Nalbant Ahmet, Cinemre Hakan, Kaya Tezcan, Varim Ceyhun, Varim Perihan, Tamer Ali
Dr. Ahmet Nalbant, Internal Medicine Consultant, Department of Internal Medicine, Sakarya University School of Medicine, Sakarya, Turkey.
Dr. Hakan Cinemre, Associate Professor, Department of Internal Medicine, Sakarya University School of Medicine, Sakarya, Turkey.
Pak J Med Sci. 2016 Jan-Feb;32(1):106-10. doi: 10.12669/pjms.321.8712.
Diagnostic performance of troponin assays is affected by renal insufficiency. Neutrophil to lymphocyte ratio(NLR) is an independent predictor of acute coronary syndrome. Our objective was to evaluate performance of NLR in diagnosing acute myocardial infarction (AMI) among patients with elevated serum creatinine.
Patients with elevated creatinine levels evaluated for coronary artery disease were included (n=284). Patients were divided into two groups according to having AMI or non-specific chest pain. AMI diagnosis was made based on clinical and laboratory data, including serial EKG and cardiac enzymes, ECHO and coronary angiography.
Troponin, neutrophil, and NLR were found to be higher in patients with AMI, compared to patients without AMI (P= 0.001, P= 0.001 and P=0.028, respectively). ROC curve analysis for NLR in diagnosing AMI was significant (AUC: 0.607; P=0.003). Sensitivity, specificity, LR +, LR-, PPV and NPV for NLR>7.4 were found as 42.3%, 74.7%, 1.68%, 0.77%, 77% and 40%, respectively. Logistic regression analysis revealed that patients whose NLR>7.4 were 2.18 times as likely to have AMI.
NLR can be used as an independent predictor of AMI in patients with renal insufficiency. This seems to get more important in the era of high sensitivity troponin assays. Our results might also help in early diagnosis of AMI in this high risk population while serial cardiac enzyme results are pending.
肌钙蛋白检测的诊断性能受肾功能不全影响。中性粒细胞与淋巴细胞比值（NLR）是急性冠状动脉综合征的独立预测指标。我们的目的是评估NLR在诊断血清肌酐升高患者急性心肌梗死（AMI）中的性能。
纳入因冠心病接受评估且肌酐水平升高的患者（n = 284）。根据是否患有AMI或非特异性胸痛将患者分为两组。AMI诊断基于临床和实验室数据，包括系列心电图、心肌酶、超声心动图和冠状动脉造影。
与无AMI的患者相比，AMI患者的肌钙蛋白、中性粒细胞和NLR更高（分别为P = 0.001、P = 0.001和P = 0.028）。NLR诊断AMI的ROC曲线分析具有显著性（AUC：0.607；P = 0.003）。NLR>7.4时的敏感性、特异性、阳性似然比、阴性似然比、阳性预测值和阴性预测值分别为42.3%、74.7%、1.68、0.77、77%和40%。逻辑回归分析显示，NLR>7.4的患者发生AMI的可能性是前者的2.18倍。
NLR可作为肾功能不全患者AMI的独立预测指标。在高敏肌钙蛋白检测时代，这一点似乎更为重要。在该高危人群中，当系列心肌酶结果尚未得出时，我们的结果可能有助于AMI的早期诊断。
