best cutoff value: 179.66, p = 0.020). Preoperative NLR (AUC: 0.759, best cutoff value: 2.35, p = 0.001) and postoperative NLR (AUC: 0.594, best cutoff value: 10.37, p = 0.246). Preoperative PLR (AUC: 0.663, best cutoff value: 116.97, p = 0.044) and postoperative PLR (AUC: 0.479, best cutoff value: 495.52, p = 0.793). Preoperative NLR (AUC: 0.848, p < 0.0001). Death at 1 year: preoperative NLR (AUC: 0.790, best cutoff: 2.75, p = 0.017), postoperative NLR (AUC: 0.840, best cutoff: 9.22, p = 0.005). Preoperative PLR (AUC: 0.675, best cutoff value: 181.27, p = 0.151) and postoperative PLR (AUC: 0.409, best cutoff value: 659.25, p = 0.456). Cox regression: The risk of readmission 1 year after surgery was increased in the high preoperative NLR group (HR: 9.56, p = 0.003);the readmission rate 1 year after surgery was 29.3% in the high preoperative NLR group and 3.6% in the low preoperative NLR group (Log-Rank p = 0.0003). The risk of death at 1 year after surgery was increased in the group with high preoperative NLR (HR: 11.68, p = 0.025), and the 1-year survival rate was 84.4% in the group with high preoperative NLR and 98.6% in the group with low preoperative NLR (Log-Rank p = 0.0044). Conclusion: In this study, preoperative NLR was a good predictor of pacemaker implantation, readmission and death 1 year after TAVR, followed by postoperative NLR, and the predictive ability of preoperative PLR and postoperative PLR was poor. High preoperative NLR significantly increased the 1-year risk of readmission and the risk of death, and the high NLR group had higher readmission and mortality rates.