中性粒细胞与淋巴细胞比值联合脉压对冠心病诊断价值及冠心病发生影响因素分析

Value of Neutrophil-to-Lymphocyte Ratio Combined with Pulse Pressure in Diagnosis of Coronary Heart Disease and Analysis of Factors Influencing the Occurrence of Coronary Heart Disease

目的探讨中性粒细胞与淋巴细胞比值(NLR)联合脉压对冠心病诊断价值及冠心病发生影响因素分析。方法选取2018年1—12月就诊疑诊冠心病并行冠状动脉造影检查748例,根据冠状动脉造影检查结果将其分为冠心病组(553例)和非冠心病组(195例)两组。比较两组临床资料,应用Spearman相关性分析对冠心病患者NLR、脉压和中性粒细胞、淋巴细胞、Gensini评分的相关性进行分析,应用受试者工作特征(ROC)曲线探讨NLR、脉压和NLR联合脉压对冠心病的诊断价值,应用多因素Logistic回归分析探讨冠心病发生影响因素。结果冠心病组男性和有吸烟史、大量饮酒史、高血压病病史、糖尿病病史所占比例,以及年龄、收缩压、脉压、心率、白细胞、中性粒细胞、NLR、空腹血糖、尿酸和Gensini评分高于非冠心病组,有血脂异常史所占比例、淋巴细胞和高密度脂蛋白胆固醇低于非冠心病组,差异有统计学意义(P<0.05或P<0.01)。Spearman相关性分析结果显示,冠心病患者NLR与脉压、中性粒细胞和Gensini评分呈正相关,与淋巴细胞呈负相关;脉压与NLR、中性粒细胞和Gensini评分呈正相关,与淋巴细胞呈负相关(P<0.01)。ROC曲线分析结果显示,对冠心病诊断的曲线下面积NLR联合脉压大于NLR和脉压,差异有统计学意义(P<0.01)。多因素Logistic回归分析结果显示,有吸烟史、高血压病病史、糖尿病病史和脉压≥55 mmHg、白细胞≥10×10^(9)/L、NLR≥3.39为冠心病发生的独立危险因素(P<0.05或P<0.01)。结论NLR联合脉压对冠心病的诊断价值较高,有吸烟史、高血压病病史、糖尿病病史和脉压≥55 mmHg、白细胞≥10×10^(9)/L、NLR≥3.39为冠心病发生的独立危险因素。

Objective To study the value of neutrophil-to-lymphocyte ratio(NLR)combined with pulse pressure in diagnosis of coronary heart disease(CHD)and to analyze factors influencing the occurrence of CHD.Methods A total of 748 patients admitted from January to December 2018 for suspected CHD were selected for coronary angiography examinations,and the patients were divided into CHD group(n=553)and non-CHD group(n=195)according to results of coronary angiography.Clinical data was compared between two groups.Spearman correlation analysis was used to analyze correlations among NLR,pulse pressure,neutrophil,lymphocyte and Gensini scores in patients with CHD.Receiver operating characteristic curve(ROC)was used to evaluate values of NLR,pulse pressure and NLR combined with pulse pressure in diagnosis of CHD.Multivariate logistic regression analysis was used to investigate factors influencing the occurrence of CHD.Results In CHD group,proportions of males,having history of smoking,heavy alcohol consumption,hypertension history,diabetes history,as well as values of age,systolic blood pressure,pulse pressure,heart rate,leukocytes,neutrophils,NLR,fasting blood glucose,uric acid,and Gensini score were significantly higher,while the proportion of dyslipidemia history,levels of lymphocytes and high density lipoprotein cholesferol(HDL-C)were significantly lower than those in non-CHD group(P<0.05 or P<0.01).Spearman correlation analysis showed that NLR was positively correlated with pulse pressure,neutrophils,and Gensini score,and it was negatively correlated with lymphocytes in patients with CHD;pulse pressure was positively correlated with NLR,neutrophils and Gensini score,and it was negatively correlated with lymphocytes(P<0.01).ROC curve analysis showed that the area under the curve in diagnosis of CHD by NLR combined with pulse pressure was greater than those by NLR and pulse pressure only(P<0.01).Multivariate logistic regression analysis showed that smoking history,hypertension history,diabetes history,pulse pressure equal or more than 55 mmHg,leukocytes equal or more than 10×10^(9)/L and NLR equal or more than 3.39 were independent risk factors for the occurrence of CHD(P<0.05 or P<0.01).Conclusion NLR combined with pulse pressure has a high value in diagnosis of CHD.Smoking history,hypertension history,diabetes history,pulse pressure equal or more than 55 mmHg,leukocytes equal or more than 10×10^(9)/L and NLR equal or more than 3.39 are independent risk factors for the occurrence of CHD.