摘要
目的评估中性粒细胞与淋巴细胞比值(NLR)是否可以作为感染新型冠状病毒(COVID-19)住院患者心肌损伤的预测指标。方法连续选取141例确诊的感染COVID-19住院患者,依据肌钙蛋白是否升高分为心肌损伤组(21例)和非心肌损伤组(120例)。收集患者临床、实验室检查等资料,通过多元Logistic回归模型评估感染COVID-19住院患者心肌损伤的危险因素,绘制受试者工作特征曲线(ROC),评估COVID-19感染患者预后的独立预测因子。结果本研究最终共入选141例COVID-19感染患者,男75例(53.2%);平均年龄(56.1±17.8)岁;发生心肌损伤21例(14.9%),构成心肌损伤组,其余120例(85.1%)构成非心肌损伤组。心肌损伤组患者年龄(70.6±19.7)岁显著高于非心肌损伤组的(53.5±16.3)岁,差异有统计学意义(P<0.05)。心肌损伤组白细胞计数为8.45(4.96,11.96)×10^(9)/L、中性粒细胞计数为6.95(5.03,9.20)×10^(9)/L、NLR为6.38(5.12,8.33)、C反应蛋白(CRP)水平为63.7(21.6,98.5)mg/L、脑钠肽(BNP)水平为786.8(302.1,1238.4)pg/ml、肌酸激酶(CK)水平为122.7(105.8,135.1)mmol/L、肌酸激酶同工酶(CK-MB)水平为54.3(50.2,80.1)mmol/L、肾小球滤过率(GFR)<60 ml/min比例为14.3%,显著高于非心肌损伤组的4.76(3.66,6.37)×10^(9)/L、3.88(2.65,5.37)×10^(9)/L、2.08(1.25,3.25)、31.5(12.2,71.2)mg/L、343.7(279.7,408.3)pg/ml、25.6(11.1,37.7)mmol/L、16.3(9.7,21.4)mmol/L、1.7%,血红蛋白水平(116.1±2.5)g/L显著低于非心肌损伤组的(120.4±2.7)g/L,差异有统计学意义(P<0.05)。两组患者性别、糖尿病、高血压、高血脂、吸烟及既往脑血管疾病(CVD)、Ⅰ型呼吸衰竭、Ⅱ型呼吸衰竭比例比较,差异无统计学意义(P>0.05)。两组患者肌酐、淋巴细胞计数、血小板计数、甘油三酯(TC)、总胆固醇(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平比较,差异无统计学意义(P>0.05)。两组患者使用血管紧张素Ⅱ受体拮抗剂(ARB)、二氢吡啶类钙通道阻滞剂(CCB)、β受体阻滞剂、他汀、利尿药、阿司匹林、抗病毒药比例比较差异无统计学意义(P>0.05)。心肌损伤组重症肺炎和死亡率比例高于非心肌损伤组,但差异无统计学意义(P>0.05)。通过多元Logistic回归模型评估NLR与心肌损伤的关系,结果显示,年龄、NLR、CRP和BNP是COVID-19感染患者心肌损伤的独立预测因子。进一步通过ROC曲线显示,NLR对COVID-19感染患者心肌损伤具有良好预测效能[ROC曲线下面积(AUC)为0.756,95%CI=(1.238,14.345)]。结论心肌损伤在COVID-19感染患者中并不少见,提示不良预后。NLR有望作为评估COVID-19住院患者心肌损伤简单易行的预测因子。
Objective To evaluate whether neutrophil-to-lymphocyte ratio(NLR)can be used as a predictor of myocardial injury in hospitalized patients with Corona Virus Disease 2019(COVID-19)infection.Methods A total of 141 hospitalized patients diagnosed with COVID-19 infection were divided into myocardial injury group(21 cases)and non-myocardial injury group(120 cases)according to whether troponin was elevated.The clinical and laboratory data of the patients were collected,and risk factors for myocardial injury in hospitalized patients with COVID-19 infection were evaluated by multivariate Logistic regression models,and the receiving operating characteristic curves(ROCs)were drawn to assess independent predictors of prognosis of patients with COVID-19 infection.Results A total of 141 patients with COVID-19 infection were finally enrolled in this study,75 cases(53.2%)were male;the mean age was(56.1±17.8)years;21 cases(14.9%)had myocardial injury and were included as the myocardial injury group,and the remaining 120 cases(85.1%)were included in the non-myocardial injury group.The age of patients in the myocardial injury group was(70.6±19.7)years,which was significantly higher than(53.5±16.3)years in the non-myocardial injury group,and the difference was statistically significant(P<0.05).In the myocardial