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中华危重症医学杂志(电子版)

中华危重症医学杂志(电子版) ›› 2020, Vol. 13 ›› Issue (05) : 351 -355. doi: 10.3877/cma.j.issn.1674-6880.2020.05.006

所属专题： 文献；

论著

中性粒细胞与淋巴细胞比值对ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗后微循环障碍的预测价值
张强1, 程铖1, 徐日新1,†(), 吴彩凤1, 谢勇1, 刘晓东1, 梅宏斌1, 曹天庆1   
  1. 1. 225001　江苏扬州，苏北人民医院心内科
  • 收稿日期:2020-05-08 出版日期:2020-10-31
  • 通信作者: 徐日新
  • 基金资助:
    扬州市科技局发展面上项目(YZ2016076)

Predictive value of neutrophil-to-lymphocyte ratio on microcirculatory disturbance in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention

Qiang Zhang1, Cheng Cheng1, Rixin Xu1,†(), Caifeng Wu1, Yong Xie1, Xiaodong Liu1, Hongbin Mei1, Tianqing Cao1   

  1. 1. Department of Cardiology, Northern Jiangsu People's Hospital, Yangzhou 225001, China
  • Received:2020-05-08 Published:2020-10-31
  • Corresponding author: Rixin Xu
  • About author:
    Corresponding author: Xu Rixin, Email:
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张强, 程铖, 徐日新, 吴彩凤, 谢勇, 刘晓东, 梅宏斌, 曹天庆. 中性粒细胞与淋巴细胞比值对ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗后微循环障碍的预测价值[J/OL]. 中华危重症医学杂志(电子版), 2020, 13(05): 351-355.

Qiang Zhang, Cheng Cheng, Rixin Xu, Caifeng Wu, Yong Xie, Xiaodong Liu, Hongbin Mei, Tianqing Cao. Predictive value of neutrophil-to-lymphocyte ratio on microcirculatory disturbance in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention[J/OL]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2020, 13(05): 351-355.

目的

基于微循环阻力指数（IMR）探讨ST段抬高型心肌梗死（STEMI）患者中性粒细胞与淋巴细胞比值（NLR）和直接经皮冠状动脉介入治疗（PCI）术后微循环障碍的关系。

方法

选择2016年1月至2018年12月期间苏北人民医院收治的50例急性STEMI患者为研究对象，将患者分为低NLR组（NLR ≤ 6.17，25例）和高NLR组（NLR > 6.17，25例）。比较两组患者的临床资料、冠状动脉病变情况、介入治疗方案及直接PCI术后IMR值，并采用Pearson相关分析NLR与直接PCI术后IMR的相关性。

结果

低NLR组和高NLR组患者糖尿病病史（7/25 vs. 15/25，χ2 = 5.195，P = 0.023）、高血脂病史（7/25 vs. 14/25，χ2 = 4.023，P = 0.045）、中性粒细胞计数[6.33（4.04，6.66）× 109/L vs. 7.90（7.23，12.09）× 109/L，H = 18 716.000，P < 0.001]、淋巴细胞计数[1.85（1.37，2.56）× 109/L vs. 0.87（0.78，1.03）× 109/L，H = 29 710.000，P < 0.001]、发病-球囊扩张时间[227.00（180.00，390.00）min vs. 360.00（270.00，435.00），H = 25 199.500，P < 0.001]及直接PCI术后IMR值[（29.9 ± 2.7）vs.（40.4 ± 1.7），t = 16.307，P < 0.001]比较，差异均有统计学意义。Pearson相关分析显示，NLR与IMR具有正相关性（r = 0.676，P < 0.001）。进一步简单线性回归分析示，患者NLR与直接PCI术后微循环障碍的发生有关（R2 = 0.457，P < 0.001）。

结论

STEMI患者入院时，较高的NLR水平与直接PCI术后严重的微循环障碍密切相关，对预测STEMI患者直接PCI术后微循环状态有一定的参考价值。

关键词: 急性心肌梗死, 中性粒细胞与淋巴细胞比值, 经皮冠状动脉介入治疗, 微循环障碍, 微循环阻力指数
Objective

To explore the relationship between the neutrophil-to-lymphocyte ratio (NLR) and microcirculatory disturbance in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) based on the index of microcirculatory resistance (IMR).

