检验医学 ›› 2026, Vol. 41 ›› Issue (10): 947-954.DOI: 10.3969/j.issn.1673-8640.2026.10.003

• 论著 • 上一篇    下一篇

术前单核细胞/淋巴细胞比值与风湿性心脏病患者术后不良预后的关系

孙圣林1, 林雅榕2, 孙林2, 顾梅秀2(), 王蓓丽2, 郭玮2   

  1. 1 上海市老年医学中心检验科, 上海 201104
    2 复旦大学附属中山医院检验科, 上海 200032
  • 收稿日期:2025-06-25 修回日期:2025-12-21 出版日期:2026-10-30 发布日期:2026-10-20
  • 通讯作者: 顾梅秀,E-mail:gu.meixiu@zs-hospital.sh.cn。
  • 作者简介:孙圣林,男,2000年生,学士,检验技师,主要从事临床检验工作;
    林雅榕,女,1998年生,博士,检验技师,主要从事临床分子生物学检验工作。

    孙圣林和林雅榕对本研究具有同等贡献,并列为第一作者。

  • 基金资助:
    国家自然科学基金面上项目(82172348);国家自然科学基金面上项目(82473063);上海市卫生健康系统重点学科(2024ZDXK0067)

Relationship between preoperative monocyte/lymphocyte ratio and postoperative poor prognosis in patients with rheumatic heart disease

SUN Shenglin1, LIN Yarong2, SUN Lin2, GU Meixiu2(), WANG Beili2, GUO Wei2   

  1. 1 Department of Clinical Laboratory, Shanghai Geriatric Medical Center, Shanghai 201104, China
    2 Department of Clinical Laboratory, Zhongshan Hospital,Fudan University, Shanghai 200032, China
  • Received:2025-06-25 Revised:2025-12-21 Online:2026-10-30 Published:2026-10-20

摘要:

目的 分析术前外周血单核细胞/淋巴细胞比值(MLR)在风湿性心脏病(RHD)患者手术后不良预后中的临床意义。方法 选取 2021年7月—2023年4月复旦大学附属中山医院行瓣膜置换术/成形术的RHD患者110例,收集其实验室检测结果、超声心动图检查结果和相关临床资料。根据MLR判断RHD患者术后不良预后的最佳临界值(0.3),将110例RHD患者分为MLR≥0.3组(46例)和MLR<0.3组(64例),采用Kaplan-Meier生存曲线分析2组患者预后情况。采用Cox回归分析评估RHD患者术后预后不良的影响因素。采用受试者工作特征(ROC)曲线评估MLR联合超声心动图评估RHD患者不良预后的效能。结果 Kaplan-Meier生存曲线显示,MLR≥0.3组术后复发率高于MLR<0.3组(Log-rank χ2=4.475,P=0.034)。MLR(P=0.049)、三尖瓣反流(P=0.018)、心包积液(P=0.007)与RHD患者术后预后不良有关;MLR≥0.3(P=0.048)、存在心包积液(P=0.020)是RHD患者术后预后不良的独立危险因素 [风险比(HR)分别为2.395、5.075,95%可信区间(CI)分别为1.007~5.692、1.296~19.868]。MLR联合三尖瓣反流判断RHD患者术后不良预后的曲线下面积(AUC)为0.699,敏感性为65.2%,特异性为69.0%。结论 MLR≥0.3是RHD患者术后预后不良的独立危险因素,联合超声心动图指标有助于临床筛选高危患者。

关键词: 单核细胞/淋巴细胞比值, 风湿性心脏病, 手术, 预后

Abstract:

Objective To analyze the clinical significance of preoperative monocyte/lymphocyte ratio(MLR) in postoperative poor prognosis of patients with rheumatic heart disease(RHD). Methods A total of 110 RHD patients who underwent valve replacement or repair surgery in Zhongshan Hospital Affiliated to Fudan University from July 2021 to April 2023 were enrolled. Laboratory determination,echocardiography and related clinical data were collected. The optimal cut-off value(0.3) for predicting postoperative poor prognosis in RHD patients based on MLR,and the 110 RHD patients were classified into MLR≥0.3 group(46 cases) and MLR<0.3 group(64 cases). The survival curves of the 2 groups were analyzed using Kaplan-Meier method. Cox regression analysis was used to evaluate the factors for the postoperative prognosis of RHD patients. Receiver operating characteristic(ROC) curve was used to evaluate the efficacy of MLR combined with echocardiography in assessing the poor prognosis of RHD patients. Results The postoperative recurrence rate of MLR≥0.3 group was higher than that of MLR<0.3 group(Log-rank χ2=4.475,P=0.034). MLR(P=0.049),tricuspid regurgitation(P=0.018) and pericardial effusion(P=0.007) were associated with the postoperative poor prognosis of RHD patients. MLR≥0.3(P=0.048) and pericardial effusion(P=0.020) were independent risk factors for the poor prognosis of RHD patients [hazard ratio(HR)=2.395,95% confidence interval(CI) 1.007-5.692;HR=5.075,95%CI 1.296-19.868,respectively]. The area under curve(AUC) of MLR combined with tricuspid regurgitation for predicting the postoperative poor prognosis of RHD patients was 0.699. The sensitivity was 65.2%,and the specificity was 69.0%. Conclusions MLR≥0.3 is an independent risk factor for the postoperative poor prognosis of RHD patients,and the combination of MLR and echocardiography is helpful for clinical screening of high-risk patients.

Key words: Monocyte/lymphocyte ratio, Rheumatic heart disease, Operation, Prognosis

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