中性粒细胞与淋巴细胞比值对非瓣膜病心房颤动患者射频消融围术期抗凝出血风险的预测价值

夏熠; 李道博; 王运松; 高睿媛; 董颖雪; 尹晓盟; 高连君; 夏云龙

doi:10.13201/j.issn.1001-1439.2020.01.012

中性粒细胞与淋巴细胞比值对非瓣膜病心房颤动患者射频消融围术期抗凝出血风险的预测价值

- 大连医科大学附属第一医院心内科(辽宁大连, 116000)

详细信息

通讯作者: 夏云龙,E-mail:yunlong_xia@126.com

中图分类号: R541.7

收稿日期: 2019-07-20

Predictive value of neutrophil-to-lymphocyte ratio on anticoagulation therapy bleeding events in the perioperative period of radiofrequency ablation in patients with nonvalvular atrial fibrillation

- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, 116000, China

More Information

Corresponding author: XIA Yunlong, E-mail: yunlong_xia@126.com

Received Date: 20 July 2019

摘要

摘要: 目的:探讨中性粒细胞与淋巴细胞比值(NLR)和非瓣膜病心房颤动(房颤)患者射频消融围术期抗凝出血风险的关系。方法:连续纳入491例非瓣膜病房颤患者,根据消融围术期抗凝方案分为华法林组278例和新型口服抗凝药组213例。并根据NLR中位数,分别将两组患者分为低NLR和高NLR亚组,记录两组患者围术期出血事件发生情况。结果:华法林组围术期出血事件24例,新型口服抗凝药组围术期出血事件16例。两组中高NLR患者的出血事件发生率均高于低NLR患者(P<0.05)。多因素Logistic回归分析显示,NLR在华法林组(OR=2.41,95%CI:1.32~4.43,P<0.05)和新型口服抗凝药组(OR=2.37,95%CI:1.03~5.42,P<0.05)均可独立预测出血事件的发生。NLR预测华法林组和新型口服抗凝药组出血事件发生的ROC曲线下面积分别为0.71(95%CI:0.59~0.83,P<0.05,临界点2.31)和0.73(95%CI:0.59~0.87,P<0.05,临界点1.88)。结论:非瓣膜病房颤患者射频消融围术期抗凝出血风险随着NLR增高而增加,NLR可成为预测非瓣膜病房颤消融围术期抗凝出血风险的独立危险因素。
- 中性粒细胞与淋巴细胞比值 /
- 非瓣膜病心房颤动 /
- 射频消融 /
- 华法林 /
- 新型口服抗凝药 /
- 药物安全性
Abstract: Objective:To investigate the relationship between neutrophil-to-lymphocyte ratio(NLR) and anticoagulation therapy bleeding events in the perioperative period of radiofrequency ablation in patients with nonvalvular atrial fibrillation(NVAF).Method:A total of 491 consecutive NVAF patients were enrolled in this study.Patients were divided into warfarin group(n=278) and non-vitamin K antagonist oral anticoagulants(NOACs) group(n=213) according to anticoagulation therapy in the perioperative period,and the two groups of patients were divided into low NLR and high NLR according to the median NLR.The occurrence of bleeding events in the perioperative period of radiofrequency ablation was recorded.Result:During perioperative period,24 cases of bleeding events occurred in warfarin group and 16 cases of bleeding events occurred in NOACs group.The incidence of bleeding events was higher in the two groups of patients with high NLR than in patients with low NLR(P＜0.05).Multivariate Logistic regression analysis showed that NLR can independently predict the occurrence of bleeding events in warfarin group(OR=2.41,95%CI:1.32~4.43,P＜0.05) and NOACs group(OR=2.37,95%CI:1.03~5.42,P＜0.05).The area under the ROC curve for NLR to predict the occurrence of bleeding events in warfarin group and NOACs group was 0.71(95%CI:0.59~0.83,P＜0.05,cutoff point 2.31) and 0.73(95%CI:0.59~0.87,P＜0.05,cutoff point 1.88),respectively.Conclusion:The occurrence of anticoagulation therapy bleeding events in the perioperative period of radiofrequency ablation in patients with NVAF increases with the increase of NLR,and NLR can be an independent predictor for bleeding events during perioperative period.
- neutrophil-to-lymphocyte ratio /
- nonvalvular atrial fibrillation /
- radiofrequency ablation /
- warfarin /
- non-vitamin K antagonist oral anticoagulants /
- drug safety

