Detection Of Peripheral Blood Neutrophil To Lymphocyte Ratio In Patients With Atrial Fibrillation And Its Clinical Significance

Objective: According to the level of peripheral blood neutrophil to lymphocyte ratio(NLR),we aim to investigate the relationship between NLR and the occurance and maintence of atrial fibrillation and investigate whether neutrophil to lymphocyte ratio is an independent risk factor for atrial fibrillation and the value of neutrophil to lymphocyte ratio for assisted screening and diagnosis of atrial fibrillation.Methods: Selecting 150 cases of atrial fibrillation patients hospitalizd in the Department of Cardiology of our hospital from January 2013 to December 2015(observation group),including 104 male and 46 female with a average age of 75.50(66.00 81.25).All atrial fibrillation patients were furtherly divided into paroxysmal atrial fibrillation group(68 cases)and persistent atrial fibrillation group(82 cases).In accordance with the clinical classification method recommended by the atrial fibrillation guidelines of 2006 ACC / AHA / ESC,69 cases of sinus rhythm patients with no history of atrial fibrillation hospitalized at the same time were selected as the control group,including 55 male and 14 female with a average age of(67.54±10.64).A detailed inquiry,auscultation,ECG examination and continuous ECG observation are implemented on all subjects.All enrolled subjects were admitted after the next morning of hospitalization fasting blood for routine detection to count the number of neutrophils and lymphocyte,the value of neutrophil to lymphocyte ratio is the ratio of the absolute value of neutrophil and the absolute value of lymphocyte.All enrolled subjects recept echocardiographic examination on the next day of hospitalization to measure left atrial diameter(LAD)and left ventricular ejection fraction(LVEF).According to compare the difference of neutrophil to lymphocyte ratio between the three groups,we investigate the effect of inflammation on occurrence and maintenance of atrial fibrillation;According to analysis the correlation of left atrial diameter and neutrophil to lymphocyte ratio,we investigate the relationship between inflammation and atrial structural remodeling;According to two multivariate Logistic regression analysis,we investigate whether neutrophil to lymphocyte ratio is an independent risk factor for atrial fibrillation and the value of neutrophil to lymphocyte ratio for assisted screening and diagnosis of atrial fibrillation.All statistical analysis were completed by SPSS 17 software,The main statistical indicators were tested with normal distribution and homogeneity of variance test.Measurement data fitted normal distribution were represented by x±s,difference between two groups were compared using t-test,difference between muitiple groups were compared using single factor variance analysis and multiple comparisons between groups using snk-q test,skewness distribution data were represented by M(P25 and p75),difference between groups were compared using rank sum test,count data were represented by case number(percentage),difference between groups were compared using chi square test.Correlation analysis between variables using Pearson or Spearman.Multivariate categorical variables analysis using non conditional Logistic stepwise regression analysis.Test level alpha is 0.05,with P<0.05 as the difference were statistically significant.results: There was a significant difference between the groups in age,history of hypertension,history of coronary heart disease(P<0.05),while there was no significant difference in gender,history of cardiomyopathy and valvular heart disease(P>0.05),there was no significant difference in constituent ratio of isolated atrial fibrillation between paroxysmal atrial fibrillation and persistent atrial fibrillation(P > 0.05).Neutrophil to lymphocyte ratio in paroxysmal atrial fibrillation group increased compared with the control group(P < 0.01);Neutrophil to lymphocyte ratio in persistent atrial fibrillation group increased compared with the control group(P < 0.01);Neutrophil to lymphocyte ratio in persistent atrial fibrillation group increased compared with the paroxysmal atrial fibrillation group(P < 0.01).Left atrial diameter of Paroxysmal atrial fibrillation group was higher than the control group(P < 0.05);Left atrial diameter of persistent atrial fibrillation group was higher than the control group(P < 0.01);Left atrial diameter of persistent atrial fibrillation group was higher than the paroxysmal atrial fibrillation group(P < 0.01).Left ventricular ejection fraction in paroxysmal atrial fibrillation group was lower than the control group(P <0.01);Left ventricular ejection fraction in persistent atrial fibrillation group was lower than the control group(P < 0.01);Left ventricular ejection fraction in persistent atrial fibrillation group was lower than the paroxysmal atrial fibrillation group(P < 0.01).Spearman correlation analysis showed that the left atrial diameter was positively correlated with neutrophil lymphocyte ratio(Spearman correlation coefficient =0.275,P=0.000).The results of multi factor Logistic regression analysis showed that hypertension,coronary heart disease,NLR increased and LAD increase were risk factors for the occurrence of atrial fibrillation,the increase of LVEF is a protective factor for the occurrence of atrial fibrillation.After adjustment for hypertension,coronary heart disease,LAD,LVEF and other factors,the increase of neutrophil to lymphocyte ratio is still an independent risk factor for atrial fibrillation,the correct discrimination rate of atrial fibrillation risk factor model composed of hypertension,coronary heart disease,NLR,LAD,LVEF is as high as 86.7%.Conclusion: 1.Peripheral blood levels of NLR significantly increased in atrial fibrillation in patients,peripheral blood levels of NLR in persistent atrial fibrillation group significantly increased compared with the paroxysmal atrial fibrillation group,indicating that NLR is closely related to the occurrence and maintenance of atrial fibrillation 2.NLR is an independent risk factor of atrial fibrillation.NLR has a certain clinical practicability and value for assisted screening and diagnosis of atrial fibrillation,but also has some limitations.