老年重症心力衰竭早期血小板和淋巴细胞比值与近期主要不良心脑血管事件的相关性分析

doi:10.3969/j.issn.1002-1949.2018.01.008

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摘要目的: 探讨老年重症心力衰竭早期血小板和淋巴细胞比值(PLR)与近期主要不良心脑血管事件(MACCE)的相关性。方法: 选取2014-10~2016-10我院收治的170例老年重症心力衰竭(HF)患者为研究对象，按照随访出院后6个月内是否发生MACCE分为MACCE组(n=60)及非MACCE组(n=110)，收集两组一般临床资料、入院时和出院时PLR，比较两组相关指标的差异，并采用Logistic回归方程分析PLR与MACCE的关系，ROC曲线分析PLR 预测MACCE的价值。结果: MACCE组房颤病史比例、收缩压(SBP)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、B型脑钠肽(BNP)、C反应蛋白(CRP)高于非MACCE组，左室射血分数(LVEF)低于非MACCE组，差异有统计学意义(P均＜0.05)； MACCE组入院时、出院时血小板计数(PLT)、PLR均高于非MACCE组，而淋巴细胞计数均低于非MACCE组，差异有统计学意义(P均＜0.05)；分别按照入院、出院时PLR水平四分位分组比较，从A1到A4组、从B1到B4组MACCE总发生率逐渐升高，四组总发生率差异有统计学意义(χ2分别为29.214、33.435，P＜0.001)；Pearson相关分析显示，入院时、出院时PLR与BNP、CRP呈正相关(P均＜0.05)，而与LVEF呈负相关(P均＜0.05)；Logistic回归分析亦显示，PLR是老年重症HF患者近期发生MACCE的独立危险因素(入院时PLR：OR=2.421，95%CI 1.520～3.476，P＜0.05；出院时PLR：OR=2.085，95%CI 1.494～3.485，P＜0.05)。ROC 曲线分析显示，入院时PLR预测MACCE的曲线下面积(AUC)为0.840，最佳的诊断截点值为132.58，敏感度和特异度分别为89.8%和 62.8%。而出院PLR预测的AUC为0.812，最佳的诊断截点值为116.45，敏感度和特异度分别为84.6%和57.9%。结论：高水平PLR可能是老年重症HF患者近期发生MACCE的独立危险因素，具有一定的临床预测价值，且入院时的预测价值略高于出院时，临床应当密切监测PLR的变化，以早期评估患者的预后。

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	黄宗银

收稿日期: 2017-08-07

作者简介: 黄宗银（1966-），男，急诊科主任，E-mail：cshzy66@sina.cn。

引用本文:

黄宗银. 老年重症心力衰竭早期血小板和淋巴细胞比值与近期主要不良心脑血管事件的相关性分析[J]. 中国急救医学, 2018, 38(1): 31-36.
Huang Zong-yin. Correlation analysis of platelet-to-lymphocyte ratio and recent major adverse cardiac and cerebrovascular events in patients with severe heart failure. Chinese Journal of Critical Care Medicine, 2018, 38(1): 31-36.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2018.01.008 或 http://www.cnemergency.org.cn/CN/Y2018/V38/I1/31

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