Faculty of Medicine, Universitas Indonesia, Jl. Salemba Raya No.6, Kenari, Kec. Senen, Jakarta Pusat, DKI Jakarta.
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jl. Let. Jend. S. Parman Kav 87, Jakarta Barat, DKI Jakarta.
Coron Artery Dis. 2022 Mar 1;33(2):137-143. doi: 10.1097/MCA.0000000000001040.
The natural history of coronary heart disease (CAD) commonly begins with atherosclerosis, progressing to chronic coronary syndrome (CCS), acute coronary syndrome (ACS), and eventually, heart failure. Despite advancements in preventive and therapeutic strategies, there is room for further cardiovascular risk reduction. Recently, inflammation has emerged as a potential therapeutic target. The neutrophil-to-lymphocyte ratio (NLR) is a novel inflammatory biomarker which predicts poor prognosis in several conditions such as metabolic syndrome, sepsis, malignancy and CAD. In atherosclerosis, a high NLR predicts plaque vulnerability and severe stenosis. This is consistent with observations in CCS, where an elevated NLR predicts long-term major adverse cardiac events (MACEs). In ACS patients, high NLR levels are associated with larger infarct sizes and poor long-term outcomes. Possible reasons for this include failure of fibrinolysis, ischemia-reperfusion injury and in-stent restenosis, all of which are associated with raised NLR levels. Following myocardial infarction, an elevated NLR correlates with pathological cardiac remodeling which propagates chronic heart failure. Finally, in heart failure patients, an elevated NLR predicts long-term MACEs, mortality, and poor left ventricular assist device and transplant outcomes. Further studies must evaluate whether the addition of NLR to current risk-stratification models can better identify high-risk CAD patients.
冠心病（CAD）的自然病程通常始于动脉粥样硬化，进展为慢性冠状动脉综合征（CCS）、急性冠状动脉综合征（ACS），最终发展为心力衰竭。尽管预防和治疗策略有所进步，但仍有进一步降低心血管风险的空间。最近，炎症已成为一个潜在的治疗靶点。中性粒细胞与淋巴细胞比值（NLR）是一种新型炎症生物标志物，可预测代谢综合征、脓毒症、恶性肿瘤和 CAD 等多种情况下的不良预后。在动脉粥样硬化中，高 NLR 预示着斑块易损性和严重狭窄。这与 CCS 中的观察结果一致，其中升高的 NLR 预示着长期主要不良心脏事件（MACE）。在 ACS 患者中，高 NLR 水平与更大的梗死面积和较差的长期预后相关。其可能的原因包括纤溶失败、缺血再灌注损伤和支架内再狭窄，所有这些都与 NLR 水平升高有关。心肌梗死后，升高的 NLR 与病理性心脏重构相关，从而导致慢性心力衰竭。最后，在心力衰竭患者中，升高的 NLR 预示着长期 MACE、死亡率以及左心室辅助装置和移植预后不良。需要进一步研究评估 NLR 是否可以加入到现有的风险分层模型中，以更好地识别高危 CAD 患者。
