Neutrophil to lymphocyte ratio in relation to risk of all-cause mortality and cardiovascular events among patients undergoing angiography or cardiac revascularization: A meta-analysis of observational studies

Objective

The aim of this study was to investigate whether neutrophil to lymphocyte ratio (NLR) was an independent predictor for all-cause mortality or cardiovascular events in patients undergoing angiography or cardiac revascularization with observational studies by meta-analysis.

Methods

Pubmed and Embase were searched without language restrictions for cohort studies published prior to November 2013. Citations were independently screened by 2 authors, and those meeting the inclusion criteria defined a priori were retained. Data on authors, year of publication, location, target participant, comparison of NLR, outcome assessment, number of event and sample size, duration and statistical adjustments were abstracted.

Results

Eight studies were identified that reported on all-cause mortality and five studies were identified that reported on cardiovascular events. The pooled relative risk (RR) of all-cause mortality was 2.33 (95% CI 1.88–2.88) and the RR of cardiovascular events was 1.89 (95% CI 1.42, 2.52) comparing the highest with the lowest category of NLR.

Conclusions

The meta-analysis indicates that NLR is a predictor of all-cause mortality and cardiovascular events. Further well-designed trials are warranted to confirm this association.     

PCI后新型生物标记物对术中对比剂引起急性肾损伤的预测作用

目的探讨PCI后新型生物标记物对术中对比剂引起急性肾损伤（AKI）的预测作用。方法选择稳定型心绞痛及急性冠脉综合征行PCI治疗患者200例,根据AKI诊断标准分为AKI组16例及正常组184例。于PCI术前及术后不同时间分别测定新型生物标记物血浆中性粒细胞明胶酶相关载脂蛋白（NGAL）、血浆半胱氨酸蛋白酶抑制剂c（CystatinC）、尿NGAL、尿肾脏损伤因子-1（Kim-1）变化情况,并以受试者工作特征曲线及曲线下面积（AUC）评价各项标志物诊断AKI的临床意义。结果①两组术前血浆NGAL、血CystatinC、尿NGAL及尿Kim-1无统计学差异（P均〉0．05）。②与术前相比,AKI组术后以上生物标记物水平均比术前升高,且差异有统计学意义（P均〈0．01）。结论PCI后AKI患者某些生物学标志物水平显著升高,可以成为AKI的早期诊断方法。     

血清PCT、NLR及BUN水平与急性胰腺炎严重程度的相关性分析

目的探讨急性胰腺炎(acute pancreatitis,AP)患者血清降钙素原(procalcitonin,PCT)、中性粒细胞与淋巴细胞比值(neutrophil lymphocyte ratio,NLR)以及尿素氮(blood urea nitrogen,BUN)水平与疾病严重程度的关系。方法收集2014年3月—2018年5月在成都医学院第二附属医院就诊的148例AP患者。所有病例均在入院后完善血生化检查,将患者按照2012亚特兰大分类标准分为轻度急性胰腺炎(mild acute pancreatitis,MAP)、中度急性胰腺炎(moderately severe acute pancreatitis,MSAP)、重度急性胰腺炎(severe acute pancreatitis,SAP)3组。比较3组患者入院后第1天清晨血清PCT、NLR及BUN水平,使用受试者工作特征(receiver operating characteristic,ROC)曲线评价血清PCT、NLR及BUN水平预测轻度、中度、重度AP的效力。使用Ranson评分对患者进行病情评估。结果SAP组血清PCT、NLR、BUN水平及Ranson评分高于MAP组、MSAP组,且MSAP组上述指标高于MAP组,差异比较具有统计学意义(P<0.05);SAP组住院天数多于MAP组、MSAP组,MSAP组住院天数多于MAP组(P<0.05);Pearson相关分析结果显示血清PCT、NLR、BUN水平均与Ranson评分得分显著正相关((r=0.48,P<0.05;r=0.62,P<0.05;r=0.40,P<0.05);ROC曲线分析表明PCT、NLR、BUN 3者联合评估轻度、中度、重度AP的AUC分别大于PCT和BUN单项(P<0.05),与NLR差异比较无统计学意义(P>0.05)。结论血清PCT、NLR、BUN水平均与AP病情严重程度呈正相关,且对轻度、中度、重度AP预测具有一定价值,3者联合应用对评估AP病情严重程度具有较好的早期预测价值。     

