CAJ | 학술논문

目的：探讨高龄急性心力衰竭（ AHF）患者入院早期中性粒细胞／淋巴细胞比值（ NLR）与近期心血管不良事件的相关性。方法选取2011－03～2014－09我院收治的78例高龄AHF患者为研究对象，以住院期间是否发生心血管不良事件分为不良事件组（ n＝31）和非事件组（n＝47）；比较两组入院时一般临床资料，血常规[白细胞计数（WBC）、中性粒细胞（NEU）计数及淋巴细胞（LYM）计数并计算两者间比值（NLR）]、高敏C－反应蛋白（hs－CRP），心功能相关指标等，并绘制受试者工作特征（ ROC）曲线，分析NLR预测患者发生心血管不良事件的临床价值。结果与非事件组比较，不良事件组患者心率偏快（ P＜0．05）， WBC、NEU计数、NLR、NT－proBNP、hs－CRP偏高（P＜0．05），而LYM计数、LVEF偏低（P＜0．05）；Pearson相关分析显示， NLR与WBC、NT－proBNP及hs－CRP呈正相关（P＜0．05），而与LVEF呈负相关（P＜0．05）；多因素Logistic回归分析显示，高水平NLR与高龄AHF患者心血管不良事件呈独立正相关（ P＜0．05）；ROC曲线分析显示，NLR预测高龄AHF患者心血管不良事件发生的曲线下面积（ AUC）为0．795（95％CI 0．536～0．927，P＜0．05），最佳的诊断截点值为7．49，敏感度和特异度分别为77．1％和82．0％；以NLR的截点值7．49为分界将患者分为两组（ NLR≥7．49组及NLR＜7．49组），NLR≥7．49组患者心血管不良事件发生率高于NLR＜7．49组（P＜0．05）。结论高水平NLR、炎症反应和心功能降低密切相关，且是高龄AHF患者发生近期心血管不良事件的高危因素，早期评估NLR水平对于判断高龄AHF患者近期预后具有一定的临床意义。
목적：탐토고령급성심력쇠갈（ AHF）환자입원조기중성립세포／림파세포비치（ NLR）여근기심혈관불량사건적상관성。방법선취2011－03～2014－09아원수치적78례고령AHF환자위연구대상，이주원기간시부발생심혈관불량사건분위불량사건조（ n＝31）화비사건조（n＝47）；비교량조입원시일반림상자료，혈상규[백세포계수（WBC）、중성립세포（NEU）계수급림파세포（LYM）계수병계산량자간비치（NLR）]、고민C－반응단백（hs－CRP），심공능상관지표등，병회제수시자공작특정（ ROC）곡선，분석NLR예측환자발생심혈관불량사건적림상개치。결과여비사건조비교，불량사건조환자심솔편쾌（ P＜0．05）， WBC、NEU계수、NLR、NT－proBNP、hs－CRP편고（P＜0．05），이LYM계수、LVEF편저（P＜0．05）；Pearson상관분석현시， NLR여WBC、NT－proBNP급hs－CRP정정상관（P＜0．05），이여LVEF정부상관（P＜0．05）；다인소Logistic회귀분석현시，고수평NLR여고령AHF환자심혈관불량사건정독립정상관（ P＜0．05）；ROC곡선분석현시，NLR예측고령AHF환자심혈관불량사건발생적곡선하면적（ AUC）위0．795（95％CI 0．536～0．927，P＜0．05），최가적진단절점치위7．49，민감도화특이도분별위77．1％화82．0％；이NLR적절점치7．49위분계장환자분위량조（ NLR≥7．49조급NLR＜7．49조），NLR≥7．49조환자심혈관불량사건발생솔고우NLR＜7．49조（P＜0．05）。결론고수평NLR、염증반응화심공능강저밀절상관，차시고령AHF환자발생근기심혈관불량사건적고위인소，조기평고NLR수평대우판단고령AHF환자근기예후구유일정적림상의의。
Objective To investigate the correlation between adverse cardiovascular events and neutrophil and lymphocyte ratio (NLR) in aged patients with acute heart failure (AHF).Methods Seventy-eight cases of aged patients with AHF in our hospital from March 2011 to September 2014 were selected as the research subjects, all cases were divided into adverse event group ( n=31 cases) and non-event group ( n =47 ) according to adverse cardiovascular events; general clinical data on admission, routine blood [ white blood cell count ( WBC ) , the number of neutrophils ( NEU ) and lymphocyte count ( LYM) and calculate the ratio between ( NLR) , high-sensitivity c-reactive protein ( hs-CRP) and cardiac function related indicators were compared among two groups;and the receiver-operating characteristic curve ( ROC curve) was drawn to analyze the clinical value of NLR predict the adverse cardiovascular events.Results Compared with the non -event group, heart rate in adverse events group was rapid, WBC counts, NEU, NLR, NT-proBNP, hs-CRP were higher (P<0.05), while LYM, LVEF were lower ( P <0.05 ); Pearson correlation analysis showed that NLR were positively correlated with WBC, NT -proBNP and hs -CRP ( P <0.05 ), while was negatively correlated with LVEF (P<0.05); Multiariable Logistic regression analysis showed that high level of NLR was independently correlated with cardiovascular adverse events in elderly patients with AHF ( P<0.05);ROC curve analysis showed that:the NLR prediction for older patients with AHF area under the curve of cardiovascular adverse events (ROCAUC) was 0.795 (95%CI=0.536~0.927, P<0.05), the best diagnostic cut-off value was 7.49, the sensitivity and specificity were 77.1% and 82.0%respectively;cut-off value of NLR with 7.49 for boundary divided the patients into two groups (NLR acuity 7.49 group and NLR<7.49), NLR acuity 7.49 higher incidence of adverse cardiovascular events in patients with NLR <7.49 group ( P <0.05 ).Conclusion NLR is closely related to the inflammatory reaction and a decreased cardiac function.It is a risk factor for cardiovascular adverse events in elderly patients with AHF, therefore early detecting of NLR has certain clinical significance in judging the prognosis of elderly patients with AHF.