中性粒细胞与淋巴细胞比值对介入治疗后急性心肌梗死患者预后的影响

吕常智辽宁省丹东市第一医院心血管内科，辽宁丹东　118000

论著

中性粒细胞与淋巴细胞比值对介入治疗后急性心肌梗死患者预后的影响

吕常智
辽宁省丹东市第一医院心血管内科，辽宁丹东118000

目的 探讨中性粒细胞与淋巴细胞比值（neutrophil and lymphocyte ratio，NLR）对经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）后急性ST段抬高型心肌梗死（acute ST segment elevation myocardial infarction，STEMI）患者预后的影响。方法 选取2009年1月~2014年11月急性ST段抬高型心肌梗死行急诊PCI的患者300例，依据入院时NLR值将其分为两组（A组NLR>3.30，B组NLR≤3.30），对两组患者心功能相关指标（NT-ProBNP水平、射血分数）、ST段回落情况、心肌酶学指标、室性心律失常及住院期间主要心血管事件（major cardiovascular events，MACE）发生情况进行比较。结果 与NLR>3.30患者相比，NLR≤3.30患者PCI术后心电图ST段在术后早期即明显回落，术中及术后恶性室性心律失常的发生率明显降低（P<0.05）。术后12 h内CK-MB水平较NLR>3.30组明显降低（P<0.05）。NLR≤3.30患者心功能恢复情况较好（P<0.05）。结论 中性粒细胞与淋巴细胞比值对PCI术后急性ST段抬高型心肌梗死患者的病情评估及预后判断有重要指导意义。

中性粒细胞与淋巴细胞比值；心肌梗死；PCI治疗；预后

[Abstract]Objective To investigate the effects of neutrophil and lymphocyte ratio(NLR)on the prognosis of patients with acute ST segment elevation myocardial infarction(SETMI)after percutaneous coronary intervention(PCI).Methods all 300 patients with SETMI who received PCI from January 2009 to November 2014 were selected and divided into two groups based on the NLR upon admission(group A:NLR>3.30;group B:NLR≤3.30).The cardiac function indexes(NT-ProBNP level,ejection fraction),ST segment resolution,myocardial zymetology,ventricular arrhythmias and major cardiovascular events(MACE)during hospitalization of the patients from both groups were compared.Results Compared to patients with NLR>3.30,obvious ST segment resolution were shown in the patients with NLR≤3.30 soon after the PCI and the incidence rate of malignant ventricular arrhythmias during and after the PCI was decreased significantly (P<0.05).The CK-MB level within 12 hours after PCI of patients with NLR≤3.30 was decreased significantly compared with patients with NLR>3.30(P<0.05).The recovery of cardiac function of patients with NLR≤3.30 was better (P<0.05).Conclusion NLR has important guiding significance on the disease evaluation and prognosis of patients with SETMI after PCI.

[Key words]Neutrophil and lymphocyte ratio;Myocardial infarction;PCI;Prognosis

急性心肌梗死是在冠状动脉粥样硬化病变的基础上，不稳定斑块破裂或糜烂，导致冠状动脉内血栓形成，受此血管供血的心肌细胞发生急性缺血坏死。研究表明，在动脉粥样硬化的发生和发展中，炎症反应起着关键性作用，炎症细胞活化及炎症反应加强可导致动脉硬化斑块进展、斑块破裂，进而导致临床缺血事件的发生[1，2]。近年研究认为，中性粒细胞与淋巴细胞比值是能稳定反映机体炎症状态的指标[3]。本研究旨在通过观察急性ST段抬高型心肌梗死患者急诊PCI治疗前后NT-ProBNP水平、射血分数、心电图ST段回落幅度、心肌酶变化、心律失常及主要心血管事件发生情况，评估NLR与STEMI患者PCI术后近期预后的相关性。