中性粒细胞-淋巴细胞比值联合身体质量指数对老年慢性心力衰竭病人肌量减少的预测价值

doi:10.3969/j.issn.1003-9198.2022.06.005

摘要/Abstract

摘要： 目的探讨中性粒细胞-淋巴细胞比值(NLR)联合BMI对老年CHF病人肌量减少的预测价值。方法选取2018年1月至2021年8月于青岛大学附属医院和青岛市第八人民医院老年医学科住院的老年(年龄≥65岁)CHF病人94例,根据2019年亚洲肌少症工作组(AWGS)制定的肌量减少诊断标准分为肌量减少组29例和肌量正常组65例。比较不同组别和不同NYHA心功能分级病人的一般资料和实验室检查指标;采用多因素Logistic回归分析老年CHF病人肌量减少的影响因素;绘制ROC曲线评价NLR、BMI对老年CHF病人肌量减少的预测价值。结果肌量减少组和肌量正常组年龄、性别、住院病人营养风险筛查(NRS2002)评分、NLR、BMI、淋巴细胞计数差异有统计学意义(P＜0.05)。不同心功能分级病人的年龄、NRS2002评分、NLR、N-端脑钠肽前体(NT-proBNP)、BMI、LVEF和骨骼肌质量指数(SMI)差异有统计学意义(P＜0.05)。多因素Logistic回归分析结果显示,BMI(OR=0.764,95%CI:0.600~0.972)、NLR(OR=2.266,95%CI:1.092~4.704)是老年CHF病人肌量减少的独立影响因素。ROC曲线分析提示,NLR、BMI预测老年CHF病人肌量减少的AUC分别为0.764(95%CI:0.660~0.868)和0.726(95%CI:0.613~0.839),而NLR与BMI两者联合预测老年CHF病人肌量减少的AUC为0.845(95%CI:0.759~0.932),敏感度为82.8％,特异度为81.2％。结论 NLR、BMI是老年CHF病人肌量减少的独立影响因素,对老年CHF病人肌量减少具有预测价值,且两者联合预测价值更高。

关键词: 老年人, 慢性心力衰竭, 中性粒细胞-淋巴细胞比值, 身体质量指数, 肌量减少

Abstract: Objective To investigate the predictive value of neutrophil to lymphocyte ratio (NLR) combined with body mass index (BMI) for decreased muscle mass in the elderly patients with chronic heart failure (CHF). Methods A total of 94 CHF patients aged≥65 years old who were hospitalized from January 2018 to August 2021 in Department of Geriatrics of the Affiliated Hospital of Qingdao University and the Eighth People’s Hospital of Qingdao were selected. According to the diagnostic criteria set by Asian Sarcopenia Working Group in 2019, the patients were divided into muscle mass loss group(n=29) and non-muscle mass loss group (n=65). The general data and laboratory indicators of the patients in different groups and different cardiac function grades were compared. The risk factors for decreased muscle mass in the elderly patients with CHF were analyzed by multivariate Logistic regression. The predictive value of NLR and BMI for decreased muscle mass in the elderly patients with CHF was evaluatd by receiver operating characteristic (ROC) curve. Results There were statistically significant differences in age, gender, nutrition risk screening (NRS2002) score, NLR, BMI and lymphocyte count between muscle mass loss group and non-muscle mass loss group (P＜0.05). There were statistically significant differences in age, NRS2002, NLR, N-terminal pro-B-type natriuretic peptide,BMI, left ventricular ejection fractions (LVEF) and skeletal muscle index (SMI) among the patients with different cardiac function grades (P＜0.05). Logistic regression analysis showed that BMI (OR=0.764, 95%CI:0.600-0.972) and NLR(OR=2.266,95%CI:1.092-4.704) were the independent influencing factors for muscle mass loss. ROC curve analysis suggested that the area under the curve (AUC) of NLR and BMI was 0.764 (95%CI:0.660-0.868) and 0.726 (95%CI:0.613-0.839) in predicting muscle mass loss, respectively, and the AUC of NLR combined with BMI was 0.845 (95%CI:0.759-0.932) in predicting muscle mass loss, with a sensitivity of 82.8％, and a specificity of 81.2％. Conclusions NLR and BMI are the independent influencing factors for decreased muscle mass in the elderly patients with CHF, and the combination of NLR and BMI shows higher predictive value for decreased muscle mass.

Key words: aged, chronic heart failure, neutrophil to lymphocyte ratio, body mass index, muscle mass loss

中图分类号:

R 541.6

尹继霞, 刘佳, 胡松, 王媚, 王艺茹, 毛拥军. 中性粒细胞-淋巴细胞比值联合身体质量指数对老年慢性心力衰竭病人肌量减少的预测价值[J]. 实用老年医学, 2022, 36(6): 565-569.

YIN Ji-xia, LIU Jia, HU Song, WANG Mei, WANG Yi-ru, MAO Yong-jun. Predictive value of neutrophil to lymphocyte ratio combined with body mass index for decreased muscle mass in elderly patients with chronic heart failure[J]. Practical Geriatrics, 2022, 36(6): 565-569.

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