陈满新, 任江华, 柏战, 张冬, 张丙雨, 孙娟娟. 中性粒细胞与淋巴细胞比值结合CHA2DS2-VASc评分与急性冠脉综合征的相关性[J]. 心脏杂志, 2020, 32(3): 239-243. DOI: 10.12125/j.chj.202004047
    引用本文: 陈满新, 任江华, 柏战, 张冬, 张丙雨, 孙娟娟. 中性粒细胞与淋巴细胞比值结合CHA2DS2-VASc评分与急性冠脉综合征的相关性[J]. 心脏杂志, 2020, 32(3): 239-243. DOI: 10.12125/j.chj.202004047
    Man-xin CHEN, Jiang-hua REN, Zhan BAI, Dong ZHANG, Bing-yu ZHANG, Juan-juan SUN. Correlation between neutrophil-lymphocytes ratio and CHA2DS2-VASc score with acute coronary syndrome[J]. Chinese Heart Journal, 2020, 32(3): 239-243. DOI: 10.12125/j.chj.202004047
    Citation: Man-xin CHEN, Jiang-hua REN, Zhan BAI, Dong ZHANG, Bing-yu ZHANG, Juan-juan SUN. Correlation between neutrophil-lymphocytes ratio and CHA2DS2-VASc score with acute coronary syndrome[J]. Chinese Heart Journal, 2020, 32(3): 239-243. DOI: 10.12125/j.chj.202004047

    中性粒细胞与淋巴细胞比值结合CHA2DS2-VASc评分与急性冠脉综合征的相关性

    Correlation between neutrophil-lymphocytes ratio and CHA2DS2-VASc score with acute coronary syndrome

    • 摘要:
        目的  探讨运用中性粒细胞与淋巴细胞比值(NLR)结合CHA2DS2-VASc评分系统对急性冠脉综合征患者(ACS)冠状动脉病变程度和行经皮冠状动脉介入(PCI)治疗中住院期间心血管事件的预测价值。
        方法  分析2016年1月~2019年1月芜湖市第二人民医院因为发生ACS行PCI治疗的患者657(男 471、女 186)例;年龄(76±14)岁,所有入选患者均利用CHA2DS2-VASc评分系统进行评分,记录患者的临床基本资料、NLR、PCI手术相关信息、实验室检查结果,住院时间和住院期间发生的主要不良心血管事件(MACE);记录手术中冠状动脉病变情况和相关SYNTAX评分,分3组:低危组(评分≤22)(n=332);中危组(评分23~32)(n=230);高危组(评分≥33)(n=95)。分别采用单因素和多因素logistic回归分析确定CHA2DS2-VASc评分结合NLR能否预测冠状动脉病变程度(SYNTAX评分评价)和住院期间MACE。
        结果  logistic回归分析表明冠状动脉病变程度和住院MACE的危险因素包括吸烟史、NLR、慢性肾脏病变、CHA2DS2-VASc评分(P<0.01);多元回归分析CHA2DS2-VASc评分≥3(OR值3.028,95%可信区间1.627-5.517,P<0.01),NLR≥5.23(OR值2.901,95%可信区间1.260-5.370,P<0.01)是冠状动脉病变程度SYNTAX评分高危组独立预测因子。多因素Cox逐步回归分析CHA2DS2-VASC评分(HR值1.365,95%可信区间1.120-1.702,P<0.01)和NLR(HR值2.20,95%可信区间1.120-4.520,P<0.05)与ACS住院病死率相关。
        结论  NLR和 CHA2DS2-VASc评分具有判定ACS冠状动脉病变严重程度和住院期间MACE的预测价值,可用于PCI手术前评估及危险分层,确定相应的治疗方案,降低ACS患者PCI手术中无复流和住院MACE的发生。

       

      Abstract:
        AIM  To investigate whether the neutrophil-lyimphocytes ratio (NLR) and CHA2DS2-VASc score could be used to predict coronary atheroscerotic burden and major adverse cardiova scular events (MACE)in-hospital in patients treated with percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS).
        METHODS  Neutrophil-lyimphocytes ratio and CHA2DS2-VASc score were applied to consecutive 657 patients age (76±14)years presenting with ACS treated by PCI from January 2016 to January 2019 in the Hospital. There were 471 males and 186 females. The aim of the present study is to investigate whether NLR and CHA2DS2-VASc score could predict higher coronary atherosclerotic burden assessed by SYNTAX score (SS) and major adverse cardiova scular events (MACE) in-hospital in ACS. A total of patients who underwent coronary angiography were divided into 3ss tertiles stratified by SS:low (≤22)(n=332); intermediate (23 to 32)(n=230); and high (≥33)(n=95); The Baseline clinical data, laboratory examination, PCI related information, blood flow grades of thrombolysis in myocardial infarction trial (TIMI) of infract-related arteries (TRA) instant after PCI and MACE in-hospital was collected and analyzed. Independent risk factors of ACS after PCI were measured by univariate and multivariate regression analyses.
        RESULTS  After logistic analyses, risk factors associated with higher coronary atherosclerotic burden and major adverse cardiova scular events (MACE)in-hospital in ACS included smoking, NLR, chronic kidney disease and CHA2DS2-VASc评分 (P<0.01). In multivariate analyses, CHA2DS2-VASc score ≥3 (OR3.028, 95% CI1.627 to 5.517, P<0.01) and NLR ≥5.23 (OR2.901, 95% CI 1.260 to 5.370, P<0.01) were an independent predictor of high SS in ACS. The NLR (HR2.20, 95%CI1.120-4.520, P<0.05) and CHA2DS2-VASc score (HR1.365, 95%CI1.120-1.702, P<0.01) were an independent predictor for ACS with in-hospital MACE in multivariate Cox regression analysis.
        CONCLUSION  CHA2DS2-VASc and NLR, as a simply calculated and reliable score, are independently associated with high SS and MACE in-hospital in patients treated with percutaneous coronary intervention for ACS. Thus, this score provides an additional level of risk stratification regarding coronary atherosclerotic burden and prognosis beyond that provided by traditional risk factors. The reasonable treatment could reduce the incidence of no-reflow without increasing MACE in-hospital. Combination CHA2DS2-VASc Score and NLR are predictive prognostic value in patients presenting with ACS treated by PCI.

       

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