中性粒细胞与淋巴细胞比值联合C反应蛋白对急性冠脉综合征患者预后的预测价值

目的 分析中性粒细胞/淋巴细胞(NLR)与急性冠脉综合征(ACS)患者危险分层及预后的关系,评估NLR联合C反应蛋白(CRP)对ACS患者预后的预测价值。 方法 选取2018年10月—2019年7月于蚌埠医学院第一附属医院行冠状动脉造影确诊为ACS的患者430例,出院后对其进行平均10个月的电话随访。将所有患者依据NLR水平的中位数分为低NLR组和高NLR组;依据GRACE、TIMI评分分为低、中及高危组;依据随访结果分为主要不良心血管事件(MACE)组及非MACE组。比较各组间临床资料并分析ACS患者发生MACE的危险因素,用ROC曲线评价NLR联合CRP对ACS患者预后的预测价值。 结果 高NLR组男性患者比例、血肌酐、CRP、MACE发生率、Gensini评分显著高于低NLR组,而左心室射血分数(LVEF)较低(均P<0.05);危险分层中,高危组NLR水平均较中危、低危组显著升高(均P<0.05),NLR预测GRACE高危组的曲线下面积(AUC)为0.684(P<0.05);MACE组患者NLR、CRP水平均显著高于非MACE组,二元logistic回归分析显示NLR、CRP是ACS患者发生MACE的独立危险因素(均P<0.05),ROC曲线显示NLR联合CRP预测ACS患者发生MACE的AUC为0.832,灵敏度为71%,特异度为87%(P<0.001)。 结论 NLR与ACS患者危险分层及预后显著相关,NLR联合CRP对ACS患者MACE的发生有较高的预测价值。 

Prognostic value of neutrophil to lymphocyte ratio combined with C-reactive protein in patients with acute coronary syndrome

Objective To analyze the relationship between neutrophil/lymphocyte(NLR) and risk stratification and prognosis in patients with acute coronary syndrome(ACS), and to assess the prognostic value of NLR combined C-reactive protein(CRP) in patients with ACS. Methods Total 430 patients diagnosed with ACS by coronary angiography in our hospital from October 2018 to July 2019 were selected and followed up by telephone for an average of 10 months. All patients were divided into low NLR group and high NLR group according to median NLR level; low risk group, middle risk group and high risk group according to the scores of GRACE and TIMI; MACE group and Non-MACE according to follow up results. The clinical data between each group were compared and the risk factors of MACE in ACS patients were analyzed. The prognostic value of NLR combined CRP was evaluated by ROC curve. Results The proportion of male patients, serum creatinine, CRP, Gensini scores and the occurrence of MACE in the high NLR group were significantly higher than those in the low NLR group, while the left ventricular ejection fraction(LVEF) was significantly lower than that in the low NLR group(all P<0.05). The NLR level of the high risk group in risk stratification was significantly higher than that in the middle and low risk groups(all P<0.05). The area under the curve(AUC) of NLR predicted the high-risk group in GRACE risk stratification was 0.684(P<0.05). The NLR and CRP levels were significantly higher in the MACE group than those in the Non-MACE group(all P<0.05). Dual logistic regression analysis showed that NLR and CRP were an independent risk factor for the occurrence of MACE in ACS patients(all P<0.05), the ROC curve showed that the AUC of NLR combined with CRP to predict the incidence of MACE was 0.832, the sensitivity was 71%, and the specificity was 87%(P<0.001). Conclusion The level of NLR is significantly associated with risk stratification and prognosis in ACS patients. NLR combined CRP have high predictive value for the occurrence of MACE in ACS patients.