Yu C, Chen M, Chen Z, Lu G
Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, No197 Ruijin Er Road, 200025, Shanghai, China.
Herz. 2016 Nov;41(7):605-613. doi: 10.1007/s00059-015-4399-8. Epub 2016 Mar 8.
The aim of this study was to examine the association between the admission neutrophil-to-lymphocyte ratio (N/L ratio) with coronary heart disease (CHD), separately from acute coronary syndrome (ACS) and stable angina (SA). A further aim was to investigate the clinical value of the N/L ratio in predicting in-hospital CHD events and the long-term prognosis of patients with CHD.
In all, 942 patients were enrolled and classified into a CHD group (comprising an ACS group and an SA group) and a normal group. Laboratory data including regular blood test results were obtained at baseline. The relationship between the N/L ratio and CHD, ACS, Gensini score, and multivessel lesions was analyzed by logistic regression. Receiver operating characteristics (ROC) curve analysis was used to identify the value of the N/L ratio in the diagnosis of CHD, ACS, and the severity of CHD. We divided the patients into four groups according to the N/L ratio quartiles and compared the differences in major adverse cardiac events (MACEs) that occurred in hospital and in the 4.26 ± 0.57-year follow-up out of hospital.
Patients with an elevated N/L ratio had a significantly increased risk of CHD [odds ratio (OR) = 1.697, 95 % confidence interval (CI) = 1.483-1.942], and an elevated N/L ratio was closely related to a higher risk of ACS (OR = 1.652, 95 % CI = 1.434-1.902). The admission N/L ratio (0.664; 95 % CI = 1.942-1.616) showed a greater ROC area than the WBC and LDL-C values. Patients with a higher N/L ratio in both the SA group and the ACS group had a higher incidence of in-hospital and out-of-hospital MACEs, including long-term mortality and occurrence of new-onset heart failure or re-occurrence of heart failure. An elevated N/L ratio on admission was also found to be a significant indicator of 4.26-year MACEs.
The admission N/L ratio was significantly associated with CHD and may become a risk predictor in the prognosis of patients with CHD.
本研究旨在分别探讨入院时中性粒细胞与淋巴细胞比值（N/L比值）与冠心病（CHD）、急性冠脉综合征（ACS）和稳定型心绞痛（SA）之间的关联。另一目的是研究N/L比值在预测冠心病患者院内CHD事件及长期预后方面的临床价值。
共纳入942例患者，分为冠心病组（包括ACS组和SA组）和正常组。在基线时获取包括血常规检查结果在内的实验室数据。通过逻辑回归分析N/L比值与CHD、ACS、Gensini评分及多支血管病变之间的关系。采用受试者工作特征（ROC）曲线分析确定N/L比值在CHD、ACS诊断及CHD严重程度评估中的价值。根据N/L比值四分位数将患者分为四组，比较院内及院外4.26±0.57年随访期间主要不良心脏事件（MACE）的差异。
N/L比值升高的患者患CHD的风险显著增加[比值比（OR）=1.697，95%置信区间（CI）=1.483 - 1.942]，且N/L比值升高与ACS风险增加密切相关（OR = 1.652，95%CI = 1.434 - 1.902）。入院时N/L比值（0.664；95%CI = 1.942 - 1.616）的ROC曲线下面积大于白细胞和低密度脂蛋白胆固醇值。SA组和ACS组中N/L比值较高的患者院内及院外MACE发生率较高，包括长期死亡率及新发心力衰竭或心力衰竭复发。入院时N/L比值升高也是4.26年MACE的显著指标。
入院时N/L比值与CHD显著相关，可能成为冠心病患者预后的风险预测指标。
