中性粒细胞与淋巴细胞比值对急性ST段抬高型心肌梗死患者PCI术后发生造影剂肾病的预测价值-东南大学学报医学版

中性粒细胞与淋巴细胞比值对急性ST段抬高型心肌梗死患者PCI术后发生造影剂肾病的预测价值

单位：1. 合肥市第二人民医院心内科, 安徽合肥 230001;
2. 东南大学附属中大医院心内科, 江苏南京 210009

分类号：R541.4;R692

出版年·卷·期（页码）：2020·39·第四期（413-419）

摘要：

目的：探讨中性粒细胞与淋巴细胞比值（NLR）对急性ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗（PCI）术后发生造影剂肾病（CIN）的预测价值。方法：连续入选2013年12月至2019年6月于合肥市第二人民医院接受PCI的STEMI患者396例，观察患者的临床特点，记录NLR、术前和术后2~3 d的血肌酐水平及其他生化指标、冠脉病变程度及心脏彩超结果。根据NLR水平按照三分位法将患者分为3组：组1 132例（NLR≤3.51），组2 132例（3.52≤NLR≤7.21），组3 132例（NLR≥7.22）。结果：STEMI患者PCI术后CIN发生情况：组1发生15例（11.4%），组2发生22例（16.7%），组3发生30例（22.7%）；3组患者PCI术后CIN发生率随NLR水平的增高而增高（P<0.05）。多因素Logistic回归分析显示，在校正其他因素后，NLR、年龄、糖尿病、贫血是STEMI患者PCI术后发生CIN的独立预测因子。NLR预测STEMI患者PCI术后CIN的曲线下面积（AUC）为0.723（95% CI 0.632~0.814，P<0.05）。结论：NLR是有效识别STEMI患者PCI术后发生CIN的早期生物标志物，且CIN发生率随NLR水平的增高而增高。年龄、糖尿病、贫血是STEMI患者PCI术后发生CIN的危险因素。

Objective: To explore the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) for the occurrence of contrast-induced nephropathy (CIN) in acute ST-elevation myocardial infarction (STEMI) patients after percutaneous coronary intervention (PCI). Methods: This study included 396 patients with STEMI who received PCI at the Second People's Hospital of Hefei from December 2013 to June 2019. The clinical characteristics of the patients, NLR, serum creatinine concentration (SCr) before and 2 to 3 days after contrast media exposure and other biochemical indicators, the severity of coronary artery disease, and ultrasonic cardiogram results were recorded. The patients were divided into 3 groups according to NLR level, Group1 (n=132, NLR ≤ 3.51), Group2 (n=132, 3.52 ≤ NLR ≤ 7.21) and Group3 (n=132,NLR ≥ 7.22). Results: The incidence of CIN in STEMI patients after PCI were 11.4% in Group1(n=15), 16.7% in Group2(n=22) and 22.7% in Group3(n=30), respectively. The incidence of CIN in the 3 groups increased with the increase of NLR level (P<0.05). Multiple Logistic regression analysis showed that NLR, age, diabetes, and anemia were independent predictors of CIN in STEMI patients after PCI. The AUC of NLR predicted the incidence of CIN in STEMI patients after PCI was 0.723 (95% CI 0.632-0.814,P<0.05). Conclusion: NLR is an early biomarker for identifying CIN in STEMI patients after PCI and the incidence of CIN increased with the increase of NLR level. Age, diabetes, and anemia are risk factors for CIN after PCI in STEMI patients.

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