中性粒细胞与淋巴细胞比值对急性主动脉夹层患者预后的预测价值
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摘要
目的:探讨中性粒细胞与淋巴细胞比值(NLR)对急性主动脉夹层(AAD)患者短期和长期死亡风险的预测价值.方法:回顾性分析141例AAD患者的临床资料,分组:①依据随访2周结果将患者分为死亡组(n=41)及存活组(n=100);②依据NLR 4分位数将患者分为NLR<4.33(Q1组,n=35),4.33≤NLR<7.26(Q2组,n=35),7.26≤NLR<11.78(Q3组,n=36),NLR≥11.78(Q4组,n=35).结果:短期内死亡组NLR显著高于存活组,死亡组NLR=9.67(6.81,13.07)、存活组NLR=6.18(3.63,11.10),死亡组的NLR水平比存活组的更高(P<0.05).KM生存曲线显示,Q4组的短期和长期死亡风险均明显高于其他3组.多因素Cox比例风险回归模型显示,与Q1组比较, Q4组增加短期死亡风险28倍,HR 28.403,95%CI 3.392(237.865),增加长期死亡风险3倍,HR 3.396,95%CI 1.596(7.228),有统计学差异(P<0.05).结论:入院NLR≥11.78可明显增加AAD患者的短期和长期死亡风险,NLR愈高,预后愈差.
Objective:To investigate the prognostic value of neutrophil to lymphocyte ratio(NLR) in short-and long-term mortality risk of patients with acute aortic dissection(AAD). Methods: A total of 141 patients diagnosed with AAD were collected for clinic data retrospectively. The Patients were divided into death group(n=41) and survival group(n=100) according to whether there was a death event in 2-week follow-up. According to the quartile count of NLR, the patients were divided into Q1 group(NLR<4.33, n=35), Q2 group(4.33≤NLR<7.26, n=35), Q3 group(7.26≤NLR<11.78, n=36) and Q4 group(NLR≥11.78, n=35). Results: The NLR was 9.67(6.81, 13.07) in deceased patients, which was significantly higher than that(6.18(3.63, 11.10)) in in survived patients(P<0.05). Kaplan-Meier analysis showed that the cumulative short-and long-term mortality risk was greatly higher in patients with elevated admission Q4 levels when compared with those with low admission NLR in the other 3 groups. In multivariate Cox regression analysis, it showed that elevated admission NLR(≥11.28) in Q4 group remained an independent predictor of short-term mortality of AAD(HR to 28.403, 95% CI 3.392～237.865) and long-term mortality(HR to 3.396, 95% CI 1.596～7.228)(all P<0.05). Conclusion:Admission NLR is an independent predictor of short-and long-term mortality risk in patients with AAD. The higher NLR, the poorer prognosis.
Objective:To investigate the prognostic value of neutrophil to lymphocyte ratio(NLR) in short-and long-term mortality risk of patients with acute aortic dissection(AAD). Methods: A total of 141 patients diagnosed with AAD were collected for clinic data retrospectively. The Patients were divided into death group(n=41) and survival group(n=100) according to whether there was a death event in 2-week follow-up. According to the quartile count of NLR, the patients were divided into Q1 group(NLR<4.33, n=35), Q2 group(4.33≤NLR<7.26, n=35), Q3 group(7.26≤NLR<11.78, n=36) and Q4 group(NLR≥11.78, n=35). Results: The NLR was 9.67(6.81, 13.07) in deceased patients, which was significantly higher than that(6.18(3.63, 11.10)) in in survived patients(P<0.05). Kaplan-Meier analysis showed that the cumulative short-and long-term mortality risk was greatly higher in patients with elevated admission Q4 levels when compared with those with low admission NLR in the other 3 groups. In multivariate Cox regression analysis, it showed that elevated admission NLR(≥11.28) in Q4 group remained an independent predictor of short-term mortality of AAD(HR to 28.403, 95% CI 3.392～237.865) and long-term mortality(HR to 3.396, 95% CI 1.596～7.228)(all P<0.05). Conclusion:Admission NLR is an independent predictor of short-and long-term mortality risk in patients with AAD. The higher NLR, the poorer prognosis.
引文
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[11] HE R, GUO D C, ESTRERA A L, et al. Characterization of the inflammatory and apoptotic cells in the aortas of patients with ascending thoracic aortic aneurysms and dissections[J]. J Thorac Cardiovasc Surg, 2006, 131(3): 671-678.