Methods

Fifty patients with acute STEMI from January 2016 to December 2018 were selected from Northern Jiangsu People's Hospital and divided into a low NLR group (NLR ≤ 6.17, n = 25) and a high NLR group (NLR > 6.17, n = 25). The clinical data, coronary artery disease, interventional treatment and IMR after primary PCI were compared between the two groups. Meanwhile, the correlation between the NLR and IMR after primary PCI was analyzed by Pearson correlation analysis.

Results

The diabetes history (7/25 vs. 15/25, χ2 = 5.195, P = 0.023), hyperlipidemia history (7/25 vs. 14/25, χ2 = 4.023, P = 0.045), neutrophil count [6.33 (4.04, 6.66) × 109/L vs. 7.90 (7.23, 12.09) × 109/L, H = 18 716.000, P < 0.001], lymphocyte count [1.85 (1.37, 2.56) × 109/L vs. 0.87 (0.78, 1.03) × 109/L, H = 29 710.000, P < 0.001], onset-balloon dilation time [227.00 (180.00, 390.00) min vs. 360.00 (270.00, 435.00) min, H = 25 199.500, P < 0.001] and IMR after primary PCI [(29.9 ± 2.7) vs. (40.4 ± 1.7), t = 16.307, P < 0.001] were statistically significantly different between the low NLR group and high NLR group. Pearson correlation analysis showed a positive correlation between the NLR and IMR (r = 0.676, P < 0.001). Further simple linear regression analysis showed that the NLR was associated with the occurrence of microcirculatory disturbance after primary PCI (R2 = 0.457, P < 0.001).

Conclusion

The higher NLR of STEMI patients at admission is closely related to their severe microcirculatory disturbance after primary PCI, and it has certain reference value for predicting their microcirculation status.

Key words: Acute myocardial infarction, Neutrophil-to-lymphocyte ratio, Percutaneous coronary intervention, Microcirculatory disturbance, Index of microcirculatory resistance
表1 两组急性前壁STEMI患者临床资料比较（ ± s）
组别 例数 年龄（岁） 性别（例，男/女） 吸烟史（例） 高血压病史（例） 糖尿病病史（例） 高血脂病史（例） 入院收缩压（mmHg）
低NLR组 25 58 ± 10 22/3 21 13 7 7 131 ± 23
高NLR组 25 62 ± 12 21/4 15 17 15 14 132 ± 19
t/H/χ2值   1.507 - 3.571 1.333 5.195 4.023 0.142
P值   0.138 1.000 0.059 0.248 0.023 0.045 0.888
组别 例数 入院舒张压（mmHg） 心率（次/min） 中性粒细胞计数[× 109/L，M（P25，P75）] 淋巴细胞计数[× 109/L，M（P25，P75）] 发病-球囊扩张时间[min，M（P25，P75）]
低NLR组 25 81 ± 13 72 ± 16 6.33（4.04，6.66） 1.85（1.37，2.56） 227.00（180.00，390.00）
高NLR组 25 83 ± 12 80 ± 12 7.90（7.23，12.09） 0.87（0.78，1.03） 360.00（270.00，435.00）
t/H/χ2值   0.661 1.968 18 716.000 29 710.000 25 199.500
P值   0.511 0.055 <0.001 <0.001 <0.001
表2 两组急性前壁STEMI患者冠状动脉病变及介入治疗方案比较[M（P25，P75）]
组别 例数 左前降支同时合并其它病变血管（例） 血栓抽吸术（例） 冠状动脉内应用糖蛋白Ⅱb/Ⅲa抑制剂（例） 植入支架直径（mm） 植入支架长度（mm）
无 左回旋支 右冠状动脉 左回旋支+右冠状动脉
低NLR组 25 2 13 4 6 6 21 3.00（3.00，3.25） 25.00（23.50，33.00）
高NLR组 25 3 7 5 10 4 15 3.00（3.00，3.25） 29.00（20.00，30.00）
χ2/H值   2.622 0.500 3.571 44 451.500 43 411.500
P值   0.411 0.480 0.059 0.548 0.135
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