山东医药

目的 基于倾向性评分匹配（PSM）分析入院中性粒细胞百分比与白蛋白比值（NPAR）对扩张型心肌病（DCM）致心力衰竭（HF）患者不良预后的预测价值。方法 回顾性选取2022年1月—2024年6月收治的DCM致HF患者220例。收集患者入院后相关临床资料，使用自动化血细胞分析仪检测中性粒细胞百分比，采用溴甲酚绿法检测白蛋白水平，计算两者比值（即NPAR）。随访1年，随访期内患者发生再次HF入院、恶性心律失常、心源性死亡或全因死亡事件定义为不良预后。采用PSM对不同预后DCM导致HF患者进行1∶1匹配，得到组间变量均衡样本。采用多因素Logistic回归分析影响DCM致HF患者不良预后的独立危险因素，并通过受试者工作特征（ROC）曲线评估各危险因素对患者不良预后的预测价值。结果 220例中82例患者预后不良，发生率为37.3%。PSM匹配后共得到78对基线特征均衡的患者样本。PSM后不良预后患者较良好预后者左心室射血分数、白蛋白低，中性粒细胞百分比、N末端前体B型钠尿肽（NT-proBNP）、肌钙蛋白I、C反应蛋白和NPAR高（P均<0.05）。多因素Logistic回归分析显示，NT-proBNP高和NPAR高为DCM致HF患者不良预后的独立危险因素（P均<0.05）。ROC曲线分析显示，NPAR预测DCM致HF患者不良预后的AUC为0.781，高于中性粒细胞百分比、白蛋白单独预测的0.699、0.716(P均<0.05);NT-proBNP与NPAR联合预测不良预后的AUC为0.850，高于NT-proBNP、NPAR单独预测的0.746、0.781(P均<0.05)。结论 入院NPAR较高为DCM致HF患者不良预后的独立危险因素，对患者预后有一定的预测价值，且联合NT-proBNP后预测价值可进一步提高。

Objective To analyze the predictive value of the admission neutrophil-percentage-to-albumin ratio(NPAR) for poor prognosis in patients with heart failure(HF) due to dilated cardiomyopathy(DCM) based on propensity score matching(PSM). Methods A total of 220 patients with HF due to DCM admitted from January 2022 to June 2024 were retrospectively selected. Relevant clinical data were collected upon admission. Neutrophil percentage was measured using an automated hematology analyzer, and albumin levels were determined using the bromocresol green method, with NPAR calculated as their ratio. During the one-year follow-up, poor prognosis was defined as the occurrence of rehospitalization for HF, malignant arrhythmia, cardiac death, or all-cause death. A 1:1 PSM was applied to patients with different prognoses to obtain a sample with balanced intergroup variables. Multivariate Logistic regression analysis was used to identify independent risk factors for poor prognosis in patients with HF due to DCM. The predictive values of N-terminal pro-Btype natriuretic peptide(NT-proBNP) and NPAR for poor prognosis were assessed using receiver operating characteristic(ROC) curve. Results Among 220 patients, 82 patients experienced poor prognosis, with an incidence of 37. 3%. After PSM, 78 matched pairs of patients with balanced baseline characteristics were obtained. Following PSM, patients with poor prognosis showed significantly lower left ventricular ejection fraction and albumin levels, and significantly higher neutrophil percentage, NT-proBNP, troponin I, C-reactive protein, and NPAR than patients with good prognosis(all P<0. 05). Multivariate Logistic regression analysis revealed that elevated NT-proBNP and elevated NPAR were independent risk factors for poor prognosis in patients with HF due to DCM(all P<0. 05). ROC curve analysis demonstrated that the area under the curve(AUC) of NPAR in predicting poor prognosis was 0. 781, which was higher than the AUCs of neutrophil percentage(0. 699) and albumin(0. 716) alone(both P<0. 05). The combined prediction of NT-proBNP and NPAR achieved an AUC of 0. 850, which was higher than the AUCs of NT-proBNP(0. 746) or NPAR(0. 781) alone(both P < 0. 05). Conclusions Elevated admission NPAR is an independent risk factor for poor prognosis in patients with HF due to DCM and holds predictive value for patient prognosis. Furthermore, combining NPAR with NT-proBNP further enhances the predictive value for poor prognosis in these patients.