| Objective: By observing the blood neutrophil to lymphocyte ratio(NLR),N-terminal B-type natriuretic peptide(NT-proBNP),and correlation parameters of UCG(left ventricular ejection fraction(LVEF)),classification of NYHA heart function and re-hospitalization of patients with heart failure caused by coronary heart disease,to explore the clinical significance of NLR levels in heart failure caused by coronary heart disease.Method: 134 patients(62 males and 72 females),with the average age of 73.73±9.20,diagnosed with chronic heart failure caused by coronary heart disease in the Department of Cardiovascular Medicine of the Second Hospital,University of South China from August 2017 to March 2019,were selected as the experimental group.134 non-heart failure people(65 males and 69 females),with the average age of 72.44±10.25 in the Health Management Center were selected as the control group.The general information,blood routine(neutrophil count,lymphocyte count),liver function(ALT,AST),renal function(creatinine,uric acid),NT-proBNP,classification of NYHA heart function,LVEF,other indicators at admission and the re-hospitalization due to exacerbation of heart failure during the six-month follow-up were collected.At the same time,NT-proBNP,LVEF,and classification of NYHA heart function of patients reexamined after six months were collected.The patients in the experimental group were divided into two groups according to the NLR level at admission: 67 patients with high NLR group(NLR>3.60)and 67 patients with low NLR group(NLR<3.60).Based on the re-hospitalization due to exacerbation of heart failure after the six-month follow-up,they were also divided into two groups: 45 patients in the re-hospitalization group and 89 patients in the non-re-hospitalization group.T test or chi-square test was used to compare the relevant indicators between the two groups;Spearman was used to analyze the correlation between NLR levels and related indicators of cardiac function.Multivariate logistic regression was used to evaluate the independent risk factors affecting patients with chronic heart failure caused by coronary heart disease who were re-hospitalized due to exacerbation of heart failure.The Receiver Operating Characteristic(ROC)curve was drawn to analyze the clinical value of NLR in predicting patients with heart failure caused by coronary heart disease who were re-hospitalized due to exacerbation of heart failure.Result:1.Comparison of NLR level in experimental group and control group: The NLR level(4.23±2.54)in experimental group was significantly higher than that in the control group(1.96±0.77),which was statistically significant(P<0.05).2.Comparison of related indexes of cardiac function at admission between high NLR group and low NLR group in patients with heart failure caused by coronary heart disease: compared with the low NLR group((2481.41±2997.56)pg/ml),NT-proBNP concentration in high NLR group((6398.87±9054.19)pg/ml)was significantly increased,which was statistically significant(P<0.05).The percentage of patients with Class II,III,IV of NYHA heart function in high NLR group was 14.9%,55.2%,29.9% respectively,and that in low NLR group was 34.3%,53.7%,11.9% respectively.Compared with the low NLR group,the number of patients with Class III,IV of NYHA heart function in high NLR group increased,but the number of patients with Class II of NYHA heart function in high NLR group decreased,which was statistically significant(P<0.05);Compared with the LVEF value in low NLR group((49.44±13.18)%),the LVEF value((41.66±13.77)%)in high NLR group significantly decreased,which was statistically significant(P<0.05).3.Spearman analysis of NLR levels and related indexes of cardiac function in patients with heart failure caused by coronary heart disease: NLR levels were positively correlated with NT-proBNP concentration and classification of NYHA heart function(P<0.05),but NLR levels were negatively correlated with LVEF(P<0.05).4.Comparison of related indexes of cardiac function in patients with heart failure caused by coronary heart disease in high NLR group and low NLR group after six months: compared with the NT-proBNP concentration((293.06±541.44)pg/ml)in low NLR group,the concentration((854.16±817.57)pg/ml)in high NLR group is higher,which was statistically significant(P<0.05).The percentage of patients with Class II,III,IV of NYHA heart function in high NLR group was 35.8%,50.7%,13.4% respectively,and that in low NLR group was 79.1%,17.9%,3.0% respectively.Compared with the low NLR group,the number of patients with Class III,IV of NYHA heart function in high NLR group increased,but the number of patients with Class II of NYHA heart function in high NLR group decreased,which was statistically significant(P<0.05);Compared with the LVEF value in low NLR group((53.73±11.68)%),the value((45.03±12.57)%)in high NLR group significantly decreased,which was statistically significant(P<0.05).5.Comparison of re-hospitalization rate of patients with heart failure caused by coronary heart disease between high NLR group and low NLR group: The rate of re-hospitalization of high NLR group(44.8%)was significantly higher than that of low NLR group(22.4%),which was statistically significant(P<0.05).6.Comparison of NLR levels and related indexes of cardiac function at the time of admission of re-hospitalization group and non-re-hospitalization group: NLR levels(5.52±3.58)and NT-proBNP concentration((6510.01±10375.62)pg/ml)in the re-hospitalization group was significantly higher than NLR levels(3.58±1.44)and NT-proBNP concentration((3393.58±4115.77)pg/ml)of non-re-hospitalization group,which was statistically significant(P<0.05).The percentage of patients with Class II,III,IV of NYHA heart function of the re-hospitalization group was 8.9%,62.2%,28.9% respectively,and that of non-re-hospitalization group was 32.6%,50.6%,16.9% respectively.Compared with the non-re-hospitalization group,the number of patients with Class III,IV of NYHA heart function in re-hospitalization group increased,but the number of patients with Class II of NYHA heart function in re-hospitalization group decreased,which was statistically significant(P<0.05);Compared with the LVEF value in non-re-hospitalization group((48.27±13.36)%),the value((40.16±13.75)%)in re-hospitalization group significantly decreased,which was statistically significant(P<0.05).7.Affecting multivariate logistic regression of re-hospitalization of patients with heart failure caused by coronary heart disease showed that NLR was an independent risk factor leading to re-hospitalization due to exacerbation of heart failure,and its OR was 1.276.8.Through the analysis of the ROC curve of NLR predicting re-hospitalization of patients with heart failure caused by coronary heart disease,the AUC predicted by NLR for re-hospitalization due to exacerbation of heart failure was 0.674(95% CI: 0.571-0.777;P=0.001);the sensitivity was 48.9%;the specificity was 83.1%;and the cutoff value was 4.9008.Conclusion:1.The NLR level is significantly increased in patients with heart failure caused by coronary heart disease,and it can reflect the severity of heart failure to a certain extent.2.The NLR level has certain clinical value for evaluating the prognosis of patients with heart failure caused by coronary heart disease. |
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