OPCAB术前中性粒细胞与淋巴细胞比值和术后房颤的相关性研究

发布时间：2018-04-09 11:28

本文选题：中性粒细胞与淋巴细胞比值　切入点：术后房颤　出处：《河北大学》2015年硕士论文

【摘要】：目的心房颤动(下称房颤AF)是冠脉旁路移植术(CABG)后最常见的并发症之一,也是术后最常见的心律失常。房颤,尤其是快速房颤经常引起血流动力学紊乱,增加心肌耗氧量,减少心肌供血。中性粒细胞与淋巴细胞比值(NLR)是中性粒细胞计数和淋巴细胞计数的比值,是新的全身炎症指标。最新研究显示NLR比总白细胞计数及中性粒细胞计数对心血管疾病的预测性更强,有助于对各种心血管疾病病人进行危险分层。本文旨在观察不停跳冠脉旁路移植术(OPCAB)病人术前NLR水平及术后房颤发生情况,并探讨二者之间的关系。研究NLR是否对OPCAB术后房颤的发生有预测作用。方法选取2009年1月至2014年9月于河北大学附属医院及北京朝阳医院心外科行不停跳冠脉旁路移植术的病人502例,收集病人临床资料并对其进行回顾性分析。收集术前最后一次血常规结果,根据中性粒细胞、淋巴细胞计数计算中性粒细胞与淋巴细胞比值(NLR),根据术前NLR值将病人分为术前NLR低值组(NLR1.69 n=167)、术前NLR中值组(NLR1.69-2.62 n=167)、术前NLR高值组(NLR2.62 n=168)值组三组。记录一般临床资料、心脏超声结果、手术及术后资料、术后至出院期间心电图有无房颤发生。根据术后有无房颤发生分为两组。使用SPSS10.0统计软件包进行三组间、两组间各变量比较。通过受试者工作特征曲线(ROC曲线)评估因素对房颤的预测能力,二元logistic回归对房颤的相关因素进行分析。结果 502例病人符合纳入标准,纳入本研究。本研究502例患者平均年龄62.2±8.2岁(37-82岁);男性有378例(75.3%),女性有124例(24.7%)。术前NLR分布为0.63-20.53,中位数为2.15。男性较女性患者术前NLR明显增高(2.25,1.85,P0.01)。心梗患者较无心梗患者术前NLR明显增高(2.28,2.06,P0.01)。502例患者中共有113例(22.5%)发生房颤。术前NLR高值组房颤发生率35.7%(60例)较中17.4%(29例)、低14.4%(24例)值组明显升高(P0.01)。房颤组术前NLR(2.71)较无房颤组术前NLR(2.0)明显增高(P0.01)。经多因素分析,年龄、左房径、术前NLR(P均0.01)为独立于其他因素的房颤危险因素。年龄、左房径、术前NLR、三者联合的ROC曲线下面积分别为0.696、0.650、0.689、0.753(P均0.01),当年龄、左房径、术前NLR最佳界值分别取60.5、3.99、2.43时,预测房颤的敏感度分别为81.4%、51.3%、67.3%,特异度分别为48.6%、75.6%、68.1%。结论 1.年龄、左房径、术前NLR为独立于其他因素的房颤危险因素。2.年龄、左房径、术前NLR均对不停跳冠脉旁路移植术术后房颤发生的有一定的预测价值。
[Abstract]:Objective Atrial fibrillation (AFF) is one of the most common complications and arrhythmia after coronary artery bypass grafting (CABG).Atrial fibrillation, especially rapid atrial fibrillation, often causes hemodynamic disturbance, increases myocardial oxygen consumption and reduces myocardial blood supply.The ratio of neutrophil to lymphocyte (NLR) is the ratio of neutrophil count and lymphocyte count, and it is a new systemic inflammatory index.Recent studies have shown that NLR is more predictive of cardiovascular disease than total leukocyte count and neutrophil count, which is helpful for risk stratification of patients with various cardiovascular diseases.The purpose of this study was to observe the preoperative NLR level and the incidence of atrial fibrillation in patients with beating coronary artery bypass grafting (OPCAB) and to explore the relationship between them.To study whether NLR can predict the occurrence of atrial fibrillation after OPCAB.Methods from January 2009 to September 2014, 502 patients underwent coronary artery bypass grafting in cardiac surgery department of affiliated Hospital of Hebei University and Chaoyang Hospital in Beijing. The clinical data of the patients were collected and analyzed retrospectively.Collect the results of the last blood routine before operation, according to the neutrophil,Record general clinical data, results of echocardiography, operation and postoperative data, electrocardiogram between postoperative and discharge whether there is atrial fibrillation.The patients were divided into two groups according to the occurrence of atrial fibrillation after operation.The SPSS10.0 statistical software package was used to compare the variables between the three groups and the two groups.The predictive ability of factors to AF was evaluated by the operating characteristic curve (ROC curve), and the correlation factors of AF were analyzed by binary logistic regression.Results 502 patients met the inclusion criteria and were included in this study.The average age of 502 patients was 62.2 卤8.2 years old or 37-82 years old, 378 cases were male and 124 cases were female.Preoperative NLR distribution was 0.63-20.53, the median was 2.15.The preoperative NLR of male patients was significantly higher than that of female patients.NLR in patients with myocardial infarction was significantly higher than that in patients without myocardial infarction before operation. The incidence of atrial fibrillation was significantly higher in patients with myocardial infarction than in patients without myocardial infarction.The incidence of atrial fibrillation in the high NLR group (n = 60) was significantly higher than that in the middle value group (n = 29) and the lower value group (n = 24).NLRN 2.71) in AF group was significantly higher than that in non-AF group (P 0.01).By multivariate analysis, age, left atrial diameter and preoperative NLR(P were risk factors of AF independent of other factors.Conclusion 1.Age, left atrial diameter, preoperative NLR were risk factors of AF independent of other factors.Age, left atrial diameter, and preoperative NLR were all valuable predictors of atrial fibrillation after coronary artery bypass grafting.
【学位授予单位】：河北大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.2

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