中性粒细胞和淋巴细胞的比值及单核细胞和淋巴细胞的比值与早发冠心病的相关性分析

Correlation of Neutrophil to Lymphocyte Ratio and Monocyte to Lymphocyte Ratio and premature coronary artery disease

目的探讨中性粒细胞和淋巴细胞的比值(NLR)及单核细胞和淋巴细胞的比值(MLR)在早发冠心病人群中的分布特征及是否与早发冠心病患者的冠状动脉病变严重程度相关。方法收集2020年8月至2021年2月就诊于陕西省人民医院因胸痛疑诊冠心病,男性<55岁,女性<65岁的患者247例,均行冠状动脉造影,其中早发冠心病组143例,包括稳定性冠心病(SCAD)组47例,非ST段抬高型急性冠状动脉综合征(NSTE-ACS)组49例和ST段抬高型心肌梗死(STEMI)组47例,除外早发冠心病的104例为对照组。比较NLR、MLR在两组患者中的分布特征,分析NLR、MLR与早发冠心病Gensini积分的相关性及早发冠心病的独立危险因素。结果与对照组相比,早发冠心病组的NLR及MLR的水平明显高(3.79比2.08,Z=-7.01,P<0.001,0.34比0.24,Z=-5.65,P<0.001)。NLR水平在STEMI组>NSTE-ACS组及SCAD组(P<0.05),NSTEACS组>SCAD组(P<0.05);MLR水平在STEMI组>NSTE-ACS组及SCAD组(P<0.05),但NSTE-ACS组和SCAD组的MLR水平差异无统计学意义(P>0.05)。NLR、MLR水平与Gensini评分之间存在正相关(r=0.383,P<0.05;r=0.285,P<0.05)。多因素logistic回归分析,NLR(OR=1.288,95%CI 1.067~1.547,P=0.01)和MLR(OR=3.270,95%CI 2.414~8.585,P=0.03)是早发冠心病的独立危险因素。NLR诊断早发冠心病的界值点为2.28,(敏感度74.1%,特异度63.5%),MLR诊断早发冠心病的界值点为0.248,(敏感度72%,特异度56.7%)。结论 NLR和MLR水平与早发冠心病患者的冠脉状动严重程度相关,是早发冠心病的独立危险因素。

Objective To investigate the distribution characteristics of the ratio of neutrophils to lymphocytes(NLR) and the ratio of monocytes to lymphocytes(MLR) in patients with premature coronary artery disease and the relation to the severity of coronary artery disease. Methods 247 patients with suspected coronary artery disease due to chest pain from August 2020 to February 2021 at Shaanxi Provincial People’s Hospital,males <55 years old and females <65 years old, all underwent coronary angiography, of which premature coronary artery disease group of 143 cases, including 47 cases of stable coronary artery disease group, 49 cases of non-STelevation acute coronary syndrome group and 47 cases of ST-elevation myocardial infarction group;and 104 cases except for premature coronary artery disease served as the control group. The distribution characteristics of NLR and MLR in the two groups of patients and the correlation between NLR, MLR and the Gensini score of premature coronary artery disease and the independent risk factors were analyzed. Results Compared with the control group,the levels of NLR and MLR in the premature coronary artery disease group were significantly higher(3.79 vs 2.08,Z=-7.01, P<0.001, 0.34 vs 0.24, Z=-5.65, P<0.001). The NLR level of STEMI group was higher than those of the NSTE-ACS group and SCAD group(P<0.05);and the NLR level of NSTE-ACS group was higher than the SCAD group(P<0.05). The MLR level of the STEMI group was higher than the NSTE-ACS group and SCAD group(P<0.05), but there was no statistically significant difference in MLR levels between the NSTE-ACS group and the SCAD group(P>0.05). There was a positive correlation between the levels of NLR, MLR and Gensini score(r=0.383, P<0.05;r=0.285, P<0.05). Multivariate logistic regression analysis showed that NLR(OR=1.288, 95%CI1.067~1.547, P=0.01) and MLR(OR=3.270, 95%CI 2.414~8.585, P=0.03) were the independent risk factors of premature coronary artery disease. The cut-off point of NLR for diagnosing premature coronary artery disease was 2.28,(sensitivity 74.1%, specificity 63.5%) and the cutoff point of MLR for diagnosing premature coronary artery disease was 0.248,(sensitivity 72%, specificity 56.7%). Conclusion The levels of NLR and MLR are related to the severity of coronary artery injury in patients with premature coronary artery disease and are the independent risk factors for premature coronary artery disease.