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目的探讨老老年高血压患者中性粒细胞/淋巴细胞(NLR)水平对近期非致死性心血管事件(NFCE)发生率的影响。方法采用前瞻性队列研究方法,选取2011年1月至2013年12月期间在解放军总医院老年心血管内科住院治疗的年龄≥80岁的男性高血压患者328例,根据入选对象入院时NLR的四分位数将患者分为4组(第1~4组),随访不同组研究对象入院后7、14、30、90d的NFCE发生情况并进行分析,通过多因素分析研究NLR与NFCE的关系。结果 90d随访结果显示,发生NFCE患者入院时NLR的水平明显高于不发生NFCE者[4.5(2.5,9.0)比2.9(1.9,5.6),P<0.05]。第1组~第4组NFCE发生率分别为8.5%、15.9%、18.3%和29.3%(χ~2=11.96,P=0.008),Kaplan-Meier风险累积分析结果显示,随着NLR水平增高,NFCE发生率明显增高。NLR水平预测NFCE的受试者工作特征(ROC)曲线下面积(AUC)为0.648(95%CI 0.574~0.723,P=0.001),截断界值点为NLR=2.16,敏感度88.3%,特异度47.1%。Cox回归分析显示NLR>2.16(HR=3.102,P=0.032)、C反应蛋白水平(HR=1.065,P=0.023)及入院时的呼吸频率(HR=1.044,P=0.032)是男性老老年高血压患者90dNFCE的独立危险因素。结论男性老老年高血压患者入院时NLR>2.16是90dNFCE的独立预测因子,监测NLR这个简单快捷的指标能够对高血压患者进行进行初步的危险性分层。
Objective To investigate the effect of neutrophil / lymphocyte (NLR) levels on the incidence of non-fatal cardiovascular events (NFCE) in elderly patients with hypertension. Methods A prospective cohort study was conducted to select 328 male hypertensive patients aged ≥ 80 years who were hospitalized in Department of Geriatric Cardiology, People’s Liberation Army General Hospital from January 2011 to December 2013. According to the four The patients were divided into 4 groups (groups 1 to 4). The incidence of NFCE at 7, 14, 30 and 90 days after admission was followed up and analyzed. The relationship between NLR and NFCE was studied by multivariate analysis. Results The 90-day follow-up results showed that the level of NLR on admission was significantly higher in patients with NFCE than in patients without NFCE [4.5 (2.5,9.0) vs 2.9 (1.9,5.6), P <0.05]. The incidences of NFCE in groups 1 to 4 were 8.5%, 15.9%, 18.3% and 29.3%, respectively (χ 2 = 11.96, P 0.008). The cumulative Kaplan-Meier risk analysis showed that as the level of NLR increased, The incidence of NFCE increased significantly. The area under the receiver operating characteristic (ROC) curve of NLR predicting NFCE was 0.648 (95% CI 0.574-0.723, P = 0.001). The cut-off point was NLR = 2.16, the sensitivity was 88.3% 47.1%. Cox regression analysis showed that the correlation between the level of C reactive protein (HR = 1.065, P = 0.023) and respiratory rate at hospital admission (HR = 1.044, P = 0.032) Blood pressure patients with 90 dNFCE independent risk factors. Conclusion NLR> 2.16 in male elderly patients with hypertension is an independent predictor of 90 dNFCE at admission. The simple and quick indicator of NLR monitoring can be used to carry out preliminary risk stratification in hypertensive patients.