肝肾功能正常的冠心病患者行经皮冠状动脉介入治疗后，天冬氨酸转氨酶与血小板比值预测其长期死亡率的回顾性队列研究。

ALT-to-Lymphocyte Ratio as a Predictor of Long-Term Mortality in Patients with Normal Liver Function Presenting Coronary Artery Disease after Undergoing PCI: A Retrospective Cohort Study.

机构信息

Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.

Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China.

出版信息

J Interv Cardiol. 2020 Apr 21;2020:4713591. doi: 10.1155/2020/4713591. eCollection 2020.

DOI:10.1155/2020/4713591

PMID:32372887

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7193295/

Abstract

BACKGROUND

Alanine aminotransferase (ALT) is referred as liver transaminase and predominantly expressed by hepatocytes. Previous evidences showed that high levels of ALT were reversely associated with short- and long-term outcomes in patients with myocardial infarction. Besides, low lymphocyte has been demonstrated to be significantly correlated with adverse clinical outcomes in coronary artery disease (CAD). However, evidences about the relationship between ALT-to-lymphocyte ratio (ALR) and outcomes in CAD patients with normal liver function are limited. The aim of this study was to assess the relationship between ALR and clinical outcomes in patients with CAD.

METHODS

This is a retrospective cohort study, and a total of 3561 patients were enrolled in Clinical Outcomes and Risk Factors of Patients with CAD after percutaneous coronary intervention (PCI), from January 2013 to December 2017. After excluding patients with liver dysfunction, we finally enrolled 2714 patients. These patients were divided into two groups according to ALR value: the lower group (ALR < 14.06, = 1804) and the higher group (ALR ≥ 14.06, = 910). The average follow-up time was 37.59 ± 22.24 months.

RESULTS

We found that there were significant differences between the two groups in the incidence of all-cause mortality (ACM) ( < 0.001) and cardiac mortality (CM) (=0.010). Kaplan-Meier survival analysis suggested that CAD patients with higher ALR tended to have an increased accumulated risk of ACM and CM (log rank < 0.001 and =0.006, respectively). Multivariate Cox regression analysis showed that ALR was an independent predictor of ACM (hazard ratio (HR) = 2.017 (95% confidence interval (CI): 1.289-3.158), =0.002) and CM (HR = 1.862 (95% CI: 1.047-3.313), =0.034). We did not find significant difference in the incidence of major adverse cardiovascular events (MACEs) and major adverse cardiovascular and cerebrovascular events (MACCEs) between the two groups after adjustments of confounders.

CONCLUSION

Our results indicate that ALR is an independent predictor of long-term adverse outcomes in CAD patients who underwent PCI.

摘要

背景

丙氨酸氨基转移酶（ALT）又称肝转氨酶，主要由肝细胞表达。先前的证据表明，心肌梗死患者的 ALT 水平较高与短期和长期预后呈负相关。此外，低淋巴细胞已被证明与冠状动脉疾病（CAD）的不良临床结局显著相关。然而，关于 ALT 与淋巴细胞比值（ALR）与肝功能正常的 CAD 患者结局之间关系的证据有限。本研究旨在评估 CAD 患者中 ALR 与临床结局之间的关系。

方法

这是一项回顾性队列研究，共纳入 2013 年 1 月至 2017 年 12 月经皮冠状动脉介入治疗（PCI）后 CAD 患者的临床结局和危险因素（Clinical Outcomes and Risk Factors of Patients with CAD after percutaneous coronary intervention，CAPPPCI）研究中的 3561 例患者。排除肝功能异常患者后，最终纳入 2714 例患者。根据 ALR 值将这些患者分为两组：低值组（ALR＜14.06，n=1804）和高值组（ALR≥14.06，n=910）。平均随访时间为 37.59±22.24 个月。

结果

我们发现两组间全因死亡率（ACM）（＜0.001）和心源性死亡率（CM）（=0.010）的发生率存在显著差异。Kaplan-Meier 生存分析提示，ALR 较高的 CAD 患者 ACM 和 CM 的累积风险增加（对数秩检验＜0.001 和=0.006）。多因素 Cox 回归分析显示，ALR 是 ACM（风险比（HR）=2.017（95%置信区间（CI）：1.289-3.158），=0.002）和 CM（HR=1.862（95% CI：1.047-3.313），=0.034）的独立预测因子。在校正混杂因素后，两组间主要不良心血管事件（MACEs）和主要不良心血管和脑血管事件（MACCEs）的发生率无显著差异。