急性心肌梗死患者中性粒细胞/淋巴细胞比值与介入术后冠状动脉血流的相关性研究

目的 探讨急性ST 段抬高型心肌梗死（STEMI）患者中性粒细胞/淋巴细胞比值（NLR）与经皮冠状动脉介入治疗（PCI）后冠状动脉无复流的关系。方法 纳入2010－2013 年接受急诊PCI 的232 例STEMI患者, 将患者分为无复流组（TIMI 血流≤2 级）和正常血流组, 采用受试者工作特征（ROC）曲线评价NLR预测无复流发生的最佳切点值, 并进行logistic 回归分析无复流的危险因素。数据分析使用SPSS 11.0 统计软件。结果 无复流组的NLR 高于正常血流组［4.1（2.4～6.5）vs. 2.4（1.7～3.8）, P＝0.001］;ROC曲线计算NLR预测无复流的最佳切点值为3.2, 其敏感度、特异度分别为80%和73%;高NLR 组的无复流发生率明显大于低NLR 组（34.8% vs.9.3%,P＜0.001）;NLR（＞3.2）是无复流的独立危险因素（OR＝3.70, 95% CI：1.39～9.80, P＝0.009）。结论 NLR是STEMI患者急诊PCI后发生无复流现象的独立危险因素, 对其早期危险分层有一定的参考价值。     

Ovine forestomach matrix biomaterial is a broad spectrum inhibitor of matrix metalloproteinases and neutrophil elastase

Proteases play a critical role in the ordered remodelling of extracellular matrix (ECM) components during wound healing and tissue regeneration. However, the usually ordered proteolysis is compromised in chronic wounds due to over‐expression and high concentrations of matrix metalloproteinase's (MMPs) and neutrophil elastase (NE). Ovine forestomach matrix (OFM) is a decellularised extracellular matrix‐based biomaterial developed for tissue regeneration applications, including the treatment of chronic wounds, and is a heterogeneous mixture of ECM proteins and proteoglycans that retains the native structural and functional characteristics of tissue ECM. Given the diverse molecular species present in OFM, we hypothesised that OFM may contain components or fragments that inhibit MMP and NE activity. An extract of OFM was shown to be a potent inhibitor of a range of tissue MMPs (IC₅₀s = 23 ± 5 to 115 ± 14 µg/ml) and NE (IC₅₀ = 157 ± 37 µg/ml), and was more potent than extracts prepared from a known protease modulating wound dressing. The broad spectrum activity of OFM against different classes of MMPs (i.e. collagenases, gelatinases and stromelysins) may provide a clinical advantage by more effectively addressing the protease imbalance seen in chronic wounds.     

Effects of Surgical Stress on Early Nonspecific Immune Response in Children

Surgery alters the body’s homeostatic balance and defense mechanisms. In adults transient postoperative cellular and humoral immunosuppression after different degrees of operative stress has been reported. In children the immunologic consequences of operations are not elaborated. This study investigates the effect of minor and major surgery on early nonspecific immune response in terms of neutrophil counts and function. Forty-three children undergoing minor and major elective procedures were studied. Blood samples were collected before, immediately after, and 72 h after surgery. Total white cell count, differential neutrophil count, and neutrophil phagocytic function were studied using nitroblue tetrazolium test. Children were divided into two groups—group 1 underwent minor surgery and group 2 major surgery. In group 1 there was a significant drop in total counts after surgery, but in group 2 total counts were not affected. In both groups, the percentage of neutrophils increased immediately after surgery but fell to near or less than preoperative levels 72 h after surgery. However, the assessment of neutrophil functions by nitroblue tetrazolium test in both unstimulated and stimulated forms revealed it to be unchanged in group 1. In group 2 the unstimulated neutrophil function was elevated 72 h after surgery, whereas stimulated function was elevated immediately after surgery. Minor surgery does not alter the early nonspecific immune response. However, major surgery seems to induce a transient increase in neutrophil phagocytic activity.     

