Collegium Medicum, Jan Kochanowski University in Kielce, Poland.
Faculty of Medical Science, Higher School of Economy, Law and Medical Science of Professor Edward Lipiński in Kielce, Poland.
Mediators Inflamm. 2020 Sep 3;2020:6027405. doi: 10.1155/2020/6027405. eCollection 2020.
Cardiovascular diseases (CVDs) are a leading cause of death in chronically hemodialyzed (HD) patients. In this group, inflammation exerts significant impact on the prevalence of CVD morbidity and mortality. Spatial QRS-T angle is an independent and strong predictor of CV events, including sudden cardiac death (SCD), both in general population and HD patients. Pathogenesis of widened QRS-T angle is complicated and is not well established.
The study is aimed at evaluating whether inflammation process can contribute to the wide QRS-T angle. . The retrospective study was performed on 183 HD patients. The control group consisted of 38 patients. Demographic, biochemical, vectorcardiographic, and echocardiographic data were evaluated in all patients. Inflammation process was expressed as neutrophil-lymphocyte ratio (NLR), as well as C-reactive protein (CRP).
Both NLR (3.40 vs. 1.95 ( < 0.0001)) and spatial QRS-T angle (50.76 vs. 93.56 ( < 0.001)) were higher in the examined group, compared to the control group. Similarly, CRP was higher in the examined group than in the control group (8.35 vs. 4.06 ( < 0.001), respectively). The QRS-T angle correlated with NLR, CRP, some structural echocardiographic parameters, parathormone (PTH), and calcium (Ca) concentrations. Multiple regression analysis showed that NLR is an independent QRS-T angle predictor ( = 0.498, = 0.0027). The ROC curve analysis indicated the cut-off point of NLR equaled 4.59, where the sensitivity and specificity were the highest for predicting myocardial inhomogeneities expressed as widened QRS-T angle.
The NLR, as an inflammation marker, may indicate myocardial inhomogeneities in HD patients.
心血管疾病（CVD）是慢性血液透析（HD）患者死亡的主要原因。在这组患者中，炎症对 CVD 发病率和死亡率有显著影响。空间 QRS-T 角是 CV 事件（包括心脏性猝死[SCD]）的独立且强有力的预测因子，这在一般人群和 HD 患者中均成立。QRS-T 角增宽的发病机制复杂，尚未完全阐明。
本研究旨在评估炎症过程是否会导致 QRS-T 角增宽。这是一项回顾性研究，共纳入 183 名 HD 患者。对照组由 38 名患者组成。对所有患者进行了人口统计学、生化、向量心电图和超声心动图数据评估。炎症过程用中性粒细胞与淋巴细胞比值（NLR）和 C 反应蛋白（CRP）表示。
与对照组相比，实验组的 NLR（3.40 比 1.95（<0.0001））和空间 QRS-T 角（50.76 比 93.56（<0.001））均更高。同样，实验组的 CRP 也高于对照组（8.35 比 4.06（<0.001））。QRS-T 角与 NLR、CRP、一些结构性超声心动图参数、甲状旁腺激素（PTH）和钙（Ca）浓度相关。多元回归分析表明，NLR 是 QRS-T 角的独立预测因子（ = 0.498， = 0.0027）。ROC 曲线分析表明，NLR 的截断值等于 4.59，此时预测以 QRS-T 角增宽为表现的心肌不均匀性的敏感性和特异性最高。
NLR 作为炎症标志物，可能提示 HD 患者存在心肌不均匀性。
