Abstract: Background　Framingham risk score is a widely used method for predicting the 10-year risk of cardiovascular disease in high risk group.Neutrophil to lymphocyte ratio（NLR）is a newly suggested inflammatory marker associated with atherosclerosis.However，the correlation between NLR and Framingham risk score，and the predictive value of NLR for high-risk cardiovascular disease are still unclear.Objective　To explore the association of NLR with Framingham risk score，and its predictive value for high-risk cardiovascular disease.Methods　Participants were recruited from Henan Provincial People's Hospital from May 2017 to May 2018，including 168 outpatients and inpatients with essential hypertension from Cardiovascular Department〔observation group consisting of low-risk subgroup（n=66），intermediate-risk subgroup（n=53），and high-risk subgroup（n=49）stratified by Framingham risk score〕，and 55 physical examinees without hypertension from Physical Examination Department（control group）．Comparisons of clinical data were made between the control group and cardiovascular risk subgroups.Influencing factors for Framingham risk score were analyzed with the multivariate ordinal regression model.The value of NLR for predicting cardiovascular risk in high-risk population of cardiovascular disease was estimated by ROC curve analysis.Results　Sex ratio，mean age，systolic blood pressure，diastolic blood pressure，prevalence of diabetes，rates of use of drugs（statins，beta blockers，calcium antagonists，ACEIs/ARBs，diuretics），mean levels of systolic and diastolic blood pressure，total cholesterol（TC），high-density lipoprotein cholesterol（HDL-C），NLR，homocysteine，and left ventricular ejection fraction（LVEF）differed significantly across the control group and three cardiovascular risk subgroups（P<0.05），but mean body mass index（BMI），triglyceride，low-density lipoprotein cholesterol（LDL-C），ALT，creatinine，and fasting blood glucose levels did not（P>0.05）．Mean NLR increased successively in control group，low-，intermediate- and high-risk subgroups.Logistic regression analysis showed that age，systolic blood pressure，diastolic blood pressure，TC，LDL-C，HDL-C，NLR and LVEF were the influencing factors of Framingham Risk Score（P<0.05）．The results of ROC curve analysis showed that when NLR was 2.86，the Youden's index was the largest（0.560），the corresponding sensitivity was 0.796，the specificity was 0.764，and the area under ROC curve was 0.836〔95%CI （0.775，0.897）〕.Conclusion　NLR associated with Framingham Risk Score，and may has a certain predictive value for high-risk cardiovascular diseases.

Key words: Cardiovascular diseases, Hypertension, Leukocytes, Lymphocytes, Forecasting, Regression analysis, ROC curve

摘要： 背景　Framingham心血管评分是目前普遍应用的评估方法，可以预测高危人群10年的心血管病发生风险。中性粒细胞与淋巴细胞比值（NLR）是目前国内外新提出的一种与动脉粥样硬化相关的炎性标志物。NLR与Framingham心血管风险等级的相关性及其对高危心血管疾病的预测价值尚不明确。目的　探究NLR和Framingham心血管风险等级的关系及其对高危心血管疾病的预测价值。方法　选取2017年5月—2018年5月于河南省人民医院心内科门诊诊治及住院治疗的原发性高血压病患者168例为观察组，选取同期于河南省人民医院体检科健康体检的非高血压人群55例为对照组。根据Framingham心血管风险评分将观察组分为低危组66例、中危组53例、高危组49例。比较不同组纳入者的临床资料，采用有序多分类Logistic回归分析Framingham心血管风险等级的影响因素，采用受试者工作特征（ROC）曲线分析NLR对心血管病高危人群的预测价值。结果　四组体质指数（BMI）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、丙氨酸氨基转移酶（ALT）、肌酐（Cr）、空腹血糖（FBG）比较，差异无统计学意义（P>0.05）；四组性别、年龄、收缩压、舒张压、糖尿病患病情况、药物〔他汀类药物、β-受体阻滞剂、钙离子拮抗剂、血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体拮抗剂（ACEI/ARB）、利尿剂〕使用情况、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、NLR、同型半胱氨酸（HCY）、左心室射血分数（LVEF）比较，差异有统计学意义（P<0.05）。低危组NLR高于对照组，中危组NLR高于对照组和低危组，高危组NLR高于对照组、低危组、中危组（P<0.05）。Logistic回归分析结果显示，年龄、收缩压、舒张压、TC、LDL-C、HDL-C、NLR、LVEF是Framingham心血管风险等级的影响因素（P<0.05）。ROC曲线分析结果显示，当NLR为2.86时，约登指数最大（为0.560），对应的灵敏度为0.796、特异度为0.764，ROC曲线下面积为0.836〔95%CI（0.775，0.897）〕。结论　NLR与Framingham心血管风险等级相关，其对高危心血管疾病具有一定的预测价值。

关键词: 心血管疾病, 高血压, 白细胞, 淋巴细胞, 预测, 回归分析, ROC曲线