摘要
目的:探讨中性粒细胞与淋巴细胞比值(NLR)及其联合N末端B型利钠肽原(NT-proBNP)对心力衰竭(心衰)患者预后的评估价值。方法:收集我院心内科2013年1月至2018年12月住院的7 681例心衰患者的临床资料,建立回顾性数据库。最终入选患者7 266例。根据患者入院时NLR值分为三组,低值组(<2.5909)2 396例、中值组(2.5909~4.3889)2 401例、高值组(>4.3889)2 469例。平均随访3.2年(2~8年),终点事件设为全因死亡及心血管死亡。比较三组患者的基线资料。多因素Cox回归模型分析NLR对预后的影响;将NLR和NT-proBNP通过三分位法相互组合比较分析死亡风险比;ROC曲线对比NLR与NT-proBNP联合与二者独立应用对预后的评估价值,并且比较联合指标对不同射血分数心衰患者预后的预测能力。结果:临床资料比较提示NLR越高,患者状态越差,心衰越重。多因素Cox回归分析显示,NLR增加,心衰患者预后不良风险增加。NLR每增加1,全因死亡风险增加1.8%(HR=1.018,95%CI:1.012~1.024,P<0.001),心血管死亡风险增加1.9%(HR=1.019,95%CI:1.012~1.025,P<0.001)。ROC曲线显示,NLR与NT-proBNP联合对心衰患者全因死亡和心血管死亡的预测价值优于独立应用NLR及NT-ProBNP。进一步按照不同心衰类型分析显示,联合指标对不同射血分数的心衰患者均有良好的预测价值。结论:NLR与心衰预后相关,NLR与NT-proBNP联合后预测价值更好。此外,联合指标对不同射血分数的心衰患者均有较好的预测价值。
Objectives: To evaluate the predictive value of neutrophil to lymphocyte ratio(NLR) alone and in combination with NTproBNP on the prognosis of patients with heart failure(HF).Methods: The clinical data of 7681 patients with heart failure, who hospitalized in our department from January 2013 to December 2018 were collected and analyzed. 7266 cases were finally included. The mean follow-up time was 3.2 years(2-8years), and the endpoints were all cause and cardiovascular death. The patients were divided into three groups according to admission NLR: low(<2.5909) NLR group, n=2 396;intermediate(2.5909~4.3889) NLR group, n=2 401;and high(>4.3889)NLR group, n=2 469. The predictive role of NLR on prognosis was analyzed by multivariate Cox regression model. Nine groups were established according NLR and NT-proBNP levels by tertiles method, and the mortality risk ratio was compared and analyzed in these groups. ROC curve was used to compare the prognostic value of NLR alone or in combination with NTproBNP. In addition, we compared the predictive power of the combined index in predicting the prognosis of patients with heart failure with different ejection fractions.Results: Clinical data indicated that the higher NLR level was related to worse state, more severe heart failure.Multivariate Cox regression analysis showed that increased NLR was associated with an increased risk of poor prognosis in patients with heart failure. For each 1 increase in NLR value, the risk of all-cause death increased by 1.8%(HR=1.018,95%CI: 1.012-1.024, P<0.001), risk of cardiovascular death increased by 1.9%(HR=1.019, 95%CI: 1.012-1.025, P<0.001).The ROC curve showed that the predictive efficacy of NLR in combination with NT-proBNP on all-cause death and cardiovascular death in patients with heart failure was superior than that of NLR or NT-proBNP alone.Further analysis showed that the combined index had also a good predictive value for heart failure patients with different ejection fractions.Conclusions: The ratio of neutrophils to lymphocytes
作者
李影
王传合
韩苏
佟菲
李志超
孙志军
LI Ying;WANG Chuanhe;HAN Su;TONG Fei;LI Zhichao;SUN Zhijun(Department of Cardiology,Shengjing Hospital of China Medical University,Shenyang(110022),Liaoning,China)
出处
《中国循环杂志》
CSCD
北大核心
2022年第3期243-249,共7页
Chinese Circulation Journal
基金
辽宁省科学技术计划项目(2018225003)。
