在接受直接经皮冠状动脉介入治疗的ST段抬高型心肌梗死患者中，中性粒细胞与淋巴细胞比值与裸金属支架再狭窄相关。
The neutrophil-to-lymphocyte ratio is associated with bare-metal stent restenosis in STEMI patients treated with primary PCI.
作者信息
Bolca Osman, Güngör Bariş, Özcan Kazim S, Karadeniz Fatma Ö, Sungur Aylin, Köroğlu Bayram, Bakhshyaliyev Nijad, Yelgeç Nizamettin S, Karataş Baran, İpek Göktürk, Yilmaz Hale, Öztürk Recep
机构信息
aDepartment of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul bDepartment of Cardiology, Derince Training and Research Hospital, Kocaeli, Turkey.
出版信息
Coron Artery Dis. 2015 Aug;26(5):402-8. doi: 10.1097/MCA.0000000000000254.
BACKGROUND
The clinical importance of complete blood count (CBC) parameters such as the neutrophil-to-lymphocyte ratio (NLR) has been shown in cardiovascular diseases. Stent restenosis (SR) is a major adverse event after stent implantation. In this study, we aimed to investigate the correlation of CBC parameters with SR rates after primary percutaneous coronary intervention (PCI).
METHODS
Patients who had undergone primary PCI for ST-segment elevation myocardial infarction (STEMI) and control angiography during follow-up were retrospectively recruited. Patients were categorized according to admission NLR tertiles, and clinical, hematological, and angiographic data were compared.
RESULTS
A total of 404 patients (207 patients with SR and 197 patients without SR) were included in the study. Patients were categorized into three groups according to the tertiles of admission NLRs; the NLR was less than 3.38 in tertile 1 (n=134), between 3.38 and 6.26 in tertile 2 (n=135), and greater than 6.26 in tertile 3 (n=135). During a follow-up period of a median of 14 months (minimum 6 months, maximum 60 months) SR developed in 80 patients of tertile 3 (59%), 74 patients of tertile 2 (55%), and 53 patients of tertile 1 (40%), which were significantly different (P=0.01). According to multivariate Cox regression analysis, male sex, stent length (odds ratio 1.04, 95% confidence interval 1.01-1.06, P=0.01), admission NLRs (odds ratio 1.13, 95% confidence interval 1.08-1.19, P=0.01), and white blood cell and neutrophil counts remained the independent predictors of SR in the study population. Other CBC parameters and admission C-reactive protein, creatinine, and fasting glucose levels were not independently correlated with SR. On receiver operating curve analysis, admission NLRs higher than 3.84 were found to predict SR with a sensitivity of 73.4% and a specificity of 50.8% (area under the curve 0.604, P=0.01).
CONCLUSION
High NLR levels, white blood cell counts, and neutrophil counts at admission are independently correlated with SR after primary PCI.
背景
全血细胞计数（CBC）参数如中性粒细胞与淋巴细胞比值（NLR）在心血管疾病中的临床重要性已得到证实。支架再狭窄（SR）是支架植入后的主要不良事件。在本研究中，我们旨在探讨CBC参数与初次经皮冠状动脉介入治疗（PCI）后SR发生率的相关性。
方法
回顾性纳入因ST段抬高型心肌梗死（STEMI）接受初次PCI并在随访期间进行对照血管造影的患者。根据入院时NLR三分位数对患者进行分类，并比较临床、血液学和血管造影数据。
结果
本研究共纳入404例患者（207例发生SR，197例未发生SR）。根据入院时NLR三分位数将患者分为三组；第一三分位数组（n = 134）的NLR小于3.38，第二三分位数组（n = 135）的NLR在3.38至6.26之间，第三三分位数组（n = 135）的NLR大于6.26。在中位随访期14个月（最短6个月，最长60个月）内，第三三分位数组80例患者（59%）发生SR，第二三分位数组74例患者（55%）发生SR，第一三分位数组53例患者（40%）发生SR，差异有统计学意义（P = 0.01）。根据多因素Cox回归分析，男性、支架长度（比值比1.04，95%置信区间1.01 - 1.06，P = 0.01）、入院时NLR（比值比1.13，95%置信区间1.08 - 1.19，P = 0.01）以及白细胞和中性粒细胞计数仍是研究人群中SR的独立预测因素。其他CBC参数以及入院时C反应蛋白、肌酐和空腹血糖水平与SR无独立相关性。在受试者工作特征曲线分析中，发现入院时NLR高于3.84可预测SR，敏感性为73.4%，特异性为50.8%（曲线下面积0.604，P = 0.01）。
结论
入院时高NLR水平、白细胞计数和中性粒细胞计数与初次PCI后SR独立相关。
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