發(fā)布時(shí)間：2018-04-09 11:28

  本文選題：中性粒細(xì)胞與淋巴細(xì)胞比值　切入點(diǎn)：術(shù)后房顫　出處：《河北大學(xué)》2015年碩士論文

【摘要】：目的 心房顫動(dòng)(下稱房顫AF)是冠脈旁路移植術(shù)(CABG)后最常見的并發(fā)癥之一,也是術(shù)后最常見的心律失常。房顫,尤其是快速房顫經(jīng)常引起血流動(dòng)力學(xué)紊亂,增加心肌耗氧量,減少心肌供血。中性粒細(xì)胞與淋巴細(xì)胞比值(NLR)是中性粒細(xì)胞計(jì)數(shù)和淋巴細(xì)胞計(jì)數(shù)的比值,是新的全身炎癥指標(biāo)。最新研究顯示NLR比總白細(xì)胞計(jì)數(shù)及中性粒細(xì)胞計(jì)數(shù)對(duì)心血管疾病的預(yù)測(cè)性更強(qiáng),有助于對(duì)各種心血管疾病病人進(jìn)行危險(xiǎn)分層。本文旨在觀察不停跳冠脈旁路移植術(shù)(OPCAB)病人術(shù)前NLR水平及術(shù)后房顫發(fā)生情況,并探討二者之間的關(guān)系。研究NLR是否對(duì)OPCAB術(shù)后房顫的發(fā)生有預(yù)測(cè)作用。方法 選取2009年1月至2014年9月于河北大學(xué)附屬醫(yī)院及北京朝陽醫(yī)院心外科行不停跳冠脈旁路移植術(shù)的病人502例,收集病人臨床資料并對(duì)其進(jìn)行回顧性分析。收集術(shù)前最后一次血常規(guī)結(jié)果,根據(jù)中性粒細(xì)胞、淋巴細(xì)胞計(jì)數(shù)計(jì)算中性粒細(xì)胞與淋巴細(xì)胞比值(NLR),根據(jù)術(shù)前NLR值將病人分為術(shù)前NLR低值組(NLR1.69 n=167)、術(shù)前NLR中值組(NLR1.69-2.62 n=167)、術(shù)前NLR高值組(NLR2.62 n=168)值組三組。記錄一般臨床資料、心臟超聲結(jié)果、手術(shù)及術(shù)后資料、術(shù)后至出院期間心電圖有無房顫發(fā)生。根據(jù)術(shù)后有無房顫發(fā)生分為兩組。使用SPSS10.0統(tǒng)計(jì)軟件包進(jìn)行三組間、兩組間各變量比較。通過受試者工作特征曲線(ROC曲線)評(píng)估因素對(duì)房顫的預(yù)測(cè)能力,二元logistic回歸對(duì)房顫的相關(guān)因素進(jìn)行分析。結(jié)果 502例病人符合納入標(biāo)準(zhǔn),納入本研究。本研究502例患者平均年齡62.2±8.2歲(37-82歲);男性有378例(75.3%),女性有124例(24.7%)。術(shù)前NLR分布為0.63-20.53,中位數(shù)為2.15。男性較女性患者術(shù)前NLR明顯增高(2.25,1.85,P0.01)。心梗患者較無心�；颊咝g(shù)前NLR明顯增高(2.28,2.06,P0.01)。502例患者中共有113例(22.5%)發(fā)生房顫。術(shù)前NLR高值組房顫發(fā)生率35.7%(60例)較中17.4%(29例)、低14.4%(24例)值組明顯升高(P0.01)。房顫組術(shù)前NLR(2.71)較無房顫組術(shù)前NLR(2.0)明顯增高(P0.01)。經(jīng)多因素分析,年齡、左房徑、術(shù)前NLR(P均0.01)為獨(dú)立于其他因素的房顫危險(xiǎn)因素。年齡、左房徑、術(shù)前NLR、三者聯(lián)合的ROC曲線下面積分別為0.696、0.650、0.689、0.753(P均0.01),當(dāng)年齡、左房徑、術(shù)前NLR最佳界值分別取60.5、3.99、2.43時(shí),預(yù)測(cè)房顫的敏感度分別為81.4%、51.3%、67.3%,特異度分別為48.6%、75.6%、68.1%。結(jié)論 1.年齡、左房徑、術(shù)前NLR為獨(dú)立于其他因素的房顫危險(xiǎn)因素。2.年齡、左房徑、術(shù)前NLR均對(duì)不停跳冠脈旁路移植術(shù)術(shù)后房顫發(fā)生的有一定的預(yù)測(cè)價(jià)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 鹵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.
【學(xué)位授予單位】：河北大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R654.2

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