NLR、PLR及LDL-C/HDL-C与急性冠脉综合征在院主要不良心脏事件的关联

Association of NLR, PLR, and LDL-C/HDL-C with acute coronary syndrome in patients with in-hospital major adverse cardiac events

目的 探讨中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）及低密度脂蛋白与高密度脂蛋白比值（LDL-C/HDL-C）与急性冠脉综合征（ACS）在院主要不良心脏事件的关系,以及对ACS患者在院主要不良心脏事件发生的预测作用.方法 将340例患者依据临床症状、辅助检查及冠脉造影分为正常对照组及ACS组,ACS组以临床诊断及预后分为UA组、NSTEMI组、STEMI组、MACEs组;ACS组又以NLR=5.44分为高NLR组、低NLR组,以PLR=129.70分为高PLR组、低PLR组,以LDL-C/HDL-C=2.75分为高LDL-C/HDL-C组、低LDL-C/HDL-C组.检测外周血白细胞分类计数、血生化,并计算NLR、PLR和LDL-C/HDL-C.应用SPSS 22.0软件进行统计分析.结果 ①NLR在正常对照组、UA组、NSTEMI组、STEMI组、MACEs组中依次升高（1.79±0.81、2.82±2.30、5.47±4.97、7.63±6.89、10.85±8.50）,且正常对照组与UA组、NSTEMI组、STEMI组、MACEs组之间差异有统计学意义（P＜0.05）,UA组与NSTEMI组、STEMI组、MACEs组之间差异有统计学意义（P＜0.05）,NSTEMI组与STEMI组、MACEs组之间差异有统计学意义（P＜0.05）,STEMI组与MACEs组之间差异有统计学意义（P＜0.05）.PLR值在正常对照组、UA组、NSTEMI组、STEMI组、MACEs组依次升高（104.15±34.79、119.73±43.22、150.12±88.33、178.24±123.49、192.13±116.25）,且MACEs组、STEMI组与正常对照组及UA组差异具有统计学意义（P＜0.05）.ACS患者LDL-C/HDL-C值高于正常对照组（2.77±0.98比2.16±0.75）,且差异有统计学意义（P＜0.05）.②高NLR组患者在院主要不良心脏事件发生率明显高于低NLR组（31.3％比6.1％）,差异有统计学意义（P＜0.05）;高PLR组患者在院主要不良心脏事件发生率高于低PLR组（22.1％比11.0％）,差异有统计学意义（P＜0.05）.③多因素Logistic回归分析显示,年龄、高血压、NLR、LDL-C/HDL-C均是ACS的独立危险因素.结论 NLR、LDL-C/HDL-C是ACS的独立危险因素,NLR、PLR对ACS患者在院发生主要不良心脏事件有预测作用.

Objective To study the relationship between neutrophil to lymphocyte ratio （NLR）, platelet to lymphocyte ratio（PLR）, low-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio（LDL-C/ HDL-C） and acute coronary syndrome （ACS） in hospital major adverse cardiac events, and to explore the predictive effect of NLR, PLR, and LDL-C/HDL-C on the major adverse cardiac events in patients with ACS. Methods A total of 340 hospitalized patients based on clinical symptoms, auxiliary examination and coronary angiography divided into normal control group and ACS group. Patients who has been confirmed as ACS were divided into 4 groups according to the clinical diagnosis and prognosis, were divided into 6 groups according to the value of NLR, PLR, LDL-C/HDL-C. White blood cell count, neutrophil, lymphocyte, LDL-C, HDL-C were measured, NLR, PLR and LDL-C/HDL-C were calculated. Statistical analyses were performed using SPSS 22.0. Results （1）NLR in the normal control group（1.79±0.81）, UA group（2.82±2.30）, NSTEMI group（5.47±4.97）, STEMI group （7.63 ±6.89）, MACEs group （10.85 ±8.50） were increased, and the difference was statistically significant between normal control group and UA group, NSTEMI group, STEMI group and MACEs group （P〈 0.05）, there was significant difference between UA group and NSTEMI group, STEMI group and MACEs group （P〈0.05）, there was significant difference between NSTEMI group and STEMI group, MACEs group （P〈0.05）, there was significant difference between STEMI group and MACEs group （P〈0.05）, the value of PLR in the normal control group（104.15±34.79）, UA group（119.73±43.22）, NSTEMI group（150.12±88.33）, STEMI group （178.24±123.49）, MACEs group （192.13±116.25） gradually increased, and the difference was significant in MACEs group, STEMI group and normal control group and UA group （P〈0.05）, ACS patients the value of LDL- C/HDL-C （2.77±0.98） higher than the normal control group （2.16±0.75）, and the difference was statistically significant （P〈0.05）. （2）High NLR groups of patients in hospital major adverse cardiac events occurred rate was significantly higher than that of low NLR group （31.3% vs 6.1% ）, the difference was statistically significant （P〈 0.05 ）, high PLR group of patients in hospital major adverse cardiac events occurrence rate was higher than the low PLR group （22.1% vs 11.0% ）, the difference was statistically significant （P〈0.05）. （3）Multivariate Logistic regression analysis showed that age, hypertension, NLR, LDL-C/HDL-C were independent risk factors for ACS. Conclusion NLR, LDL-C/HDL-C is an independent risk factor for ACS, PLR, NLR has a predictive effect on the major adverse cardiac events in patients with ACS.