injury group,the leukocyte count was 8.45(4.96,11.96)×10^(9)/L,neutrophil count was 6.95(5.03,9.20)×10^(9)/L,NLR was 6.38(5.12,8.33),C-reactive protein(CRP)level was 63.7(21.6,98.5)mg/L,brain natriuretic peptide(BNP)level was 786.8(302.1,1238.4)pg/ml,creatine kinase(CK)level was 122.7(105.8,135.1)mmol/L,creatine kinase isoenzyme(CK-MB)level was 54.3(50.2,80.1)mmol/L and the proportion of estimated glomerular filtration rate(GFR)<60 ml/min was 14.3%,which were significantly higher than(4.76(3.66,6.37)×10^(9)/L,3.88(2.65,5.37)×10^(9)/L,2.08(1.25,3.25),31.5(12.2,71.2)mg/L,343.7(279.7,408.3)pg/ml,25.6(11.1,37.7)mmol/L,16.3(9.7,21.4)mmol/L,1.7%in non-myocardial injury group;the hemoglobin level of myocardial injury group was(116.1±2.5)g/L,which was significantly lower than(120.4±2.7)g/L of non-myocardial injury group;the differences were statistically significant(P<0.05).There was no statistically significant difference between the two groups in the comparison of gender,proportions of diabetes mellitus,hypertension,hyperlipidemia,smoking,previous cerebrovascular disease(CVD),typeⅠrespiratory failure and typeⅡrespiratory failure(P>0.05).There was no statistically significant difference between the two groups in the comparison of creatinine,lymphocyte count,platelet count,triglyceride(TC),total cholesterol(TG),low density lipoprotein cholesterol(LDL-C)and high density lipoprotein cholesterol(HDL-C)levels(P>0.05).There was no statistically significant difference between the two groups in the proportions of angiotensinⅡreceptor blockers(ARBs),dihydropyridine calcium channel blockers(CCBS),β-blockers,statins,diuretics,aspirin and antiviral drugs(P>0.05).The proportion of severe pneumonia and mortality in myocardial injury group was higher than that in non-myocardial injury group,but the difference was not statistically significant(P>0.05).The correlation between NLR and myocardial injury was assessed by multivariate Logistic regression model,which showed that age,NLR,CRP and BNP were independent predictors of myocardial injury in patients with COVID-19 infection.It was further shown by ROC curves that NLR had good predictive efficacy for myocardial injury in patients with COVID-19 infection[area under the curve(AUC)of 0.756,95%CI=(1.238,14.345)].Conclusion Myocardial injury is common in COVID-19 infection patients,suggesting a poor prognosis.NLR might act as a simple and facile predictor for assessing myocardial injury in COVID-19 patients.
作者
纪荣庄
雷元国
张艳芳
李斌
李克乐
刘阳阳
JI Rong-zhuang;LEI Yuan-guo;ZHANG Yan-fang(Department of Cardiology,Zhongshan Huangpu People's Hospital,Zhongshan 528429,China)
出处
《中国实用医药》
2023年第5期11-15,共5页
China Practical Medicine
基金
2020年度中山市第一批社会公益与基础研究项目(医疗卫生)(项目编号:2020B1009)。
