Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria.
Atherosclerosis. 2013 Dec;231(2):274-80. doi: 10.1016/j.atherosclerosis.2013.10.002. Epub 2013 Oct 11.
Inflammation is associated with atherosclerotic disease. In this context, it has been shown that an increased neutrophil count is a risk factor for cardiovascular events in patients with coronary and peripheral artery disease. However, the impact of neutrophils on long-term mortality in patients with carotid atherosclerosis is not yet fully understood.
We prospectively studied 853 of 1268 consecutive patients with neurologically asymptomatic carotid stenosis for all-cause and cardiovascular death, respectively.
During a median follow-up time of 6.3 years (IQR 5.8-6.7 years) a total of 203 deaths (23.8%), including 134 cardiovascular deaths (15.7%), were recorded. An increase of 1 G/L of neutrophil count indicated an increased risk for all-cause mortality of 1.20 (CI [95%] 1.10-1.31, P < 0.001) and of cardiovascular death of 1.30 (CI 1.17-1.45, P < 0.001), respectively. For the second to the fourth quartile of the neutrophil count, adjusted hazard ratios for all-cause mortality were 1.12 (CI, 0.71-1.75), 1.46 (CI, 0.96-2.21), and 1.76 (CI, 1.15-2.69; P = 0.03 for trend); and 1.41 (CI, 0.80-2.49), 1.53 (CI, 0.88-2.68), and 2.54 (CI, 1.49-4.33; P < 0.01 for trend) for cardiovascular mortality, compared to the lowest quartile, respectively. Patients with baseline carotid stenosis of more than 50% and/or increased neutrophil count (≥median), had a 1.9-2.4 fold increase in risk of (CV-) death, compared to patients with carotid narrowing of less than 50% and/or neutrophil count less than the median (P < 0.001). After adjusting for cardiovascular risk factors, only neutrophils, but not eosinophils, basophils, monocytes, lymphocytes, or the total leukocyte count showed a significant association with long-term mortality. No significant association was found between white blood cell subtypes with either baseline degree or progression during a 6 month follow-up of carotid stenosis.
The baseline neutrophil count was an independent predictor for all-cause and cardiovascular mortality in neurologically asymptomatic patients with carotid stenosis. Thus, the measurement of neutrophils could provide prognostic information on outcome in patients at risk.
炎症与动脉粥样硬化疾病有关。在这种情况下，已经表明中性粒细胞计数增加是冠心病和外周动脉疾病患者心血管事件的危险因素。然而，中性粒细胞对颈动脉粥样硬化患者长期死亡率的影响尚不完全清楚。
我们前瞻性研究了 1268 例连续的神经无症状性颈动脉狭窄患者中的 853 例，分别为全因和心血管死亡。
在中位随访时间为 6.3 年（IQR 5.8-6.7 年）期间，共记录了 203 例死亡（23.8%），包括 134 例心血管死亡（15.7%）。中性粒细胞计数增加 1 G/L 表示全因死亡率增加 1.20（CI [95%] 1.10-1.31，P < 0.001）和心血管死亡率增加 1.30（CI 1.17-1.45，P < 0.001）。对于中性粒细胞计数的第二至第四四分位数，全因死亡率的调整后的危险比分别为 1.12（CI，0.71-1.75）、1.46（CI，0.96-2.21）和 1.76（CI，1.15-2.69；P = 0.03 趋势）；心血管死亡率分别为 1.41（CI，0.80-2.49）、1.53（CI，0.88-2.68）和 2.54（CI，1.49-4.33；P < 0.01 趋势），与最低四分位数相比。与颈动脉狭窄小于 50%和/或中性粒细胞计数低于中位数的患者相比，基线颈动脉狭窄超过 50%和/或中性粒细胞计数升高（≥中位数）的患者发生（CV-）死亡的风险增加了 1.9-2.4 倍（P < 0.001）。在调整心血管危险因素后，只有中性粒细胞，而不是嗜酸性粒细胞、嗜碱性粒细胞、单核细胞、淋巴细胞或白细胞总数，与长期死亡率有显著相关性。在 6 个月的颈动脉狭窄随访期间，白细胞亚型与基线程度或进展之间未发现显著相关性。
在神经无症状性颈动脉狭窄患者中，基线中性粒细胞计数是全因和心血管死亡率的独立预测因子。因此，中性粒细胞的测量可以为高危患者的预后提供信息。
