NLR联合hs-cTnT对非体外循环冠状动脉旁路移植术后心房颤动的预测价值

摘要：目的　探讨中性粒细胞与淋巴细胞比值（NLR）联合高敏心肌肌钙蛋白T（hs-cTnT）对非体外循环冠状动脉旁路移植术（OPCAB）后心房颤动（AF）的预测价值。方法　选取2017年1月—2019年6月在我院接受OPCAB治疗的冠心病患者108例，根据患者术后是否发生AF分为AF组（32例）和非AF组（76例），比较2组一般资料、心功能、OPCAB围术期指标、NLR、hs-cTnT的变化，多因素Logistic回归分析OPCAB后发生AF的危险因素，受试者工作特征（ROC）曲线分析NLR、hs-cTnT对OPCAB后AF的预测价值。结果　AF组患者的年龄、NYHA心功能分级≥Ⅲ级比例、左心房内径（LAD）、NLR、hs-cTnT、机械通气时间均高于非AF组（P＜0.05）。LAD（OR=3.032，95%CI：1.614～5.696）、NLR（OR=2.186，95%CI：1.171～4.081）、hs-cTnT（OR=2.284，95%CI：1.313～3.973）升高均是OPCAB后AF的独立危险因素（P＜0.05）。ROC分析结果显示，NLR和hs-cTnT对OPCAB后AF的预测价值均较高，曲线下面积分别为0.781（95%CI：0.685~0.877）、0.764（95%CI：0.663~0.866），最佳临界值分别为3.52、13.08 ng/L；而两者联合分析可使得预测价值进一步提升，曲线下面积为0.846（95%CI：0.767~0.925）。结论　NLR联合hs-cTnT对OPCAB后AF的预测效能较高，具有一定的临床应用价值。

The predictive value of NLR combined with hs-cTnT on atrial fibrillation after off-pump coronary artery bypass grafting

Abstract: Objective　To investigate the predictive value of neutrophil to lymphocyte ratio (NLR) combined with high-sensitivity cardiac troponin T (hs-cTnT) for atrial fibrillation (AF) after off-pump coronary artery bypass grafting (OPCAB). Methods　A total of 108 patients who were received OPCAB treatment in our hospital from January 2017 to June 2019 were selected, and they were divided into AF group (n=32) and non AF group (n=76) according to whether AF occurred after operation. The general data, cardiac function, OPCAB perioperative indexes, NLR and hs-cTnT were collected and compared between the two groups. The risk factors of AF after OPCAB were analyzed by multiple Logistic regression. The predictive values of NLR and hs-cTnT on AF after OPCAB were analyzed by receiver operating characteristic (ROC) curve. Results　The age, NYHA cardiac function grade≥grade Ⅲ, left atrial diameter (LAD), NLR, hs-cTnT and mechanical ventilation time of patients were significantly higher in the AF group than those in the non AF group (P＜0.05). Multiple Logistic regression analysis showed that the elevated LAD (OR=3.032, 95%CI: 1.614-5.696), NLR (OR=2.186, 95%CI: 1.171-4.081) and hs-cTnT (OR=2.284, 95%CI: 1.313-3.973) were independent risk factors of AF after OPCAB (P＜0.05). ROC analysis showed that NLR and hs-cTnT had higher predictive values for AF after OPCAB, and the areas under the curve were 0.781 (95%CI: 0.685-0.877) and 0.764 (95%CI: 0.663-0.866). The cut-off values were 3.52 and 13.08 ng/L respectively. The combined analysis of the two could further improve the predictive values, and the area under the curve was 0.846 (95%CI: 0.767-0.925). Conclusion　The combination of NLR and hs-cTnT has a higher clinical value in predicting AF after OPCAB, which has certain clinical application value.