已有多项研究表明，中性粒细胞与淋巴细胞比值（NLR）是一个反映机体炎症状态的指标，与多种疾病（如恶性肿瘤、感染性疾病）的预后密切相关。

在心血管疾病领域，越来越多的研究表明NLR与心血管事件的发生风险以及预后有关。比如有研究表明急性心肌梗死患者NLR越高，预后越差。近期Am J Cardiol刊登的一篇来自克利夫兰诊所的文章指出：在进展期心力衰竭患者中，NLR越高，患者预后越差。

该研究从电子病历库中提取527例进展期心力衰竭患者的临床资料，这些患者均于2007年至2010年期间求治于克利夫兰诊所。同时，研究者还通过社保信息系统对研究人群进行了随访，随访截止至2012年（平均随访时间近1年）。随访期间，共有121例患者接受了心脏移植，158例患者死亡。

统计分析结果表明：在校正了年龄、BNP、肾功能等近二十个传统的心力衰竭预后因子后，患者的基线NLR仍然与心衰患者的全因死亡率密切相关，NLR大于5.4的患者，发生死亡的风险是NLR小于3的患者的2.16倍。

NLR是血常规指标，具有廉价、客观的优点，其之所以能反映心力衰竭病人预后，可能与以下因素有关：中性粒细胞反映机体的炎症状态，炎症反应越剧烈，中性粒细胞计数越高；淋巴细胞计数则反映机体的应激状况，机体的应激反应程度越剧烈，淋巴细胞计数越低。

另一方面，以往的研究表明炎症反应与应激状态均与心力衰竭的预后密切相关。NLR这一指标融合了机体炎症反应和应激状态，因而能较好地反映心力衰竭的预后。

美捷登编辑：晋川

原文摘要：

Usefulnessof Neutrophil-to-Lymphocyte Ratio in Risk Stratification of Patients WithAdvanced Heart Failure

The American Journal of Cardiology. 2015,115(1):57–61

Elevated neutrophil-to-lymphocyte ratio(NLR) has been associated with increasedmortality in patients with acute heart failure (HF) and neoplastic diseases. Weinvestigated the association between NLR and mortality or cardiactransplantation in a retrospective cohort of 527 patients presented to theCleveland Clinic for evaluation of advanced HF therapy options from 2007 to2010. Patients were divided according to low, intermediate, and high tertilesof NLR and were followed longitudinally for time to all-cause mortality orheart transplantation (primary outcome). The median NLR was 3.9 (interquartilerange 2.5 to 6.5). In univariate analysis, intermediate and highest tertiles ofNLR had a higher risk than the lowest tertile for the primary outcome andall-causes mortality. Compared with the lowest tertile, there was no differencein the risk of heart transplantation for intermediate and high tertiles. Inmultivariate analysis, compared with the lowest tertile, the intermediate andhigh NLR tertiles remained significantly associated with the primary outcome(hazard ratio [HR] = 1.61, 95% confidence interval [CI] 1.10 to 2.37 and HR =1.55, 95% CI 1.02 to 2.36, respectively) and all-cause mortality (HR = 1.83,95% CI 1.07 to 3.14 and HR = 2.16, 95% CI 1.21 to 3.83, respectively). Inconclusion, elevated NLR is associated with increased mortality or hearttransplantation risk in patients with advanced HF.

原文链接：http://www.sciencedirect.com/science/article/pii/S0002914914019298

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