[12] 王莹莹, 张健芳, 蒋亚斌, 等. 中性粒细胞与淋巴细胞比值对急性脑梗死溶栓患者预后的预测[J]. 暨南大学学报(自然科学与医学版), 2018, 39(1): 35-40. WANG Y Y, ZHANG J F, JIANG Y B et al. Prognosis of neutrophil and lymphocyte ratios in patients with acute cerebral infarction with thrombolytic therapy[J]. Journal of Jinan University (Natural Science and Medicine Edition), 2018, 39(1): 35-40.
[13] SHAH N, PARIKH V, PATEL N, et al. Neutrophil lymphocyte ratio significantly improves the Framingham risk score in prediction of coronary heart disease mortality: insights from the national health and nutrition examination survey-Ⅲ[J]. Int J Cardiol, 2014, 171(3): 390-397.
[14] BALTA S, DEMIRKOL S, UNLU M, et al. Neutrophil to lymphocyte ratio may be predict of mortality in all conditions[J]. Br J Cancer, 2013, 109(12): 3125-3126.
[15] AZAB B, ZAHER M, WEISERBS K F, et al. Usefulness of neutrophil to lymphocyte ratio in predicting short- and long-term mortality after non-ST-elevation myocardial infarction[J]. Am J Cardiol, 2010, 106(4): 470-476.
[16] HORNE B D, ANDERSON J L, JOHN J M, et al. Which white blood cell subtypes predict increased cardiovascular risk[J]. J Am Coll Cardiol, 2005, 45(10): 1638-1643.
[17] TAMHANE U U, 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.
[18] UTHAMALINGAM S, PATVARDHAN E A, SUBRAMANIAN S, et al. Utility of the neutrophil to lymphocyte ratio in predicting long-term outcomes in acute decompensated heart failure[J]. Am J Cardiol, 2011, 107(3): 433-438.
[19] KARAKOYUN S, GURSOY M O, AKGUN T, et al. Neutrophil-lymphocyte ratio may predict in-hospital mortality in patients with acute type a aortic dissection[J]. Herz, 2015, 40(4): 716-721.
[20] LAFCI G, CICEK O F, UZUN H A, et al. Relationship of admission neutrophil-to-lymphocyte ratio with in-hospital mortality in patients with acute type I aortic dissection[J]. Turk J Med Sci, 2014, 44(2): 186-192.
[21] KALKAN M E, KALKAN A K, GUNDES A, et al. Neutrophil to lymphocyte ratio: a novel marker for predicting hospital mortality of patients with acute type A aortic dissection[J]. Perfusion, 2017, 32(4): 321-327.
[22] 陆政日. 外周血中性粒细胞与淋巴细胞比值和平均血小板体积与血小板比值与急性主动脉夹层预后的相关性分析[D]. 河南: 郑州大学, 2018:1-66. LU Z R. Correlation analysis on neutrophil-lymphocyte ratio and mean platelet volume to platelet count ratio with prognosis in patients with acute aortic dissection[D]. Henan: Zhengzhou University, 2018:1-66.
[23] 古孜丽·努尔普拉提. 中性粒细胞-淋巴细胞比值对急性主动脉夹层患者预后的预测价值[D]. 新疆维吾尔自治区: 新疆医科大学, 2017:1-41. GU Z L N E P L T. Prognostic value of neutrophil to lymphocyte ratio in patients with acute aortic dissection[D]. Xinjiang Uygur Autonomous Region: Xinjiang Medical University, 2017:1-41.
[2] BALTA I, BALTA S, DEMIRKOL S, et al. Aortic arterial stiffness is a moderate predictor of cardiovascular disease in patients with psoriasis vulgaris[J]. Angiology, 2014, 65(1): 74-78.
[3] TRIMARCHI S, EAGLE K A, NIENABER C A, et al. Role of age in acute type A aortic dissection outcome: report from the International Registry of Acute Aortic Dissection (IRAD)[J]. J Thorac Cardiovasc Surg, 2010, 140(4): 784-789.
[4] HARRIS K M, STRAUSS C E, EAGLE K A, et al. Correlates of delayed recognition and treatment of acute type A aortic dissection: the International Registry of Acute Aortic Dissection (IRAD)[J]. Circulation, 2011, 124(18): 1911-1918.
[5] COADY M A, RIZZO J A, GOLDSTEIN L J, et al. Natural history, pathogenesis, and etiology of thoracic aortic aneurysms and dissections[J]. Cardiol Clin, 1999, 17(4): 615-635.
[6] TAN M E, MORSHUIS W J, DOSSCHE K M, et al. Long-term results after 27 years of surgical treatment of acute type a aortic dissection[J]. Ann Thorac Surg, 2005, 80(2): 523-529.
