中性粒-淋巴细胞比值在2型糖尿病并发心脑血管疾病中的诊断价值

The role of neutrophil-lymphocyte ratio in diagnosing ischemic cardiovascular or cerebrovascular diseases-the complications of type 2 diabetes mellitus

目的探讨中性粒-淋巴细胞比值(neutrophil-lymphocyte ratio,NLR)对糖尿病并发缺血性心脑血管疾病的诊断价值。方法测定208例2型糖尿病(diabetes mellitus,DM)患者和66例健康人员(对照组)活化血小板指标、白细胞(white blood cell,WBC)参数、游离脂肪酸(free fat acid,FFA)和C反应蛋白(C reactive protein,CRP)水平,分析NLR与各指标的相关性,采用受试者工作特性(ROC)曲线评价其对并发缺血性心脑血管疾病的诊断价值。结果DM组血小板活化指标、WBC、NLR、CRP和FFA水平均显著高于对照组(P<0.01);有并发症的DM患者WBC、NLR、CRP水平均显著高于单纯DM患者(P<0.01),NLR、CRP敏感度分别为70.63%、53.85%,特异度为76.92%、78.46%,Youden指数(0.47、0.32)高于其它指标。NLR、CRP、WBC均呈显著正相关(P<0.01);NLR的ROC曲线下面积最大(0.88),诊断界值为2.25,敏感度88.11%,特异度69.23%,Youden指数0.57。结论 NLR可作为2型糖尿病并发缺血性心脑血管疾病辅助诊断的实用指标。

Objective To evaluate the role of neutrophil-lymphocyte ratio （ NLR） in diagnosing the complications-ischemic cardiovascular or cerebrovascular diseases-of ype 2 diabetes mellitus.Method Activated platelet markers, white blood cell parameters（ WBC） , free fat acid（ FFA） and C-reactive protein（ CRP） were measured in 208 diabetes mellitus patients and 66 healthy volunteers.The neutrophil-lymphocyte ratio（NLR） was calculated and the correlation between NLR and other indicators was analyzed.The receiver operating characteristic（ ROC） curve was used to evaluate the diagnostic value of some indicators in type 2 diabetes mellitus complicating ischemic cardiovascular or cerebrovascular diseases.Findings Of group DM, the levels of platelet activation markers, WBC, NLR, CRP and FFA were significantly higher than those of the control group （P 〈0.01）.Of the group complicating acute cerebral infarction（ACI） , the group complicating acute coronary syndrome（ ACS） , and the group complicating ACI and ACS, the WBC, NLR and CRP levels were remarkably higher than those of group single DM（P〈0.01）.In the patients with complication, the sensitivity of NLR and CRP was 70.63%and 53.85% and the specificity was 76.92% and 78.46% respectively.Their Youden indexes （ 0.475 and 0.323） were higher than those of other indicators.There was significantly positive correlation between NLR and CRP or WBC（P〈0.01） .The area under ROC curve of NLR was 0.88, 95%CI（0.83~0.93）, which was the largest in all indicators.The cutoff value of NLR was 2.25 with the sensitivity, specificity and Youden index of 88.11%,69.23%and 0.571, respectively.Conclusion Neutrophil-lymphocyte ratio can serve as an indicator of ischemic cardiovascular or cerebrovascular diseases of type 2 diabetes mellitus patients.