中性粒细胞/淋巴细胞比值(NLR)与高血压左心室肥厚的研究进展

Research Progress on the Association between Neutrophil-to-Lymphocyte Ratio (NLR) and Hypertensive Left Ventricular Hypertrophy

摘要: 左心室肥厚(LVH)是原发性高血压最典型、危害最突出的靶器官损害，是心力衰竭、恶性心律失常、心源性猝死的独立危险因素。慢性低度炎症是高血压诱导心肌重构的核心驱动通路。中性粒细胞/淋巴细胞比值(NLR)由常规血常规指标计算获得，具备简便、廉价、基层全覆盖、可重复检测等优势，能够客观反映机体促炎/抗炎免疫稳态失衡状态。近年大量回顾性、横断面临床研究证实，NLR与高血压发病、血压分级、血压控制水平及LVH发生发展密切相关，有望成为高血压人群LVH早期初筛、风险分层、远期心血管预后评估的经济型辅助生物标志物。本文系统梳理NLR独特的免疫生物学特征，批判性总结现有临床证据中NLR与高血压、LVH的关联规律，深度剖析中性粒细胞、淋巴细胞失衡介导心肌重构的交叉串扰病理生理通路，客观评析当前研究存在的方法学、人群异质性、临床转化瓶颈等局限，并提出具体化、可落地的后续研究方案，旨在为基层医疗机构开展高血压LVH分层防控、精准干预提供理论依据与实践参考。

Abstract: Left ventricular hypertrophy (LVH) is the most common target organ damage of essential hypertension and an independent predictor of adverse cardiovascular endpoints. Chronic low-grade inflammation serves as a central pathological driver of hypertensive myocardial remodeling. Derived from routine blood routine tests, neutrophil-to-lymphocyte ratio (NLR) is an economical, accessible and repeatable systemic inflammatory biomarker that mirrors the imbalance between pro-inflammatory and anti-inflammatory immunity. Accumulated retrospective and cross-sectional clinical studies have verified that elevated NLR is strongly correlated with hypertension incidence, blood pressure severity, poor blood pressure control and LVH progression, which renders NLR a promising auxiliary marker for early screening, risk stratification and long-term prognostic evaluation of LVH in hypertensive patients. This review elaborates the immunobiological characteristics of NLR, critically synthesizes existing clinical evidence linking NLR to hypertension and LVH, deeply dissects the crosstalk signaling pathways through which neutrophil-lymphocyte imbalance triggers myocardial remodeling, objectively analyzes methodological defects, population heterogeneity and translational barriers of current researches, and proposes concrete, operable research directions for future investigations. This work provides theoretical support and practical guidance for stratified prevention and precise intervention of hypertensive LVH in primary medical institutions.