[7] WEN D, DU X, DONG J Z, et al. Value of D-dimer and C reactive protein in predicting inhospital death in acute aortic dissection[J]. Heart, 2013, 99(16): 1192-1197.
[8] CIFANI N, PROIETTA M, TRITAPEPE L, et al. Stanford-A acute aortic dissection, inflammation, and metalloproteinases: a review[J]. Ann Med, 2015, 47(6): 441-446.
[9] NOMURA F, TAMURA K, YOSHITATSU M, et al. Changes in coagulation condition, cytokine, adhesion molecule after repair of type A aortic dissection[J]. Eur J Cardiothorac Surg, 2004, 26(2): 348-350.
[10] BALIGA R R, NIENABER C A, BOSSONE E, et al. The role of imaging in aortic dissection and related syndromes[J]. JACC Cardiovasc Imaging, 2014, 7(4): 406-424.
[11] HE R, GUO D C, ESTRERA A L, et al. Characterization of the inflammatory and apoptotic cells in the aortas of patients with ascending thoracic aortic aneurysms and dissections[J]. J Thorac Cardiovasc Surg, 2006, 131(3): 671-678.
[12] 王莹莹, 张健芳, 蒋亚斌, 等. 中性粒细胞与淋巴细胞比值对急性脑梗死溶栓患者预后的预测[J]. 暨南大学学报(自然科学与医学版), 2018, 39(1): 35-40. WANG Y Y, ZHANG J F, JIANG Y B et al. Prognosis of neutrophil and lymphocyte ratios in patients with acute cerebral infarction with thrombolytic therapy[J]. Journal of Jinan University (Natural Science and Medicine Edition), 2018, 39(1): 35-40.
[13] SHAH N, PARIKH V, PATEL N, et al. Neutrophil lymphocyte ratio significantly improves the Framingham risk score in prediction of coronary heart disease mortality: insights from the national health and nutrition examination survey-Ⅲ[J]. Int J Cardiol, 2014, 171(3): 390-397.
[14] BALTA S, DEMIRKOL S, UNLU M, et al. Neutrophil to lymphocyte ratio may be predict of mortality in all conditions[J]. Br J Cancer, 2013, 109(12): 3125-3126.
[15] AZAB B, ZAHER M, WEISERBS K F, et al. Usefulness of neutrophil to lymphocyte ratio in predicting short- and long-term mortality after non-ST-elevation myocardial infarction[J]. Am J Cardiol, 2010, 106(4): 470-476.
[16] HORNE B D, ANDERSON J L, JOHN J M, et al. Which white blood cell subtypes predict increased cardiovascular risk[J]. J Am Coll Cardiol, 2005, 45(10): 1638-1643.
[17] TAMHANE U U, 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.
[18] UTHAMALINGAM S, PATVARDHAN E A, SUBRAMANIAN S, et al. Utility of the neutrophil to lymphocyte ratio in predicting long-term outcomes in acute decompensated heart failure[J]. Am J Cardiol, 2011, 107(3): 433-438.
[19] KARAKOYUN S, GURSOY M O, AKGUN T, et al. Neutrophil-lymphocyte ratio may predict in-hospital mortality in patients with acute type a aortic dissection[J]. Herz, 2015, 40(4): 716-721.
[20] LAFCI G, CICEK O F, UZUN H A, et al. Relationship of admission neutrophil-to-lymphocyte ratio with in-hospital mortality in patients with acute type I aortic dissection[J]. Turk J Med Sci, 2014, 44(2): 186-192.
[21] KALKAN M E, KALKAN A K, GUNDES A, et al. Neutrophil to lymphocyte ratio: a novel marker for predicting hospital mortality of patients with acute type A aortic dissection[J]. Perfusion, 2017, 32(4): 321-327.
[22] 陆政日. 外周血中性粒细胞与淋巴细胞比值和平均血小板体积与血小板比值与急性主动脉夹层预后的相关性分析[D]. 河南: 郑州大学, 2018:1-66. LU Z R. Correlation analysis on neutrophil-lymphocyte ratio and mean platelet volume to platelet count ratio with prognosis in patients with acute aortic dissection[D]. Henan: Zhengzhou University, 2018:1-66.
[23] 古孜丽·努尔普拉提. 中性粒细胞-淋巴细胞比值对急性主动脉夹层患者预后的预测价值[D]. 新疆维吾尔自治区: 新疆医科大学, 2017:1-41. GU Z L N E P L T. Prognostic value of neutrophil to lymphocyte ratio in patients with acute aortic dissection[D]. Xinjiang Uygur Autonomous Region: Xinjiang Medical University, 2017:1-41.