Zazula Ana Denise, Précoma-Neto Daniel, Gomes Aline Maria, Kruklis Heidi, Barbieri Giovano Franco, Forte Rafael Yared, Langowiski André Ribeiro, Facin Giuseppe, Guarita-Souza Luiz César, Faria Neto José Rocha
Pontifícia Universidade Católica do Paraná, Santa Casa de Misericórdia Hospital, Curitiba, PR - Brazil.
Arq Bras Cardiol. 2008 Jan;90(1):31-6. doi: 10.1590/s0066-782x2008000100006.
Leukocytes total count is an independent risk marker for cardiovascular events. The ratio between neutrophils and lymphocytes (N/L) count has been investigated as a new predictor for cardiovascular risk, although its diagnostic role when assessing patients suspected of an acute coronary syndrome (ACS) condition is not yet known.
To evaluate the diagnostic power of N/L ratio in patients who have been admitted at a Chest Pain Unit (CPU) with the suspicion of ACS.
Evaluation was conducted in 178 patients admitted with chest pain. Diagnostic flowchart including clinical, electrocardiographic, and laboratory data. Diagnosis obtained was: acute myocardial infarction (AMI) with (AMI-STE) and with no segment T elevation (AMI-NSTE), unstable angina (UA ) and non-cardiac pain (NC). Total and differential leukocyte count was conducted in peripheral blood sample collected at admission.
Patients diagnosed with non-cardiac pain reported the lowest N/L ratio (n=45; 3.0 +/- 1.6), followed by UA (n=65; 3.6 +/- 2.9), AMI-NSTE (n=33; 4.8 +/- 3.7) and AMI-STE (n=35; 6.9 +/- 5.7); p < 0.0001. N/L ratio above 5.7 (highest quartile) reported 91.1% specificity, 4.51 odds ratio (CI 95% 1.51 to 13.45) for the final diagnosis of ACS when compared to the groups at lower quartiles.
The N/L ratio presents correlation with final diagnosis of patients with suspicion of ACS at admission. Considering this is a low cost, good reproductibility test, new studies should ellucidate whether the ratio may be of relevance for diagnosis flowcharts currently in use.
白细胞总数是心血管事件的独立风险标志物。中性粒细胞与淋巴细胞计数之比（N/L）已被研究作为心血管风险的新预测指标，尽管其在评估疑似急性冠状动脉综合征（ACS）患者时的诊断作用尚不清楚。
评估N/L比值在因疑似ACS而入住胸痛单元（CPU）的患者中的诊断价值。
对178例因胸痛入院的患者进行评估。诊断流程包括临床、心电图和实验室数据。最终诊断结果为：伴ST段抬高的急性心肌梗死（AMI-STE）、不伴ST段抬高的急性心肌梗死（AMI-NSTE）、不稳定型心绞痛（UA）和非心源性胸痛（NC）。入院时采集外周血样本进行白细胞总数和分类计数。
诊断为非心源性胸痛的患者N/L比值最低（n=45；3.0±1.6），其次是UA（n=65；3.6±2.9）、AMI-NSTE（n=33；4.8±3.7）和AMI-STE（n=35；6.9±5.7）；p<0.0001。与较低四分位数组相比，N/L比值高于5.7（最高四分位数）时，最终诊断为ACS的特异性为91.1%，优势比为4.51（95%CI为1.51至13.45）。
N/L比值与入院时疑似ACS患者的最终诊断相关。鉴于这是一项低成本、重现性好的检测，新的研究应阐明该比值是否与目前使用的诊断流程相关。
