NLR与NSTE-ACS冠脉病变程度及PCI术后心血管终点事件的相关性

The correlation between neutrophil-to-lymphocyte ratio and coronary artery lesion severity as well as cardiovascular end point events after percutaneous coronary intervention in patients with non-ST-elevation acute coronary syndrome

目的探讨中性粒细胞与淋巴细胞比值(NLR)与非ST段抬高急性冠脉综合征(NSTE-ACS)患者的冠状动脉病变程度以及经皮冠状动脉介入治疗术(percutaneous coronary intervention,PCI)后心血管终点事件发生的相关性。方法选择2010年8月至2011年5月确诊为NST-ACS并行PCI治疗的患者共206例作为研究对象,应用Gensini评分计算冠脉病变程度并检测外周血白细胞分类计数计算NLR。入组的患者根据Gensini评分分为低分组(<46.5分)、高分组(≥46.5分),患者随访5年,观察是否发生心血管终点事件来评估预后。结果2组年龄、性别、吸烟史、糖尿病患病率、高血压病患病率、NLR水平、LVEF和BNP差异有统计学意义(P<0.05)。经二元逐步Logistic回归分析结果显示高NLR值(OR:3.302,95%CI:2.208~4.940,P=0.000)、吸烟(比值比OR:3.112,95%CI:1.408~6.879,P=0.005)、年龄(OR:1.075,95%CI:1.031~1.120)均为冠脉严重病变程度的独立预测因子。单因素线性相关分析显示:NLR与冠脉病变严重程度呈正相关(r=0.477,P<0.01)。按照出院后心血管终点事件的发生与否将纳入患者分成事件组(45例)与非事件组(161例),其中,事件组糖尿病患病率、NLR水平、BNP水平明显高于非事件组(P<0.05)。ROC曲线分析结果显示:NLR预测冠心病患者PCI术后发生心血管终点事件的曲线下面积(AUC)为0.682(95%可信区间:0.594~0.770,P<0.05),当NLR切点(最佳临界值)取2.615时,其诊断效率最高,敏感性为73.3%,特异性为60.2%。结论NLR是NST-ACS的独立危险因素,对冠脉病变程度与心血管事件的发生具有一定的预测价值。

Objective To investigate the correlation between neutrophil-to-lymphocyte ratio(NLR)and coronary artery lesion severity as well as cardiovascular end point events after percutaneous coronary intervention(PCI)in patients with non-ST-elevation acute coronary syndrome(NSTE-ACS).Methods A total of 206 patients with NST-ACS who were treated by PCI in our hospital from August 2010 to May 2011 were enrolled in the study,who were divided into low score group(<46.5 points)and high score group(≥46.5 points)according to Gensini scores.The Gensini scoring was used to evaluate the severity of coronary artery lesion,and the peripheral white blood cell count was performed to calculate NLR.All the patients were followed up for 5 years,and the incidence of cadiovascular end point events was observed.Results There were significant differences in patient’s age and gender,smoking history,prevalence of hypertension and diabetes mellitus,the levels of NLR,LVEF and BNP between the two groups(P<0.05).The binary stepwise Logistic regression analysis showed that NLR value,smoking and age were independent predictive factors of the severity of coronary artery lesion(P<0.05).The single factor linear correlation analysis showed that NLR was closely correlated with the severity of coronary artery lesion(P<0.05).The patients were divided into event group(n=45)and no event group(n=161)according the incidence of cadiovascular end point events after discharging from hospital,in which,the prevalence of diabetes mellitus,the levels of BNP and NLR in event group were significantly higher than those in no event group(P<0.05).ROC curve analysis results showed that the AUC of NLR in predicting the incidence of cadiovascular end point events after discharging from hospital was 0.682(95%confidence interval:0.594~0.770,P<0.05).When the NLR value was taken as 2.615,its diagnostic efficiency was the highest,with sensitivity and specificity being 73.3%,60.2%,respectively.Conclusion NLR is not only an independent risk predictor of NSTE-ACS,but also can reflect the severity of coronary lesions,which can also predict the incidence of cardiovascular end point events after PCI.