中性粒细胞/淋巴细胞比值对PCI术后ACS患者预后评价的价值

目的:探讨中性粒细胞与淋巴细胞计数比值(NLR)对行经皮冠脉介入治疗(PCI)的急性冠脉综合征(ACS)患者主要不良心血管事件(MACE)的预测价值。方法:选择在我院行PCI的ACS患者125例,根据GRACE评分(GRS)患者被分为低危组(GRS≤108分,38例)、中危组(109分≤GRS≤140分,46例)、高危组(GRS>140分,41例)。比较不同危险分层组血清C反应蛋白(CRP)、心肌肌钙蛋白T(cTnT)和血浆N末端脑钠肽前体(NT-proBNP)水平及NLR值。根据住院期间和出院后1年内MACE发生情况,患者被分为MACE组(94例)和非MACE组(31例),比较两组GRS、NLR值及CRP水平。采用ROC曲线评价NLR对患者MACE的预测价值。结果:随着ACS的危险分层的上升,NLR值[1.80(0.76)比2.68(1.33)比3.82(3.25)]显著升高(P均=0.001)。与非MACE组比较,MACE组GRS[114.0(37.5)分比162.0(52.0)分]、NLR值[2.4(1.5)比3.9(4.8)]和CRP[3.5(6.9)mg/L比12.2(40.8)mg/L]水平均显著升高(P均=0.001)。ROC曲线分析NLR、GRS、GRS+NLR对发生MACE的预测价值,其曲线下面积(AUC)分别为:0.810(95%CI:0.722~0.897)、0.837(95%CI:0.756~0.917)、0.849(95%CI:0.774~0.925)。结论:NLR作为一项简便易获取的常规检验指标,联合GRACE评分可更加准确地预测PCI术后ACS患者的预后,具有重要临床价值。

Prognostic value of ratio of neutrophil to lymphocyte for ACS patients after PCI

Objective:To explore predictive value of neutrophil/lymphocyte(NLR)for major adverse cardiovascular events(MACE)in patients with acute coronary syndrome(ACS)undergoing percutaneous coronary intervention(PCI).Methods:A total of 125 ACS patients undergoing PCI in our hospital were selected.According to GRACE risk score(GRS),patients were divided into low risk group(GRS≤108 scores,n=38),medium risk group(109 scores≤GRS≤140 scores,n=46)and high risk group(GRS>140 scores,n=41).Levels of serum C reactive protein(CRP),cardiac troponin T(cTnT),plasma N terminal pro brain natriuretic peptide(NT-proBNP)and NLR were compared among different risk stratification group.According to incidence of MACE during hospitalization and within one year after discharge,patients were divided into MACE group(n=94)and non-MACE group(n=31),then GRS score,NLR and CRP level were compared between them.ROC curve was used to assess predictive value of NLR for MACE.Results:Along with risk stratification of ACS rose,there was significant rise in NLR[1.80(0.76)vs.2.68(1.33)vs.3.82(3.25)],P=0.001 all.Compared with non-MACE group,there were significant rise in GRS[114.0(37.5)scores vs.162.0(52.0)scores],NLR[2.4(1.5)vs.3.9(4.8)]and CRP level[3.5(6.9)mg/L vs.12.2(40.8)mg/L]in MACE group,P=0.001 all.ROC curve analysis indicated that area under the curve(AUC)of NLR,GRS and GRS+NLR was 0.810(95%CI:0.722~0.897),0.837(95%CI:0.756~0.917)and 0.849(95%CI:0.774~0.925)respectively in predicting MACE.Conclusion:As an simple and available routine index,NLR can more accurately predict prognosis of ACS patients after PCI when combined with GRACE score,which possesses important clinical value.