Abstract: Background　Acute coronary syndrome （ACS） has a higher rate of disability and mortality，and early detection and intervention for high-risk patients with ACS is of great significance to reduce the rate of hospitalization and mortality.At present，the ratio of neutrophil to lymphocyte （NLR），a new inflammatory marker，has important predictive value for the prognosis of cardiovascular diseases.Objective　To explore the associations of NLR，GRACE score with cardiac function indices，and the performance of NLR，GRACE score，according to the occurrence of major adverse cardiac events （MACE） within 6 months，NLR，GRACE score and the combination of the two for predicting the outcomes of ACS patients.Methods　In this retrospective study，we enrolled 284 ACS patients from January 2016 to October 2017 from the Second Affiliated Hospital of Zhengzhou University.We collected their clinical data.Our cohort was divided into low-risk group （n=113，<109 points），medium-risk group （n=71，109 to 140 points），and high-risk group （n=100，>140 points） according to baseline GRACE score，and stratified into high NLR group （n=142，>3.02） and low NLR group （n=142，≤3.02） by the baseline NLR level for investigating the correlations of GRACE score and NLR level with cardiac functions，respectively.ROC analysis was conducted to probe the performance of NLR，GRACE score，and the combination of the two for evaluating the outcome of ACS.Results　Mean age，BMI，heart rate，systolic blood pressure （SBP），diastolic blood pressure （DBP），NLR，N-terminal brain natriuretic peptide（NT-proBNP），left ventricular ejection fraction （LVEF），left ventricular end-diastolic diameter （LVEDD），and incidence of MACE differed significantly between the low-，medium- and high-risk groups （P<0.05）．High NLR group showed greater mean age，higher mean BMI，heart rate，SBP，DBP，GRACE score，NT-proBNP and LVEDD as well as higher incidence of MACE but low mean triacylglycerol （TG），LVEF compared with the low NLR group（P<0.05）．NLR was positively correlated with GRACE score，NT-proBNP and LVEDD （r=0.852，0.417，0.293，P<0.05），while negatively correlated with LVEF （r=-0.416，P<0.05）．GRACE score was positively correlated with NT-proBNP and LVEDD （r=0.445，0.361，P<0.05），but negatively correlated with LVEF （r=-0.508，P<0.05）．The incidence of MACE among all participants was 25.0%（71/284）．For evaluating the outcome of ACS patients，the area under the ROC curve of NLR combined with GREACE score （0.877） was greater than that of NLR alone（0.732）（Z=3.394，P=0.000 7）and GRACE score alone （0.757）（Z=3.045，P=0.002）．Conclusion　Both NLR and GRACE score had correlations with cardiac function indices.NLR combined with GRACE score is more valuable in predicting the outcome of ACS than NLR or GRACE score alone，so it may be used as an auxiliary index for evaluating the outcome.

Key words: Acute coronary syndrom, Neutrolphil to lymphocyte ratio, Prognosis

摘要： 背景　急性冠脉综合征（ACS）具有更高的致残率和病死率，早期发现高危患者并进行干预治疗对减少患者的入院率、降低死亡率具有至关重要的意义。目前一种新兴的炎性指标中性粒细胞与淋巴细胞比值（NLR）对心血管疾病的预后具有重要预测价值。目的　探究ACS患者NLR及全球急性冠状动脉事件注册研究（GRACE）评分与心功能相关指标的相关性，根据6个月内发生主要不良心血管事件（MACE）的情况，分析NLR、GRACE评分、NLR联合GRACE评分对ACS患者预后的评估价值。方法　回顾性分析2016年1月—2017年10月郑州大学第二附属医院收治的284例诊断为ACS的住院患者，记录患者临床资料，根据GRACE评分将患者分为低危组（<109分）113例、中危组（109~140分）71例、高危组（>140分）100例；根据NLR中位数将患者分为低NLR组（≤3.02）142例和高NLR组（>3.02）142例。记录患者发病6个月内MACE发生情况。采用受试者工作特征（ROC）曲线分析NLR、GRACE评分、NLR联合GRACE评分对ACS患者预后评估的价值。结果　低、中、高危组ACS患者年龄、体质指数（BMI）、心率、收缩压、舒张压、NLR、N末端脑钠肽前体（NT-proBNP）、左心室射血分数（LVEF）、左心室舒张末期内径（LVEDD）、MACE发生率比较，差异均有统计学意义（P<0.05）。高NLR组ACS患者年龄、BMI、心率、收缩压、舒张压、GRACE评分、NT-proBNP、LVEDD、MACE发生率高于低NLR组，三酰甘油（TG）、LVEF低于低NLR组（P<0.05）。NLR与GRACE评分、NT-proBNP、LVEDD呈正相关（r=0.852、0.417、0.293，P<0.05），与LVEF呈负相关（r=-0.416，P<0.05）；GRACE评分与NT-proBNP、LVEDD呈正相关（r=0.445、0.361，P<0.05），与LVEF呈负相关（r=-0.508，P<0.05）。284例ACS患者发病6个月内发生MACE者71例（25.0%）。NLR联合GRACE评分预测ACS患者发病6个月内发生MACE的ROC曲线下面积（0.877）大于NLR（0.732）（Z=3.394，P=0.000 7）、GRACE评分（0.757）（Z=3.045，P=0.002）。结论　NLR及GRACE评分与心功能相关指标具有相关性，NLR联合GRACE评分预测ACS患者预后较单一指标临床价值更大，NLR联合GRACE评分可作为早期评估ACS患者预后的辅助参考指标。

关键词: 急性冠脉综合征, 中性粒细胞与淋巴细胞比值, 预后