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参考文献(17)

[1]	周自强,胡大一,陈捷,等.中国心房颤动现状的流行病学研究[J].中华内科杂志,2004,11(7):15-18.
[2]	Wolf PA,Abbott RD,Kannel WB.Atrial fibrillation as an independent risk factor for stroke:the Framingham Study[J].Stroke,1991,22(8):983-988.
[3]	Calkins H,Hindricks G,Cappato R,et al.2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation[J].Heart Rhythm,2017,14(10):e275-e444.
[4]	Doherty JU,Gluckman TJ,Hucker WJ,et al.2017 ACC expert consensus decision pathway for periprocedural management of anticoagulation in patients with nonvalvular atrial fibrillation:a report of the American College of Cardiology Clinical Expert Consensus Document Task Force[J].J Am Coll Cardiol,2017,69(7):871-898.
[5]	Guo X,Zhang S,Yan X,et al.Postablation neutrophil/lymphocyte ratio correlates with arrhythmia recurrence after catheter ablation of lone atrial fibrillation[J].Chin Med J (Engl),2014,127(6):1033-1038.
[6]	张志鹏,高连君,张树龙,等.中性粒细胞与淋巴细胞比值对孤立性心房颤动射频消融术后复发的预测价值[J].临床心血管病杂志,2017,33(3):246-250.
[7]	Ertaş G,Sönmez O,Turfan M,et al.Neutrophil/lymphocyte ratio is associated with thromboembolic stroke in patients with non-valvular atrial fibrillation[J].J Neurol Sci,2013,324(1-2):49-52.
[8]	Flegel KM,Shipley MJ,Rose G.Risk of stroke in non-rheumatic atrial fibrillation[J].Lancet,1987,1(8532):526-529.
[9]	Camm AJ,Lip GY,De Caterina R,et al.2012 focused update of the ESC Guidelines for the management of atrial fibrillation:an update of the 2010 ESC Guidelines for the management of atrial fibrillation--developed with the special contribution of the European Heart Rhythm Association[J].Europace,2012,14(10):1385-1413.
[10]	Viles-Gonzalez JF,Mehta D.Thromboembolic risk and anticoagulation strategies in patients undergoing catheter ablation for atrial fibrillation[J].Curr Cardiol Rep,2011,13(1):38-42.
[11]	Cappato R,Calkins H,Chen SA,et al.Updated worldwide survey on the methods,efficacy,and safety of catheter ablation for human atrial fibrillation[J].Circ Arrhythm Electrophysiol,2010,3(1):32-38.
[12]	关静,王松涛,常瑜,等.不同口服抗凝药物对非瓣膜病心房颤动患者生活质量的影响[J].临床心血管病杂志,2018,34(11):1069-1072.
[13]	Afari ME,Bhat T.Neutrophil to lymphocyte ratio (NLR) and cardiovascular diseases:an update[J].Expert Rev Cardiovasc Ther,2016,14(5):573-577.
[14]	黄涛,曾恋,冉旋,等.中性粒细胞淋巴细胞比值与急性冠脉综合征患者住院死亡风险的相关性分析[J].临床心血管病杂志,2019,35(7):600-603.
[15]	Yoshida R,Ishii H,Morishima I,et al.Impact of nutritional and inflammation status on long-term bleeding in patients undergoing percutaneous coronary intervention with an oral anticoagulant[J].J Atheroscler Thromb,2019,26(8):728-737.
[16]	Campbell CL,Steinhubl SR,Hooper WC,et al.Bleeding events are associated with an increase in markers of inflammation in acute coronary syndromes:an ACUITY trial substudy[J].J Thromb Thrombolysis,2011,31(2):139-145.
[17]	Ho-Tin-Noé B,Boulaftali Y,Camerer E.Platelets and vascular integrity:how platelets prevent bleeding in inflammation[J].Blood,2018,131(3):277-288.