中性粒细胞/淋巴细胞比值与慢性心力衰竭患者的相关性研究

目的探讨慢性心力衰竭(chronic heart failure,CHF)患者中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)改变的影响因素以及NLR与心脏收缩功能的关系。方法2016年9月至2018年5月在山西省汾阳医院心血管内科住院的CHF患者135例,采用前瞻性研究方法,依据NLR水平,将患者分为3组:低NLR组(NLR<2.3,46例)、中NLR组(NLR≥2.3~≤4.3,45例)、高NLR组(NLR>4.3,44例)。比较3组患者的基本临床资料、实验室检查资料及无创心脏血流动力指标。结果(1)通过对不同NLR组患者资料的比较,发现氨基末端脑钠肽前体(N-terminal pro-brain natriuretic pepfide,NT-proBNP)(F=4.485,P=0.013)、总胆红素(F=6.085,P=0.003)、白蛋白(F=3.695,P=0.027)在不同NLR组间比较差异均有统计学意义;(2)NLR与NT-proBNP、总胆红素、白蛋白均有相关性(r值分别为0.267、0.256、-0.243,P值分别为0.002、0.003、0.005);(3)经多元线性回归分析发现,CHF患者NLR与左室射血分数(left ventricular ejection fraction,LVEF)、NT-proBNP、总胆红素、白蛋白相关(标准回归系数分别为-0.239、0.223、0.247、-0.213,P均<0.05);(4)经过Pearson相关分析显示:CHF患者NLR与心输出量(r=-0.173,P=0.045)、心指数(r=-0.175,P=0.042)、LVEF(r=-0.278,P=0.001)、最大射血速率(maximum ejection velocity,AMPC)(r=-0.207,P=0.016)、收缩指数(r=-0.214,P=0.013)、收缩功能指数(hearther index,HI)(r=-0.179,P=0.038)、左心室每分作功(cardiac work,CW)(r=-0.235,P=0.006)、心功能指数(cardiac work index,CWI)(r=-0.244,P=0.004)呈负相关。结论NT-proBNP、总胆红素、白蛋白、LVEF是影响CHF患者NLR的因素,NLR对CHF的病情评估、治疗效果及预后预测等具有一定的价值。

Correlational research between neutrophil/lymphocyte ratio and chronic heart failure

Objective To explore the influencing factors of neutrophil to lymphocyte ratio(NLR)in patients with chronic heart failure(CHF)and the relationship between NLR and cardiac contractile function.Methods From September 2016 to May 2018,135 CHF patients were enrolled in the cardiovascular department of Fenyang hospital,Shanxi Province for prospective research.According to the level of NLR,the patients were divided into three groups:low NLR group(<2.3,46 cases),middle NLR group(≥2.3~≤4.3,45 cases),high NLR group(>4.3,44 cases).The basic clinical data,laboratory examination data and noninvasive cardiac hemodynamic indexes of the three groups were compared.Results(1)By comparing the data of different NLR groups,we found that there were significant differences in(N-terminal pro-brain natriuretic pepfide,NT-proBNP)(F=4.485,P=0.013),total bilirubin(F=6.085,P=0.003),albumin(F=3.695,P=0.027).(2)NLR was correlated with NT proBNP,total bilirubin,albumin(r=0.267,0.256,-0.243,P=0.002,0.003,0.005,respectively).(3)Multiple linear regression analysis showed that NLR of CHF patients was correlated with left ventricular ejection fraction(LVEF),NT proBNP,total bilirubin and albumin(standard regression coefficients were-0.239,0.223,0.247 and-0.213,respectively,P<0.05).(4)Pearson correlation analysis showed that NLR and cardiac output(r=-0.173,P=0.045),cardiac index(r=-0.175,P=0.042),LVEF(r=-0.278,P=0.001),maximum ejection velocity(r=-0.207,P=0.016),systolic index(r=-0.214,P=0.013),hearther index(HI)(r=-0.179,P=0.038),cardiac work(CW)(r=-0.235,P=0.006),cardiac workindex(CWI)=(r=-0.244,P=0.004)were negatively correlated.Conclusion NT-proBNP,total bilirubin,albumin and LVEF are the factors that affect the NLR of patients with CHF.NLR has a certain value in the evaluation of CHF,therapeutic effect and prognosis prediction.