标题：NLR与PLR联合检测对急性ST段抬高型心肌梗死后发生心力衰竭的预测价值

      作者：冯彩玲 1，李利军 2，李正卿 1    1.神木市医院心血管内科，陕西 榆林 719300；2.神木市职业技术教育中心医学系，陕西 榆林 719300

      卷次： 2020年31卷24期

      【摘要】 目的 探讨中性粒细胞计数与淋巴细胞计数比值(NLR)与血小板计数与淋巴细胞计数比值(PLR)联合检测对急性ST段抬高型心肌梗死(STEMI)后发生心力衰竭的预测价值。方法 回顾性分析2015年1月1日至2017年12月30日于神木市医院住院的218例STEMI患者的临床资料，根据是否合并心力衰竭分为心力衰竭组61例和非心力衰竭组157例。采用Pearson相关性分析NLR、PLR与氨基末端脑钠肽前体(NT-proBNP)的相关性；通过受试者工作特征曲线(ROC)分析NLR、PLR以及两者联合检测预测STEMI后发生心力衰竭的曲线下面积、敏感度、特异度、Cut-off值；采用多因素Logistic回归模型分析STEMI患者发生心力衰竭的影响因素。结果 心力衰竭组与非心力衰竭组患者的年龄、既往高血压病史、淋巴细胞计数(L)、血小板计数(PLT)、NLR、PLR、NT-proBNP等指标比较差异均有统计学意义(P<0.05)；Pearson相关性分析结果显示，NLR、PLR与NT-proBNP呈正相关(r=0.51、0.96，P<0.05)；ROC分析结果显示，NLR预测STEMI发生心力衰竭的曲线下面积(AUC)为0.762，敏感度为91.8%，特异度为 58%，Cut-off值为 4.07；PLR预测 STEMI发生心力衰竭的 AUC为 0.728，敏感度为 73.8%，特异度为 63.7%，Cut-off值为 130.15；NLR联合PLR预测STEMI发生心力衰竭的AUC为 0.773，敏感度为 93.4%，特异度为 58.6%，Cut-off值为 1.30；多因素 Logistic回归分析发现，NLR、PLR、PLT是 STEMI患者发生心力衰竭的独立预测因子(P<0.05)。结论 NLR、PLR与STEMI后发生心力衰竭相关，NLR、PLR值越高，STEMI后心力衰竭发生率越高；NLR、PLR、PLT是STEMI患者发生心力衰竭的独立预测因子；同时发现 NLR、PLR两者联合检测对STEMI发生心力衰竭的预测价值可能更高。
      【关键词】 中性粒细胞计数/淋巴细胞计数比值；血小板计数/淋巴细胞计数比值；急性ST段抬高型心肌梗死；心力衰竭
      【中图分类号】 R542.2+2 【文献标识码】 A 【文章编号】 1003—6350（2020）24—3141—04

Predictive value of the combined detection of NLR and PLR for heart failure after ST elevation myocardialinfarction.
FENG Cai-ling 1, LI Li-jun 2, LI Zheng-qing 1. 1. Department of Cardiovascular Medicine, Shenmu Hospital,Yulin 719300, Shaanxi, CHINA; 2. Department of Medicine, Shenmu Vocational and Technical Education Center, Yulin719300, Shaanxi, CHINA
【Abstract】 Objective To explore the predictive value of the combined detection of neutrophil-lymphocyte ra-tio (NLR) and platelet-lymphocyte ratio (PLR) for heart failure after ST elevation myocardial infarction (STEMI).Methods A total of 218 patients with STEMI, who admitted to Shenmu Hospital from January 1, 2015 to December30, 2017, were retrospectively analyzed. According to whether or not heart failure occurred, they were divided into heartfailure group (n=61) and non-heart failure group (n=157). Pearson correlation analysis was used to analyze the correla-tion between NLR, PLR and amino-terminal pro-brain natriuretic peptide (NT-pro-BNP); the area under curve, sensitivi-ty, specificity, and cut-off point of PLR was determined by ROC curve. Multivariate logistic regression model was usedto analyze the influencing factors of heart failure in STEMI patients. Results There were significant differences in age,history of hypertension, lymphocyte count (L), platelet count (PLT), NLR, PLR, NT-proBNP between the two groups(all P<0.05). Pearson correlation analysis showed that NLR and PLR were positively correlated with NT-proBNP (corre-lation coefficients were 0.51, 0.96, P<0.05). ROC curve analysis showed that the AUC of NLR was 0.762, the sensitivitywas 91.8%, the specificity was 58%, and the cut off value was 4.07; the AUC of PLR was 0.728, the sensitivity was73.8%, the specificity was 63.7%, and the cut-off value was 130.15; the AUC of NLR combined with PLR was 0.773,the sensitivity was 93.4%, and the specificity was 58.6%, the cut-off value was 1.30. Multivariate logistic regressionanalysis showed NLR, PLR, PLT were independent predictors of heart failure after STEMI patients. Conclusion NLRand PLR are associated with heart failure after STEMI. The higher the NLR, PLR value, the higher the incidence of heartfailure after STEMI. NLR, PLR, PLT are independent predictors of heart failure after STEMI. At the same time, it isfound that the combination of NLR and PLR may have a higher predictive value for the occurrence of heart failure inSTEMI.
      【Key words】 Neutrophil count/lymphocyte count ratio (NLR); Platelet count/lymphocyte count ratio (PLR); STelevation myocardial infarction (STEMI); Heart failure