中性粒细胞/淋巴细胞比值对心肌梗死患者心肌灌注及预后的评估

摘要

Objective To observe the influences of neutrophil/lymphocyte ratio ( NLR ) on the judgement of myocardial perfusion and prognosis in the patients with acute ST-segment elevation myocardial infarctionrn( STEMI ) after percutaneous coronary intervention ( PCI ) . Methods The patients with acute STEMI ( n=551 ) after accepting PCI were divided into 4 groups according to the first NLR at admission and quartile method. The clinical features, results of coronary angiography ( CAG ) , mortality and major adverse cardiovascular eventsrn( MACE ) within 30 days after hospitalization, and influences of TIMI frame count ( CTFC ) and TIMI myocardial perfusion grade ( TMPG ) were compared among all groups. Results In the group with the highest NLR, the patients' age was higher, diastolic blood pressure was lower at admission, proportion of patients with Killip grade II to Killip grade IV was higher ( P<0.05 ) and proportion of patients with serum creatinine over 1.5 mg/dL increased, and proportion of patients with 2—vessel disease or 3-vessel disease were significantly higher than those in other 3 groups ( P<0.05 ) . At the same time CTFC was higher, proportion of patients with TMPG grade 0 or TMPG grade 1 increased, left ventricular ejection fraction decreased significantly ( P<0.05 ) , and incidence of MACE and mortality within 30 days after PCI were higher in the group with the highest NLR than those in other 3 groups. The results of multiple regression analysis showed that LogNLR was correlated to MACE within 30 days after PCI ( r=2.27, P<0.05 ) . Conclusion STEMI patients with higher NLR at admission will have poor myocardial perfusion after PCI, and their heart function is affected and mortality increases within 30 days.%目的 观察中性粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)对判断急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗后患者的心肌灌注和预后的影响.方法 选取接受直接PCI治疗的急性STEMI患者551例,根据入院第一次NLR,将患者按照四分位数法分成4组.比较各组患者临床特征、冠脉造影结果,入院30天内的死亡、心血管事件和校正的TIMI帧计数(CTFC)和TIMI心肌灌注分级(TMPG).结果 在NLR最高组中,患者年龄较大,入院舒张压偏低,Killip心功能分级Ⅱ至Ⅳ级患者比例较高(P＜0.05),血清肌酐＞133μmol/L患者比例增加;双支病变和三支病变患者比例明显高于其他三组(P＜0.05).同时,CTFC数值高于其他三组,TMPG0-1级比例亦显著增加.左室射血分数明显降低(P＜0.05);PCI术后30天内的主要心血管事件以及死亡均高于其他3组,具有统计学意义,多元回归分析logNLR与30天内的主要心血管事件相关(r=2.27,P＜0.05).结论 入院时NLR较高的STEMI患者,PCI术后的其心肌灌注较差,且预后不良.