单核细胞与淋巴细胞比值在鉴别重度主动脉瓣狭窄患者射血分数降低的心力衰竭中的预测价值——一项回顾性分析
Predictive Value of Monocyte-To-Lymphocyte Ratio in Differentiating Heart Failure with Reduced Ejection Fraction in Patients with Severe Aortic Stenosis-A Retrospective Analysis.
作者信息
Olasińska-Wiśniewska Anna, Urbanowicz Tomasz, Perek Bartłomiej, Misterski Marcin, Grodecki Kajetan, Grygier Marek, Straburzyńska-Migaj Ewa, Jemielity Marek
机构信息
Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, 61-848 Poznan, Poland.
First Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland.
出版信息
J Clin Med. 2024 Oct 19;13(20):6249. doi: 10.3390/jcm13206249.
: Advanced calcific aortic stenosis, with or without coronary artery disease [CAD], may lead to severe systolic dysfunction. The aim of the study was to reveal clinical and laboratory parameters that may differentiate patients with severe aortic stenosis with and without systolic dysfunction. : A retrospective, single-center study included all consecutive patients diagnosed with severe aortic stenosis with overt heart failure. Patients with hematological and neoplastic diseases were excluded. Demographic, clinical and laboratory data were analysed. Neutrophil-to-lymphocyte [NLR], monocyte-to-lymphocyte [MLR], and platelet-to-lymphocyte [PLR] ratios were calculated. The study group was divided based on left ventricular ejection fraction [LVEF]. : The final study population comprised 301 patients [133 males [44%]; median [Q1-3] age of 80 [75-83] years]. Co-morbidities included CAD [48.8%], arterial hypertension [75.4%], diabetes mellitus [n = 124, 41.2%], atrial fibrillation [39.2%], chronic kidney disease [60.8%]. Fifty-seven patients presented with LVEF ≤ 40% (heart failure with reduced ejection fraction (HFrEF)) and 244 with LVEF > 40%. In the multivariable analysis, N-terminal pro-B-type natriuretic peptide [NTproBNP] [ < 0.001, OR 1.000, 95%CI 1.000-1.000], baseline MLR [ < 0.020, OR 7.393, 95%CI 1.363-40.091] and female sex [ < 0.001, OR 0.308, 95%CI 0.160-0.593] were revealed as significant predictors of HFrEF. Baseline MLR weakly correlated with EuroScore II [Spearman r = 0.141, = 0.015] and NTproBNP [r = 0.142, = 0.014]. Cut-off values were established as 0.36 for MLR and 3927 pg/mL for NTproBNP. After excluding 147 patients with CAD, there was still a statistically significant difference in MLR between the subgroups [ = 0.024]. : Increased values of MLR and NTproBNP together with female sex are predictive parameters for LVEF ≤ 40% in patients with severe aortic stenosis.
重度钙化性主动脉瓣狭窄，无论有无冠状动脉疾病（CAD），都可能导致严重的收缩功能障碍。本研究的目的是揭示可能区分有和没有收缩功能障碍的重度主动脉瓣狭窄患者的临床和实验室参数。
一项回顾性单中心研究纳入了所有连续诊断为重度主动脉瓣狭窄且有明显心力衰竭的患者。排除血液系统和肿瘤性疾病患者。分析了人口统计学、临床和实验室数据。计算了中性粒细胞与淋巴细胞比值（NLR）、单核细胞与淋巴细胞比值（MLR）和血小板与淋巴细胞比值（PLR）。根据左心室射血分数（LVEF）对研究组进行划分。
最终的研究人群包括301例患者[133例男性（44%）；年龄中位数（Q1 - 3）为80（75 - 83）岁]。合并症包括CAD（48.8%）、动脉高血压（75.4%）、糖尿病（n = 124，41.2%）、心房颤动（39.2%）、慢性肾脏病（60.8%）。57例患者LVEF≤40%（射血分数降低的心力衰竭（HFrEF）），244例患者LVEF>40%。在多变量分析中，N末端B型利钠肽原（NTproBNP）（<0.001，OR 1.000，95%CI 1.000 - 1.000）、基线MLR（<0.020，OR 7.393，95%CI 1.363 - 40.091）和女性性别（<0.001，OR 0.308，95%CI 0.160 - 0.593）被揭示为HFrEF的显著预测因素。基线MLR与欧洲心脏手术风险评估系统II（EuroScore II）弱相关（Spearman r = 0.141，P = 0.015），与NTproBNP弱相关（r = 0.142，P = 0.014）。MLR的截断值确定为0.36，NTproBNP的截断值确定为3927 pg/mL。排除147例CAD患者后，亚组间MLR仍有统计学显著差异（P = 0.024）。
MLR和NTproBNP升高以及女性性别是重度主动脉瓣狭窄患者LVEF≤40%的预测参数。
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