非ST段抬高型急性冠脉综合征患者MLR变化及其与冠脉病变程度的关系

Changes of monocyte to lymphocyte ratio and its relationship with severity of coronary artery lesions in patients with non-ST-elevation acute coronary syndrome

目的探讨非ST段抬高型急性冠脉综合征(NSTE-ACS)患者单核细胞与淋巴细胞比值(MLR)变化及其与冠脉病变程度的关系。方法选择NSTE-ACS患者319例,根据SYNTAX评分将患者分为轻度病变组152例、中度病变组89例、重度病变组78例,另选非冠心病患者237例(非冠心病组),采集各组外周静脉血进行单核细胞和淋巴细胞计数,计算MLR。采用受试者工作特征(ROC)曲线评价MLR诊断NSTE-ACS的价值。采用线性回归方程分析MLR与NSTE-ACS冠脉病变程度的关系。结果轻度病变组、中度病变组、重度病变组MLR均高于对照组,且随着冠脉病变程度加重,MLR逐渐升高(P均<0.01)。ROC曲线分析显示,MLR诊断NSTE-ACS的曲线下面积为0.712(95%CI:0.636~0.752),诊断临界值为0.23,此时其诊断NSTE-ACS的敏感性为68.15%、特异性为63.89%。线性回归方程分析显示,MLR与SYNTAX评分呈正相关关系(r=0.54,P<0.01)。结论 NSTE-ACS患者MLR水平升高,且其水平变化与冠脉病变程度有关。

Objective To investigate the relationship between monocyte to lymphocyte ratio（ MLR） and severity of coronary artery lesion in patients with non-ST-elevation acute coronary syndrome（ NSTE-ACS）. Methods Based on SYNTAX score,319 patients with NSTE-ACS were divided into the mild stenosis group（ n = 152）,moderate stenosis group（ n= 89）,and severe stenosis group（ n = 78）. And the non-coronary artery disease group consisted of 237 patients without coronary artery disease. The peripheral venous blood of all patients was collected to measure the counts of monocytes and lymphocytes which were used for the calculation of MLR. Receiver operating characteristic（ ROC） curve was utilized to evaluate the diagnostic value of MLR in NSTE-ACS. Liner regression equation was used to analyze the relationship between MLR and severity of coronary artery lesions in patients with NSTE-ACS. Results The MLR levels of the mild stenosis group,moderate stenosis group,and severe stenosis group were higher than that of the non-coronary artery disease group;and MLR gradually increased with the degree of coronary artery lesions（ all P〈0. 01）. ROC analysis demonstrated that the areas under curve（ AUC） for MLR detecting NSTE-ACS was 0. 712（ 95% CI： 0. 636-0. 752）,and an optimized cut-off point of MLR was 0. 23 with a sensitivity and specificity of 68. 15% and 63. 89%. Linear regression equation analysis showed that MLR was positively correlated with lesion severity（ r = 0. 54,P〈0. 01）. Conclusion The level of MLR is elevated in patients with NSTE-ACS,which is positively correlated with coronary artery severity of NSTE-ACS.