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中性粒细胞与淋巴细胞比值联合全球急性冠状动脉事件注册研究评分与急性冠脉综合征患者预后的相关性分析 预览

NLR Combined with GRACE Score for the Prediction of Outcome of ACS Patients
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摘要 背景急性冠脉综合征(ACS)具有更高的致残率和病死率,早期发现高危患者并进行干预治疗对减少患者的入院率、降低死亡率具有至关重要的意义。目前一种新兴的炎性指标中性粒细胞与淋巴细胞比值(NLR)对心血管疾病的预后具有重要预测价值。目的探究 ACS 患者 NLR 及全球急性冠状动脉事件注册研究(GRACE)评分与心功能相关指标的相关性,根据 6 个月内发生主要不良心血管事件(MACE)的情况,分析 NLR、GRACE 评分、NLR 联合 GRACE 评分对 ACS 患者预后的评估价值。方法回顾性分析 2016 年 1 月 2017 年 10 月郑州大学第二附属医院收治的 284 例诊断为 ACS 的住院患者,记录患者临床资料,根据 GRACE 评分将患者分为低危组(<109 分)113 例、中危组(109~140 分)71 例、高危组(>140 分)100 例;根据 NLR 中位数将患者分为低 NLR 组(≤ 3.02)142 例和高 NLR 组(>3.02)142 例。记录患者发病 6 个月内 MACE 发生情况。采用受试者工作特征(ROC)曲线分析 NLR、GRACE 评分、 NLR 联合 GRACE 评分对 ACS 患者预后评估的价值。结果低、中、高危组 ACS 患者年龄、体质指数(BMI)、心率、收缩压、舒张压、NLR、N 末端脑钠肽前体(NT-proBNP)、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、MACE 发生率比较,差异均有统计学意义(P<0.05)。高 NLR 组 ACS 患者年龄、BMI、心率、收缩压、舒张压、 GRACE 评分、 NT-proBNP、 LVEDD、 MACE 发生率高于低 NLR 组,三酰甘油(TG)、 LVEF 低于低 NLR 组(P<0.05)。NLR 与 GRACE 评分、NT-proBNP、LVEDD 呈正相关(r=0.852、0.417、0.293,P<0.05),与 LVEF 呈负相关(r=-0.416,P<0.05);GRACE 评分与 NT-proBNP、LVEDD 呈正相关(r=0.445、0.361,P<0.05),与 LVEF 呈负相关(r=-0.508,P<0.05)。284 例 ACS 患者发病 6 个月内发生 MACE 者 71 例(25.0%)。NLR 联合 GRACE 评分预测 ACS 患者发病 6个月内发生 MACE 的 ROC 曲线下面积(0.877)大于 NLR(0.732)(Z=3.394,P=0.000 7)� Background Acute coronary syndrome (ACS) has a higher rate of disability and mortality,and early detection and intervention for high-risk patients with ACS is of great significance to reduce the rate of hospitalization and mortality. At present,the ratio of neutrophil to lymphocyte (NLR),a new inflammatory marker,has important predictive value for the prognosis of cardiovascular diseases.Objective To explore the associations of NLR,GRACE score with cardiac function indices,and the performance of NLR,GRACE score,according to the occurrence of major adverse cardiac events (MACE) within 6 months,NLR,GRACE score and the combination of the two for predicting the outcomes of ACS patients.Methods In this retrospective study,we enrolled 284 ACS patients from January 2016 to October 2017 from the Second Affiliated Hospital of Zhengzhou University.We collected their clinical data.Our cohort was divided into low-risk group (n=113,<109 points), medium-risk group (n=71,109 to 140 points),and high-risk group (n=100,>140 points) according to baseline GRACE score,and stratified into high NLR group (n=142,>3.02) and low NLR group (n=142,≤ 3.02) by the baseline NLR level for investigating the correlations of GRACE score and NLR level with cardiac functions,respectively.ROC analysis was conducted to probe the performance of NLR,GRACE score,and the combination of the two for evaluating the outcome of ACS.Results Mean age,BMI,heart rate,systolic blood pressure (SBP),diastolic blood pressure (DBP),NLR,N-terminal brain natriuretic peptide(NT-proBNP),left ventricular ejection fraction (LVEF),left ventricular end-diastolic diameter (LVEDD), and incidence of MACE differed significantly between the low-,medium- and high-risk groups (P<0.05).High NLR group showed greater mean age,higher mean BMI,heart rate,SBP,DBP,GRACE score,NT-proBNP and LVEDD as well as higher incidence of MACE but low mean triacylglycerol (TG),LVEF compared with the low NLR group(P<0.05).NLR was positively correlated with GRACE score,NT-proBNP and LVEDD (r=0.852,0.417
作者 徐晓婷 张强 杨丽红 郑红梅 孙彩红 方士杰 刘英 刘方方 许慧艳 XU Xiaoting;ZHANG Qiang;YANG Lihong;ZHENG Hongmei;SUN Caihong;FANG Shijie;LIU Ying;LIU Fangfang;XU Huiyan(Department of Cardiology,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014,China;Department of Cardiopulmonary Function Examination,Henan Provincial People's Hospital,Zhengzhou 450003,China;Department of Cardiology,Zhengzhou Yihe Hospital,Zhengzhou 450046,China)
出处 《中国全科医学》 CAS 北大核心 2019年第11期1302-1306,共5页 Chinese General Practice
关键词 急性冠脉综合征 中性粒细胞与淋巴细胞比值 预后 Acute coronary syndrom Neutrolphil to lymphocyte ratio Prognosis
作者简介 通信作者:张强,主任医师;E-mail:zq3397@163.com.
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