Neutrophil activation in Alzheimer’s disease and mild cognitive impairment: A systematic review and meta-analysis of protein markers in blood and cerebrospinal fluid

Inflammation is involved in the pathophysiology of Alzheimer’s disease (AD), with multiple inflammatory processes implicated in its risk and progression. This review included original peer-reviewed studies measuring the cerebrospinal fluid or peripheral blood concentrations of protein markers specifically related to neutrophil activity in healthy controls (HC) and in patients with AD or mild cognitive impairment (MCI). A total of 35 studies (N_HC = 3095, N_AD = 2596, N_MCI = 1203) were included. Random-effects meta-analyses were used to estimate between-groups standardized mean differences (SMD) and 95 % confidence intervals. In blood, concentrations of myeloperoxidase (MPO; N_AD/N_HC = 271/209, SMD = 0.41 [0.20, 0.62]; I² = 15.7 %) and neutrophil gelatinase associated lipocalin (NGAL; N_AD/N_HC = 273/185, SMD = 0.30 [0.11, 0.49]; I² < 0.005 %) were significantly higher in AD relative to HC. Peripheral blood concentrations of NGAL were also higher in MCI compared to HC (N_MCI/N_HC = 489/145, SMD = 0.39 [0.11, 0.67]; I² = 38.6 %). None of the protein markers exhibited a significant difference between HC, MCI, or AD groups in the cerebrospinal fluid. The evidence suggests that peripheral neutrophil activation, as indicated by blood concentrations of NGAL and MPO, may be a pathological feature of cognitive impairment due to AD, evident at stages of MCI and AD dementia.     

Diagnostic value of serum neutrophil gelatinase-associated lipocalin,interleukin-6 and anti-citrullinated alpha-enolase peptide 1 for lower respiratory tract infections

ObjectivesThe aim of this study was to explore the auxiliary diagnostic value of neutrophil gelatinase-associated lipocalin (NGAL) and anti-citrullinated alpha-enolase peptide 1 (CEP-1) in lower respiratory tract infections (LRTIs).MethodsBlood samples were collected from 99 in-patients with LRTIs [62 community-acquired pneumonia (CAP), 14 acute exacerbated chronic obstructive pulmonary diseases (AECOPD), 23 other diseases] and 50 healthy subjects. NGAL, CEP-1 and IL-6 were measured and compared. IL-6 was tested by electrochemiluminescence assay kit on Roche E601 immunology analyzer, CEP-1 was assessed with enzyme-linked immunosorbent assay kit, and NGAL was detected by latex immunoturbidimetric assay kit on Beckman Coulter AU2700.ResultsCompared with healthy controls, NGAL and IL-6 levels were significantly increased in the patients with LRTIs, the area under the curves (AUC) was 0.97 and 0.88 respectively (P < 0.01). The sensitivity and specificity of NGAL at a cut-off of 86 ng/ml were 93.0% and 96.0%, respectively, in which the sensitivity was consistent with IL-6 (P = 0.21) and the specificity was better than IL-6 (P < 0.01). CEP-1 slightly increases in the patient group, however the difference was not significant (P = 0.41). The levels of NGAL and IL-6 was no differences in different diseases, the P-value was 0.50 and 0.29, respectively. LRTIs with and without underlying diseases have similar NGAL and IL-6 values.ConclusionsNGAL, rather than CEP-1, may be appealing adjuncts for diagnosis of LRTIs. NGAL proved to be a better biomarker than IL-6.     

抗磷脂抗体和子痫前期的研究进展

抗磷脂抗体是一类能与磷脂或磷脂结合蛋白结合的自身免疫性抗体,与血栓形成、不良孕产史密切相关。抗磷脂抗体中高滴度阳性的患者易有子痫前期等不良妊娠结局。子痫前期发生于妊娠期,可导致全身多脏器的损伤,严重危及母儿生命和健康。子痫前期的发病机制目前还不是很清楚,研究提示抗磷脂抗体可能通过诱导氧化应激,促进血管内炎症等作用参与子痫前期的发病;对于抗磷脂抗体阳性的患者,早期发现和早期干预对获得良好的妊娠结局至关重要。