|关键词||急性冠脉综合征 中性粒细胞 淋巴细胞|
|其他题名||Association of neutrophil to lymphocyte ratio and non-ST-elevation acute coronary syndrome and its severity and outcomes|
Objective: Investigating the relationship between the neutrophil to lymphocyte ratio（NLR）and the non-ST-elevation acute coronary syndrome (NSTE-ACS), which leads to research on the role of NLR in the severity and predictive value for Major Adverse Cerebral Cardiovascular Events(MACCE).
Methods: A total of 307 hospitalized patients undergoing coronary angiography were participated in the study. Control group were consisted of patients with normal coronary arteries. Patients with coronary stenosis who had been confirmed as NSTE-ACS by at least one cardiologist were divided into 3 groups according to SYNTAX scores. The clinical data including neutrophil count, lymphocyte count, classic cardiovascular risk factors, and N-terminal pro-brain natriuretic peptide (NT-proBNP) were recorded, and NLR was calculated after admission. And then 212 patients undergoing primary percutaneous coronary intervention were followed up for at least 6 months. The primary endpoints refered as MACCE, including death, targeted vascular revascularization, non-fatal myocardial infarction, rehospitalization due to unstable angina, rehospitalization due to heart failure, transient ischemic attack, and stroke. Statistical analyses were performed with SAS 9.20.
Results: (1) The NLR was higher in high risk group and mild risk group compared with control group (P<0.05); The NLR was higher in high risk group compared with mild risk group and low risk group (P<0.05); The NLR was higher in mild risk group compared with low risk group (P<0.05). After univariate and multivariate logistic regression analysis, NLR〔OR=1.627，95%CI(1.176-2.252)，P<0.05〕was an independent risk predictor of NSTE-ACS together with age, arterial hypertension and diabetes mellitus.(2) In correlation analysis, NLR showed significant correlation with SYNTAX scores（r=0.55163，P<0.05）which can reflect the severity of coronary lesions.(3) In a receiver-operating characteristic curve analysis, an NLR value of 2.145 was identified as an effective cut point in predicting NSTE-ACS with a sensitivity and specificity of 62% and 69% (area under curve [AUC]=0.664,95% confidence interval [CI] 0.8-0.92). (4) Patients who had completed survey were divided into three groups based on their NLR levels: high NLR group (>2.89; n=68), intermediate NLR group (1.97-2.89; n=70), and low NLR group (≤1.97; n=68). A total of 43 patients suffered from MACCE during the follow-up. The level of NLR was significantly higher in patients with MACCE than those without MACCE (P<0.05). And then the groups which were divided based on NLR levels were transferred to subgroups which were contained in three groups accord to GRACE scores. In the low risk group there was no MACCE. In the mild risk group and high risk group, an elevating MACCE ratio from low NLR subgroup to high NLR subgroup was observed (P<0.05). (5) Kaplan-Meier survival analysis suggested that patients with high NLR tended to have a decreased event-free survival (Wilcoxon=10.8464, P<0.05). After univariate and multivariate COX regression analysis, NLR was an independent risk predictor of MACCE in patients with NSTE-ACS〔RR=1.782,95%CI(1.033-3.074), P<0.05〕. (6) In order to analysis the effectiveness of NLR in detecting MACCE in patients with NSTE-ACS, the AUC from the first month to the sixth month were showed in ROC as follows, 0.948(95%CI:0.893-1.004),0.937(95%CI:0.883-0.990),0.929(95%CI:0.876-0.982),0.852(95%CI:0.783-0.921), 0.814(95%CI:0.739-0.889), 0.797(95%CI:0.719-0.875).
Conclusions: NLR was not only an independent risk predictor of NSTE-ACS but also can forecast the severity of coronary lesions and MACCE.
|李阳. 中性粒细胞与淋巴细胞比值与非ST段抬高急性冠脉综合征及其严重程度和预后关系研究[D]. 北京大学民航临床医学院. 北京大学,2013.|