NLR在心血管疾病中的临床应用研究进展

Research Progress on the Clinical Application of NLR in Cardiovascular Diseases

摘要: 背景：心血管疾病是全球范围内导致死亡和残疾的主要原因，炎症在其发生发展中起着核心作用。中性粒细胞与淋巴细胞比值(NLR)作为一种易获取、经济的炎症标志物，近年来备受关注。目的：系统综述NLR在冠心病、心力衰竭、高血压及心房颤动等心血管疾病中的临床应用研究进展，总结NLR对于疾病预后的评估价值，探讨现有的局限性，并探索未来的研究方向。结果：现有证据表明，NLR水平升高与冠心病患者的长期死亡率、心力衰竭患者的预后恶化、高血压患者的发病风险及靶器官损害、心房颤动患者的复发及血栓事件风险增加均显著相关。在心血管–肾脏–代谢综合征危险分层等新兴领域亦展现出应用前景。然而，目前该领域仍面临截断值不统一、人群异质性显著、因果关系不明及干预价值待验证等挑战。结论：NLR作为一种反映炎症–免疫平衡的复合指标，在多种心血管疾病中具有可靠的预后价值。未来需着力解决阈值标准化、开展高质量前瞻性研究，以推动其临床转化。

Abstract: Background: Cardiovascular diseases (CVDs) are the leading cause of mortality and disability globally, with inflammation playing a central role in their pathogenesis. The neutrophil-to-lymphocyte ratio (NLR), as a readily available and cost-effective inflammatory biomarker, has attracted significant attention in recent years. Objective: This systematic review summarizes the research progress on the clinical application of NLR in cardiovascular diseases such as coronary heart disease, heart failure, hypertension, and atrial fibrillation. It also evaluates its prognostic value, discusses existing limitations, and outlines future research directions. Results: Existing evidence indicates that elevated NLR levels are significantly associated with increased long-term mortality in patients with coronary heart disease, worse outcomes in patients with heart failure, higher risk of incident hypertension and target organ damage, and higher risks of recurrence and thrombotic events in patients with atrial fibrillation. NLR also shows potential applications in emerging areas such as the risk stratification of cardiovascular-kidney-metabolic syndrome. However, the field still faces challenges including lack of standardized cutoff values, significant population heterogeneity, unclear causal relationships, and the need to validate the therapeutic implications of NLR modulation. Conclusion: As a composite indicator reflecting the inflammation-immunity balance, NLR demonstrates reliable prognostic value in various cardiovascular diseases. Future efforts should focus on establishing standardized thresholds and conducting high-quality prospective studies to facilitate its clinical translation.