急性冠状动脉综合征患者血清中性粒细胞/淋巴细胞比值、血小板/淋巴细胞比值水平对冠状动脉病变程度及院内主要不良心血管事件的评估价值

The value of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in evaluating the degree of coronary artery stenosis and the occurrence of major cardiovascular adverse events in patients with acute coronary syndrome

目的探讨急性冠状动脉综合征(ACS)患者中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)与冠状动脉狭窄程度及院内主要不良心血管事件(MACE)发生的关系。方法收集2018年4月至2020年4月于新疆医科大学第一附属医院初次行冠状动脉造影ACS患者(426例)的临床基本资料、实验室参数,根据住院MACE情况,将纳入的患者分为MACE组(104例)和无MACE组(322例)。根据Gensini评分的三分位数,将患者分为三组:低Gensini组(≤34分,143例),中Gensini组(34~58分,142例),高Gensini组(>58分,141例),使用t检验、方差分析、卡方检验、非参数Mann-Whitney U检验、Kruskal-Wallish H检验、logistic回归分析和受试者工作特性曲线等统计方法对数据进行分析。结果MACE组NLR[4.48(2.42,7.47)比2.82(1.79,4.70),P<0.001]和PLR[133.21(92.88,190.25)比101.03(75.33,134.01),P<0.001]显著高于无MACE组,差异有统计学意义。在基于Gensini评分分组的三组中,低Gensini组、中Gensini组、高Gensini组NLR[3.59(1.56,3.58)比3.47(1.94,5.73)比3.71(2.13,6.21),P<0.001]、PLR[93.98(66.03,127.94)比110.90(88.26,140.79)比120.37(84.58,174.54),P<0.001]比较,差异均有统计学意义。logistic回归分析显示,NLR(OR 1.189,95%CI 1.003~1.409,P=0.046;OR 1.102,95%CI 1.005~1.208,P=0.039)、PLR(OR 1.008,95%CI 1.002~1.014,P=0.021;OR 1.004,95%CI 1.002~1.009,P=0.042)是院内MACE和高Gensini评分的独立危险因素。NLR预测院内MACE发生的截断值为4.516,敏感度为50.00%,特异度为74.53%,曲线下面积(AUC)为0.633(95%CI 0.585~0.679,P<0.001);PLR预测院内MACE发生的截断值为153.103,敏感度为45.19%,特异度为84.78%,AUC为0.666(95%CI 0.619~0.711,P<0.001)。NLR预测高Gensini评分(>58分)的截断值为3.802,敏感度为49.62%,特异度为66.44%(AUC=0.600,95%CI 0.552~0.647,P<0.001);PLR预测高Gensini评分的截断值为153.543,敏感度为37.40%,特异度为84.75%(AUC=0.616,95%CI 0.567~0.662,P<0.001)。结论NLR、PLR作为一种新的炎症标志物,与ACS患者院内MACE的发生和冠状动脉狭窄的严重程度有显著的独立相关性。NLR、PLR作为一种容易获得且价格便宜的炎症指标,可作为有效的炎症标志物广泛应用于鉴别高危患者,从而有助于指导个体化治疗以改善ACS预后。

Objective To investigate the relationship between neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR)and the degree of coronary artery stenosis,the occurrence of major cardiovascular adverse event(MACE)in patients with acute coronary syndrome(ACS).Methods The demographic,clinical and laboratory parameters of 426 ACS patients who underwent coronary angiography for the first time in our hospital from 2018-04 to 2020-04 were collected.According to the presence of in-hospital MACE,the patients were divided into MACE group(n=104)and non-MACE group(n=322).According to the tertiles of Gensini scores,patients were divided into three groups:low Gensini group(≤34 points,n=143),medium Gensini group(34–58 points,n=142),and high Gensini group(>58 points,n=141).The data were analyzed by t test,variance analysis,chi-square test,non-parametric Mann-Whitney U test,Kruskal-Wallish H test,logistic regression analysis,and receiver operating characteristic curve.Results The NLR and PLR values of the MACE group were significantly higher than those of the non-MACE group[4.48(2.42,7.47)vs.2.82(1.79,4.70),P<0.001;133.21(92.88,190.25)vs.101.03(75.33,134.01),P<0.001].There were significant diff erences in NLR and PLR among the tertiles of Gensini[3.59(1.56,3.58)vs.3.47(1.94,5.73)vs.3.71(2.13,6.21),P<0.001;93.98(66.03,127.94)vs.110.90(88.26,140.79)vs.120.37(84.58,174.54),P<0.001].NLR and PLR were independent risk factors of in-hospital MACE(OR 1.189,95%CI 1.003-1.409,P=0.046;OR 1.008,95%CI 1.002-1.014,P=0.021)and severe ACS assessed by the Gensini(OR 1.102,95%CI 1.005-1.208,P=0.039;OR 1.004,95%CI 1.002-1.009,P=0.042).The cut-off value of NLR predicted the occurrence of MACE in the hospital was 4.516,sensitivity was 50.00%,and specifi city was 74.53%[area under curve(AUC)0.633,95%CI 0.585-0.679,P<0.001].The cut-off value of PLR in predicting MACE in hospital was 153.103,sensitivity 45.19%,specificity 84.78%(AUC=0.666,95%CI 0.619-0.711,P<0.001).NLR predicted high Gensini(>58 points)with an cutoff point of 3.802,a sensitivity of 49.62%,and a specifi city of 66.44%(AUC=0.600,95%CI 0.552-0.647,P<0.001).PLR predicted high Gensini with a cut-off point of 153.543,a sensitivity of 37.40%,and a specifi city of 84.75%(AUC=0.616,95%CI 0.567-0.662,P<0.001).Conclusions As new infl ammatory markers,NLR and PLR have signifi cant independent correlation with the occurrence of MACE and the severity of coronary stenosis in ACS patients.As readily available and inexpensive inflammatory markers,NLR and PLR can be widely used as eff ective infl ammatory markers to identify high-risk patients.Thus,it is helpful to guide the individualized treatment to improve the prognosis of ACS.