中性粒细胞与高密度脂蛋白比值对老年急性心肌梗死患者具有更好的预后价值：一项对比研究。

Neutrophil to high-density lipoprotein ratio has a superior prognostic value in elderly patients with acute myocardial infarction: a comparison study.

机构信息

Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Second Clinical School, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

出版信息

Lipids Health Dis. 2020 Apr 4;19(1):59. doi: 10.1186/s12944-020-01238-2.

DOI:10.1186/s12944-020-01238-2

PMID:32247314

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7126405/

Abstract

BACKGROUND

The importance of the lipid-related biomarkers has been implicated in the pathological process and prognosis of acute myocardial infarction (AMI). Our work was conducted to discuss and compare the predictive ability of the neutrophil to high-density lipoprotein cholesterol (HDL-C) ratio (NHR) with other existing prognostic indices, for instance, the monocyte to HDL-C ratio (MHR) and the low-density lipoprotein cholesterol (LDL-C) to HDL-C ratio (LDL-C/HDL-C) in elderly patients with AMI.

METHODS

Our population was 528 consecutive elderly AMI patients (65-85 years) who were enrolled from Tongji Hospital and grouped according to the cutoff points which were depicted by the receiver operating characteristic (ROC). The Kaplan-Meier curves were plotted with the survival data from the follow-up to investigate the difference between cutoff point-determined groups. Moreover, we assessed the impact of NHR, MHR, LDL-C/HDL-C on the long-term mortality and recurrent myocardial infarction (RMI) with Cox proportional hazard models.

RESULTS

Mean duration of follow-up was 673.85 ± 14.32 days (median 679.50 days). According to ROC curve analysis, NHR ≥ 5.74, MHR ≥ 0.67, LDL-C/HDL-C ≥ 3.57 were regarded as high-risk groups. Kaplan-Meier analysis resulted that the high-NHR, high-MHR and high-LDL-C/HDL-C groups presented higher mortality and RMI rate than the corresponding low-risk groups in predicting the long-term clinical outcomes (log-rank test: all P < 0.050). In multivariate analysis, compared with MHR and LDL-C/HDL-C, only NHR was still recognized as a latent predictor for long-term mortality (harzard ratio [HR]: 1.96, 95% confidence interval [CI]: 1.02 to 3.75, P = 0.044) and long-term RMI (HR: 2.23, 95% CI: 1.04 to 4.79, P = 0.040). Furthermore, the positive correlation between NHR and Gensini score (r = 0.15, P < 0.001) indicated that NHR was relevant to the severity of coronary artery to some extent.

CONCLUSIONS

NHR, a novel laboratory marker, might be a predictor of the long-term clinical outcomes of elderly patients with AMI, which was superior to MHR and LDL-C/HDL-C.

摘要

背景

脂质相关生物标志物在急性心肌梗死（AMI）的病理过程和预后中具有重要意义。我们的工作旨在讨论并比较中性粒细胞与高密度脂蛋白胆固醇（HDL-C）比值（NHR）与其他现有预后指标（如单核细胞与 HDL-C 比值（MHR）和低密度脂蛋白胆固醇（LDL-C）与 HDL-C 比值（LDL-C/HDL-C））在老年 AMI 患者中的预测能力。

方法

我们的研究人群为 528 例连续的老年 AMI 患者（65-85 岁），他们来自同济医院，并根据受试者工作特征（ROC）曲线确定的截断点进行分组。通过随访获得的生存数据绘制 Kaplan-Meier 曲线，以研究截断点确定组之间的差异。此外，我们使用 Cox 比例风险模型评估 NHR、MHR、LDL-C/HDL-C 对长期死亡率和复发性心肌梗死（RMI）的影响。

结果

平均随访时间为 673.85±14.32 天（中位数 679.50 天）。根据 ROC 曲线分析，NHR≥5.74、MHR≥0.67、LDL-C/HDL-C≥3.57 被认为是高危组。Kaplan-Meier 分析结果表明，在预测长期临床结局方面，高 NHR、高 MHR 和高 LDL-C/HDL-C 组的死亡率和 RMI 发生率均高于相应的低危组（对数秩检验：均 P<0.050）。多变量分析显示，与 MHR 和 LDL-C/HDL-C 相比，只有 NHR 仍被认为是长期死亡率（风险比 [HR]：1.96，95%置信区间 [CI]：1.02 至 3.75，P=0.044）和长期 RMI（HR：2.23，95%CI：1.04 至 4.79，P=0.040）的潜在预测因子。此外，NHR 与 Gensini 评分之间的正相关（r=0.15，P<0.001）表明，NHR 在一定程度上与冠状动脉的严重程度相关。