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学科主题: 内科学
题名:
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
作者: 李阳
答辩日期: 2013-05-17
导师: 季汉华
专业: 内科学
授予单位: 北京大学
授予地点: 北京大学民航临床医学院
学位: 硕士
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
分类号: R541.4
摘要:

目的:

研究中性粒细胞与淋巴细胞比值(NLR)与非ST段抬高急性冠脉综合征(NSTE-ACS)的关系,探讨NLRNSTE-ACS患者冠脉病变严重程度和心脑血管主要不良事件(MACCE)的预测价值

 

资料与方法:

307例行冠脉造影检查且资料完整的非冠心病和NSTE-ACS患者,分为非冠心病组81例和NSTE-ACS226例。NSTE-ACS组又根据SYNTAX评分结果,分为低危组(1-22)137例、中危组(23-32)47例、高危组(33)42例。记录所有患者的临床资料,包括外周血白细胞分类计数并计算NLR、心血管病危险因素及血浆N端前体脑钠肽(NT-proBNP)等。并进一步对212例行冠脉介入治疗的NSTE-ACS患者定期随访6个月,记录终点事件发生情况。终点事件指MACCE,包括全因死亡、靶血管病变重建、随访期间发生的心肌梗死、脑卒中或一过性脑缺血、需要住院治疗的不稳定性心绞痛和心力衰竭。应用SAS9.2软件进行统计分析。

 

结果:

     (1)NSTE-ACS的中、高危亚组与非冠心病组间NLR差异均有统计学意义(P<0.05)NSTE-ACS各亚组中,高危组与中、低危组间NLR差异均有统计学意义(P<0.05),中危组与低危组间NLR差异亦有统计学意义(P<0.05)。单因素及多因素Logistic回归分析显示,NLROR=1.62795%CI(1.176-2.252)P<0.05〕与年龄、高血压及糖尿病均是NSTE-ACS的独立危险因素。(2)线性分析显示,NLRNSTE-ACS患者冠脉病变严重程度正相关(r=0.55163P<0.05)。(3)受试者工作特征曲线(ROC曲线)显示,NLR的曲线下面积为0.66495%CI:0.599-0.730),且当其切值取2.145时,诊断效率最高,敏感性为58%,特异性为71.6%(4)将完成随访的206例患者根据NLR水平分为3组,并进一步作为亚组纳入GRACE评分危险度分层,低危组中3亚组均未有MACCE发生;中危组中3亚组MACCE发生率由低NLR亚组至高NLR亚组升高(P<0.05);高危组中3亚组MACCE发生率亦由低NLR亚组至高NLR亚组升高(P<0.05)。共43例患者发生MACCEMACCE组较无MACCENLR升高(P<0.05)(5)Kaplan-Meier生存曲线显示,随着NLR水平升高,NSTE-ACS患者的MACCE发生率增加,无事件生存率明显降低(Wilcoxon=10.8464P<0.05)。单因素及多因素COX回归分析显示,NLRNSTE-ACS患者MACCE的独立危险预测因素〔RR=1.78295%CI(1.033-3.074)P<0.05〕。 (6)ROC曲线探索NLRNSTE-ACS患者MACCE诊断效率,随访的第1个月至第6个月曲线下面积分别为0.94895%CI:0.893-1.004)、0.93795%CI:0.883-0.990)、0.92995%CI:0.876-0.982)、0.85295%CI:0.783-0.921)、0.81495%CI:0.739-0.889)、0.79795%CI:0.719-0.875)。

 

结论:

NLR英文摘要:

Objective: Investigating the relationship between the neutrophil to lymphocyte ratioNLRand 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, NLROR=1.62795%CI(1.176-2.252)P<0.05was 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 scoresr=0.55163P<0.05which 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-ACSRR=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.

语种: 中文
出处: http://xuewei.bjmu.edu.cn/simpsearch.action?keyword=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&dbid=72
相关网址: 查看原文
内容类型: 学位论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/105453
Appears in Collections:北京大学民航临床医学院_学位论文

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作者单位: 北京大学民航临床医学院

Recommended Citation:
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.
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