The Relationship Among Hypersensitive C-reactive Protein,Red Cell Distribution Width,Neutrophil To Lymphocyte Ratio And Non-valvular Atrial Fibrillation In Elderly Patients

Objective To investigate the relationship between Hypersensitive C-reactive protein(hs-CRP),Red blood cell distribution width(RDW),Neutrophil to lymphocyte ratio(NLR)and the occurrence and duration of non-valvular atrial fibrillation in elderly and the risk of stroke,and to analyze whether hs-CRP,RDW and NLR are independent risk factors for non-valvular atrial fibrillation in the elderly or not.Methods 1 From October 2015 to September 2017 retrospectively,194 elderly patients with non-valvular atrial fibrillation in the Department of Cardiology and Geriatrics of the Affiliated Hospital of North China University of Science and Technology were enrolled continuously as atrial fibrillation group(AF group),194 patients with non-atrial fibrillation who were older than 60 years old were selected as the control group,whose admission time,age and gender were the same as the AF group.Collected and recorded the clinical data of all subjects detailedly,including age,sex,history of past illness,history of present illness,blood routine test(including hs-CRP,RDW,NLR),blood biochemical indexes,echocardiographic indexes,and compared the indicators between atrial fibrillation group and control group,and analyze the relationship between hs-CRP,RDW,NLR and the occurrence of non valvular atrial fibrillation in the elderly.2 According to the duration of atrial fibrillation,atrial fibrillation group was divided into paroxysmal atrial fibrillation subgroup(duration≤7days)and persistent/iong-standing persistent/permanent atrial fibrillation subgroup(duration>7days).The number of patients in paroxysmal atrial fibrillation subgroup is 115 cases and the number of patients in persistent/iong-standing persistent/permanent atrial fibrillation subgroup is 79 cases.Compared hs-CRP,RDW,NLR between two subgroups.3 Risk assessment of stroke(CHA2DS2-VASc score)was performed in patients with atrial fibrillation.According to the score,the patients in the atrial fibrillation group were further divided into low risk subgroup of stroke(score≤1 points)and high risk subgroup of stroke(score≥2 points).The number of patients in low risk subgroup of stroke is 42 cases and the number of patients in high risk subgroup of stroke is 152 cases.Compared hs-CRP,RDW,NLR between two subgroups.4 The correlation between hs-CRP,RDW,NLR and LAD,as well as the correlation between hs-CRP,RDW and NLR were analyzed by Spearman rank correlation analysis or Pearson correlation analysis.Results 1 There were no significant differences in age,sex,hyperlipidemia,history of hypertension,history of coronary heart disease,history of diabetes,RBC,WBC,ALT,AST,Cre,LVEF between control group and AF group(P>0.05).History of cerebral infarction of AF group was higher than that of control group(P<0.05).The levels of hsCRP 、 RDW 、 NLR 、 LAD of AF group were 1.99±0.66 、 12.93%±0.98% 、2.14±0.69、41.22±2.99.The levels of hs-CRP、RDW、NLR、LAD of the control group were 1.43±0.72、11.97%±0.81%、1.56±0.44、37.29±4.64.The levels of hs-CRP,RDW,NLR and LAD of the AF group were significantly higher than those of the control group(P<0.01).In the whole population of the study,the average numbers of hs-CRP,RDW and NLR were 1.71,12.45% and 1.85,respectively.Let hs-CRP,RDW and NLR be greater than or equal to the mean value for exposure,the three indicators were associated with non valvular atrial fibrillation in the elderly patients.The levels of hsCRP,RDW and NLR increased,and the risk of senile non valvular atrial fibrillation increased.High levels of hs-CRP,RDW and NLR were significantly correlated with non valvular atrial fibrillationin the elderly(P<0.05),and the OR values were 2.41,2.88 and 3.25.Multivariate Logistic regression analysis showed that hs-CRP,RDW,NLR and LAD were independent predictors for non-valvular atrial fibrillation in the elderly(OR values were 1.704,1.774,2.034 and 1.096,P<0.05).hs-CRP,RDW,NLR in predicting the area under the curve of non-valvular atrial fibrillation in the elderly were 0.716(95%CI=0.665~0.767,P<0.001),0.763(95%CI=0.717~0.810,P<0.001),0.753(95%CI=0.706~0.801,P<0.001),the best diagnostic Cut-off value were 1.435,12.95%,1.985,the sensitivity were 83.0%,51.0%,53.6%,and the specificity were 83.0%,91.2%,85.1%.2 Hs-CRP,RDW and NLR of persistent/iong-standing persistent/permanent atrial fibrillation subgroup were significantly higher than those of paroxysmal atrial fibrillation subgroup(P<0.05).3 Hs-CRP,RDW and NLR of high risk subgroup of stroke were significantly higher than those of low risk subgroup of stroke(P<0.05).4 The single factor correlation analysis showed that hs-CRP,RDW and NLR were correlated positively with LAD(P<0.05).RDW and NLR were correlated positively with hs-CRP(P<0.05).RDW was correlated positively with NLR(P<0.05).Conclusions 1 High levels of hs-CRP,RDW and NLR were closely associated with non-valvular atrial fibrillation in the elderly.The levels of hs-CRP,RDW and NLR increased,and the risk of senile non valvular atrial fibrillation increased.hs-CRP,RDW and NLR were independent risk factors for non-valvular atrial fibrillation in the elderly.2 hs-CRP,RDW,NLR were closely related to the duration of non-valvular atrial fibrillation in the elderly.hs-CRP,RDW and NLR of patients with persistent/iongstanding persistent/permanent atrial fibrillation were significantly higher than those of patients with paroxysmal atrial fibrillation.3 hs-CRP,RDW and NLR were closely related to the risk of stroke in elderly patients with non-valvular atrial fibrillation.hs-CRP,RDW and NLR of atrial fibrillation patients with high risk of stroke were significantly higher than those of atrial fibrillation patients with low risk of stroke.4 hs-CRP,RDW and NLR were correlated positively with LAD.hs-CRP,RDW and NLR might affect the occurrence and maintenance of atrial fibrillationby involving in the atrial structure remolding.