血小板/淋巴细胞与急性冠状动脉综合征患者非罪犯动脉粥样硬化斑块易损性的相关性-光学相干断层扫描技术研究

Relationship between platelet-to-lymphocyte ratio and non-culprit atherosclerotic plaque vulnerability in patients with acute coronary syndrome:an optical coherence tomography study

目的:通过光学相干断层扫描技术探讨急性冠状动脉综合征(ACS)患者血小板与淋巴细胞比值(PLR)与非罪犯动脉粥样硬化斑块易损性的关系。方法:回顾性纳入74例就诊于首都医科大学附属北京安贞医院,诊断为ACS并接受经皮冠状动脉造影及OCT检查的患者。结果:PLR是易损斑块(TCFA)的危险因素(OR=1.011,95%CI:1.002~1.020,P=0.015)。PLR对TCFA的诊断敏感性为84.0%,特异性为55.1%。高PLR组患者冠状动脉血管内非罪犯脂质斑块的最大脂质核心角度[(162.30±64.31)vs.(133.33±55.29)°,P=0.012]、平均脂质核心角度[(123.51±44.46)vs.(107.11±44.84)°,P=0.049]、脂质斑块长度[4.75(2.93,7.20)vs. 3.40(2.20,5.30)mm,P=0.023]及脂质指数[535.40(303.26,877.19)vs. 344.03(181.93,673.00),P=0.014]均显著高于低PLR组患者,纤维帽厚度[100.00(60.00,157.50)vs. 130.00(80.00,195.00)μm,P=0.031]显著低于低PLR组。高PLR组的纤维斑块数量(P=0.038)、易损斑块发生率(P=0.006)及斑块破裂发生率(P=0.007)均高于低PLR组。同时,PLR与脂质斑块纤维帽厚度(FCT)呈负相关(R=0.205,P=0.020)。结论:高水平PLR可能与ACS患者易损斑块特征有关。PLR水平在评估ACS患者非罪犯动脉粥样硬化斑块的易损性方面具有潜在价值。

Objective: To investigate the relationship between platelet-to-lymphocyte ratio(PLR) and non-culprit atherosclerotic plaque vulnerability assessed by optical coherence tomography in patients with acute coronary syndrome(ACS). Methods: 74 patients with ACS were enrolled in Beijing anzhen hospital and received coronary angiography and optical coherence tomography test. Results: PLR(OR=1.011,95%CI:1.002-1.020,P=0.015)was found to be an independent risk factor of thin cap fibroatheroma(TCFA). PLR could differentiate TCFA with a sensitivity of 84.0% and a specificity of 55.1%.The coronary plaques in high PLR group exhibited thinner fibrous cap thickness(FCT) [100.00(60.00,157.50) vs. 130.00(80.00,195.00)μm,P=0.031], greater maximum lipid arc [(162.30±64.31) vs.(133.33±55.29)°,P=0.012],greater mean lipid arc[(123.51±44.46) vs.(107.11±44.84)°,P=0.049],longer lipid plaque length [4.75(2.93,7.20) vs. 3.40(2.20,5.30)mm,P=0.023] and greater lipid index [535.40(303.26,877.19) vs. 344.03(181.93,673.00),P=0.014].Besides, the number of fibrous plaques on each criminal coronary artery(P=0.038),the incidence of TCFA(P=0.006) and plaque rupture(P=0.007) were higher in high PLR group. Furthermore, PLR was negatively associated with FCT(R=0.205,P=0.020). Conclusions: High level of PLR may be associated with vulnerable plaque features in patients with ACS(ACS).PLR level has potential value in assessing non-culprit coronary atherosclerotic plaque vulnerability in patients with ACS.