NLR联合MLR在非ST段抬高型心肌梗死危险分层中的预测价值
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摘要
目的探讨中性粒细胞/淋巴细胞比率(NLR)联合单核细胞/淋巴细胞比率(MLR)在非ST段抬高型心肌梗死(NSTEMI)危险分层中的价值。方法纳入2013年6月至2014年12月于第三军医大学附属新桥医院行冠状动脉照影的患者288例,分为对照组(110例),稳定性心绞痛(SAP)组(66例)和NSTEMI组(112例),对NSTEMI组患者计算GRACE评分,并根据GRACE评分分为低危组和中高危组。收集所有受试者的血常规指标并计算NLR、MLR。结果 NSTEMI组的NLR、MLR明显高于对照组和SAP组(P<0.01)。Spearman相关分析表明NLR、MLR与GRACE评分呈正相关(r=0.342,P<0.01;r=0.398,P<0.01);中高危组比低危组的NLR(P<0.01)、MLR(P<0.01)高。通过受试者工作曲线(ROC)分析,预测NSTEMI危险分层的ROC曲线下面积(AUC)分别是NLR的AUC为0.747(95%CI:0.656~0.837,P<0.01);MLR的AUC为0.765(95%CI:0.677~0.852,P<0.01);NLR联合MLR的AUC为0.778(95%CI:0.693~0.863,P<0.01)。结论NLR、MLR与GRACE评分呈正相关,NLR联合MLR对NSTEMI患者的危险分层有一定的预测价值。
Objective To investigate the value of neutrophil to lymphocyte ratio(NLR)and monocyte to lymphocyte ratio(MLR)in the risk stratification of non-ST segment elevation myocardial infarction(NSTEMI).Methods A total of 288 patients undergoing coronary angiography in the Affiliated Xinqiao Hospital of the Third Military Medical University from June 2013 to December 2014 were included and divided into the control group(110cases),stable angina pectoris(SAP)group(66cases)and NSTEMI group(110cases)according to their coronary angiography outcome.The Global Registry of Acute Coronary Event(GRACE)scores in the NSTEMI group were calculated and divided into the low risk group and the middle and high risk group.The blood routine indices were collected and the NLR and MLR values were calculated.Results The values of NLR and MLR in the NSTEMI group were significantly higher than those in the control group and SAP group(P<0.01).The Spearman correlation analysis showed that NLR and MLR were positively correlated with the GRACE score(r=0.342,P<0.01;r=0.398,P<0.01).The NLR and MLR values in the middle and high risk group were higher than those in the low risk group(P<0.01).The receiver operating characteristic(ROC)curve analysis showed that the areas under the curve(AUC)for NLR,MLR and NLR combined with MLR were 0.747,95%CI:0.656-0.837(P<0.01),0.765,95%CI:0.677-0.852(P<0.01)and 0.778,95%CI:0.693-0.863(P<0.01).Conclusion The NLR and MLR values are positively correlated with the GRACE score.NLR combined with MLR has certain predictive value in the stratification of NSTEMI.
Objective To investigate the value of neutrophil to lymphocyte ratio(NLR)and monocyte to lymphocyte ratio(MLR)in the risk stratification of non-ST segment elevation myocardial infarction(NSTEMI).Methods A total of 288 patients undergoing coronary angiography in the Affiliated Xinqiao Hospital of the Third Military Medical University from June 2013 to December 2014 were included and divided into the control group(110cases),stable angina pectoris(SAP)group(66cases)and NSTEMI group(110cases)according to their coronary angiography outcome.The Global Registry of Acute Coronary Event(GRACE)scores in the NSTEMI group were calculated and divided into the low risk group and the middle and high risk group.The blood routine indices were collected and the NLR and MLR values were calculated.Results The values of NLR and MLR in the NSTEMI group were significantly higher than those in the control group and SAP group(P<0.01).The Spearman correlation analysis showed that NLR and MLR were positively correlated with the GRACE score(r=0.342,P<0.01;r=0.398,P<0.01).The NLR and MLR values in the middle and high risk group were higher than those in the low risk group(P<0.01).The receiver operating characteristic(ROC)curve analysis showed that the areas under the curve(AUC)for NLR,MLR and NLR combined with MLR were 0.747,95%CI:0.656-0.837(P<0.01),0.765,95%CI:0.677-0.852(P<0.01)and 0.778,95%CI:0.693-0.863(P<0.01).Conclusion The NLR and MLR values are positively correlated with the GRACE score.NLR combined with MLR has certain predictive value in the stratification of NSTEMI.
