Relationship Between Neutrophil-lymphocyte Ratio (NLR) And Cardiac Function And Myocardial Injury In Patients With Acute Myocardial Infarction

Objective:To investigate the relationship between the severity of inflammatory disease(venous blood neutrophil/lymphocyte count ratio,NLR)and cardiac function and myocardial injury in patients with acute myocardial infarction(AMI),and to investigate the early diagnosis indicators and prognosis of patients with acute myocardial infarction.Methods:The clinical data of 715 AMI patients admitted to hospital from 2015 to 2016 were selected.The average NLR was calculated according to the descriptive statistical analysis of SPSS(2.76±2.96).The patients were divided into A1 group(NLR≤2.76,n= 522)and A2 groups(NLR>2.76,n=193).Using Spearman correlation analysis of NLR and detected clinical data,such as AMI patients’ heart function index(EF,FS,SV)and myocardial damage index(CK-MB,etc.)correlation,P<0.05 was considered statistically significant significance.Arterial blood samples were obtained from AMI patients at random,and concentrations of IL-10 and TGF-P in the arterial plasma of patients were determined by enzyme-linked immunosorbent assay(ELISA).Significant differences were found between arterial blood inflammatory factors(IL-10 and TGF-β).Based on the NLR value,715 AMI patients were re-divided into B1 group(NLR≤4,n=602)and B2 group(NLR>4,n=113).in each group NLR and further analysis the relationship between the cardiac function and myocardial injury.Results:1.Clinical data from 715 patients with AMI showed that the NLR ranged from 0.50 to 46 with a mean of 2.76±2.96(mean±SD).NLR was positively correlated with CK-MB(r = 0.264,P<0.0001),NLR was negatively correlated with EF(r =-0.208,P<0.0001),and NLR was negatively correlated with FS(r =-0.225,P<0.0001).NLR was negatively correlated with SV(r =-0.086,P<0.05).2.The value of CK-MB in group A2 was significantly higher than that in group A1,with a significant difference(P<0.05).The mean value of EF in the A1 group(60.39±5.74)was higher than that in the A2 group(57.21±7.26).The difference was statistically significant(P<0.001).The mean value of FS in groupA1(30.19±4.85)was higher than that in group A2(28.00±5.37).The difference was statistically significant(P<0.001).The mean value of SV in group A1(71.43±8.58)was higher than that in group A2(69.99±9.54),with a significant difference(P=0.05).3.In group A1,there was a positive correlation between NLR and CK-MB(r=0.143,P = 0.001).NLR was negatively correlated with EF(r =-1.31,P = 0.003).NLR was negatively correlated with FS(r =-0.102,P = 0.020),there is a clear correlation.NLR and SV showed correlation tendency(P=0.055).In group A2,there was no correlation between NLR and CK-MB(r = 0.083,P = 0.253),NLR and EF(r =-0.128,P = 0.076),NLR and SV(r = 0.101,P= 0.164).There was a negative correlation between NLR and FS(r =-0.228,P = 0.001).The difference was statistically significant.4.The inflammatory factors(IL-10 and TGF-β)in the arterial blood of patients were further measured.Analysis of the correlation between NLR and two inflammatory factors resulted in TGF-β being significantly higher than NLR<4 when NLR>4(P<0.05).When NLR>4.6,IL-10 was significantly higher than NLR<4.6,with statistically significant differences(P<0.05).5.In group B2,the value of CK-MB was significantly higher than that of group B1,and the difference was statistically significant(P<0.05).There was significant difference between group B1 and group B2 in EF and FS(P<0.05).There was no significant difference in SV between the two groups(P=0.311).In group B1,NLR was positively correlated with myocardial injury(r = 0.200,P<0.05)and negatively correlated with cardiac function(NLR and EF,r =-0.207,P<0.05;NLR and FS,r =-0.158,P<0.05),showing significant correlation.There was no correlation between NLR and SV in the two groups(P>0.05).In group B2,NLR was negatively correlated with cardiac function(NLR and EF r =-0.18,P<0.05;NLR and FS r =-0.300,P<0.05;NLR and SV r =-0.98,P<0.05),however,there was no correlation between NLR and myocardial injury(NLR and CK-MB,P>0.05)。Conclusion:1.Our analysis from 715 AMI patients showed that high NLR is correlated with cardiac dysfunction and myocardial damage.2.NLR greater than 2.76 predict the degree of myocardial damage in AMI patients and systolic dysfunction.3.When NLR>4,inflammatory markers of arterial blood IL-10 and TGF-βare significantly increased in AMI patients,suggesting the possibility that the injured myocardium enters the repair phase.4.As an indicator of the body’s inflammatory response,venous NLR can be used as an early diagnostic indicator of heart function and myocardial injury and prognosis in patients with AMI.