引文
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[15]Yue S,Zhang J,Wu J,et al.Use of the monocyte-to-lymphocyte ratio to predict diabetic retinopathy[J].Int J Environ Res Public Health,2015,12(8):10009-10019.
[16]Warimwe GM,Fletcher HA,Olotu A,et al.Peripheral blood monocyte-to-lymphocyte ratio at study enrollment predicts efficacy of the RTS,S malaria vaccine:analysis of pooled phaseⅡclinical trial data[J].BMC Med,2013(11):184.
[17]Gary T,Pichler M,Belaj K,et al.Lymphocyte-to-monocyte ratio:a novel marker for critical limb ischemia in PAOD patients[J].Int J Clin Pract,2014,68(12):1483-1487.
[18]Kaya H,Ertas F,Soydinc MS,et al.Association between neutrophil to lymphocyte ratio and severity of coronary artery disease[J].Clin Appl Thromb Hemost,2014,20(2):221.
[2]Fiechter M,Ghadri JR,Jaguszewski M,et al.Impact of inflammation on adverse cardiovascular events in patients with acute coronary syndromes[J].J Cardiovasc Med(Hagerstown),2013,14(11):807-814.
[3]Wang L,Long W,Li PF,et al.An elevated peripheral blood monocyte-to-lymphocyte ratio predicts poor prognosis in patients with primary pulmonary lymphoepithelioma-like carcinoma[J].PLoS One,2015,10(5):e126269.
[4]Han S,Liu Y,Li Q,et al.Pre-treatment neutrophil-to-lymphocyte ratio is associated with neutrophil and T-cell infiltration and predicts clinical outcome in patients with glioblastoma[J].BMC Cancer,2015(15):617.
[5]孙筱笛,刘闺男.中性粒细胞/淋巴细胞比例对急性前壁心肌梗死患者急性期左心功能不全的预测价值[J].临床心血管病杂志,2015,21(3):302-306.
[6]Kurtul A,Yarlioglues M,Celik IE,et al.Association of lymphocyte-to-monocyte ratio with the no-reflow phenomenon in patients who underwent a primary percutaneous coronary intervention for ST-elevation myocardial infarction[J].Coron Artery Dis,2015,26(8):706-712.
[7]Roffi M,Patrono C,Collet JP,et al.2015ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation:task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the european society of cardiology(ESC)[J].Eur Heart J,2016,37(3):267-315.
[8]Baldus S,Heeschen C,Meinertz T,et al.Myeloperoxidase serum levels predict risk in patients with acute coronary syndromes[J].Circulation,2003,108(12):1440-1445.
[9]Tamhane UU,Aneja S,Montgomery D,et al.Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome[J].Am J Cardiol,2008,102(6):653-657.
[10]Liu X,Zhang Q,Wu H,et al.Blood neutrophil to lymphocyte ratio as a predictor of hypertension[J].Am J Hypertens,2015,28(11):1339-1346.
[11]Yu XY,Li XS,Li Y,et al.Neutrophil-lymphocyte ratio is associated with arterial stiffness in postmenopausal women with osteoporosis[J].Arch Gerontol Geriatr,2015,61(1):76-80.
[12]Mizuno Y,Jacob RF,Mason RP.Inflammation and the development of atherosclerosis[J].J Atheroscler Thromb,2011,18(5):351-358.
[13]Nozawa N,Hibi K,Endo M,et al.Association between circulating monocytes and coronary plaque progression in patients with acute myocardial infarction[J].Circ J,2010,74(7):1384-1391.
[14]van der Laan AM,Hirsch A,Robbers LF,et al.A proinflammatory monocyte response is associated with myocardial injury and impaired functional outcome in patients with ST-segment elevation myocardial infarction:monocytes and myocardial infarction[J].Am Heart J,2012,163(1):57-65.
[15]Yue S,Zhang J,Wu J,et al.Use of the monocyte-to-lymphocyte ratio to predict diabetic retinopathy[J].Int J Environ Res Public Health,2015,12(8):10009-10019.
[16]Warimwe GM,Fletcher HA,Olotu A,et al.Peripheral blood monocyte-to-lymphocyte ratio at study enrollment predicts efficacy of the RTS,S malaria vaccine:analysis of pooled phaseⅡclinical trial data[J].BMC Med,2013(11):184.
[17]Gary T,Pichler M,Belaj K,et al.Lymphocyte-to-monocyte ratio:a novel marker for critical limb ischemia in PAOD patients[J].Int J Clin Pract,2014,68(12):1483-1487.
[18]Kaya H,Ertas F,Soydinc MS,et al.Association between neutrophil to lymphocyte ratio and severity of coronary artery disease[J].Clin Appl Thromb Hemost,2014,20(2):221.