NLR联合LDL-C/HDL-C比值与ACS患者冠状动脉病变严重程度的相关性分析

Correlation between neutrophil/lymphocyte ratio combined with low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio and severity of coronary artery disease in patients with acute coronary syndrome

目的:分析中性粒细胞/淋巴细胞比值(NLR)联合低密度脂蛋白胆固醇/高密度脂蛋白胆固醇比值(LDL-C/HDL-C)与急性冠脉综合征(ACS)患者冠状动脉(冠脉)病变严重程度的相关性。方法:选择2017年1月至2020年6月中国科学技术大学附属第一医院和安徽医科大学附属医院因胸痛诊断ACS并接受急诊冠脉造影的患者。收集患者的性别、年龄、体质量指数(BMI)、既往史以及入院时急诊血常规指标〔中性粒细胞计数(NEU)、淋巴细胞计数(LYM)、NLR、单核细胞计数(MON)、嗜酸粒细胞计数(EOS)、嗜碱粒细胞计数(BAS)、红细胞计数(RBC)、平均红细胞体积(MCV)、红细胞体积分布宽度(RDW)、平均血小板体积(MPV)、血小板体积分布宽度(PDW)〕和血脂指标〔总胆固醇(TC)、三酰甘油(TG)、LDL-C、HDL-C、极低密度脂蛋白胆固醇(VLDL-C)〕以及冠脉造影检查等资料。采用冠脉Gensini评分评定冠脉造影结果,根据Gensini评分将患者分为对照组(Gensini评分=0分,55例)和研究组(Gensini评分>0分,889例);再将研究组患者分为低评分组(Gensini评分<66分,419例)和高评分组(Gensini评分≥66分,470例)。比较各组间上述指标的差异;采用线性分析有统计学意义的变量与Gensini评分之间的相关性;采用Logistic回归分析得到联合诊断因子(NLR联合LDL-C/HDL-C比值),绘制受试者工作特征曲线(ROC曲线),评估NLR联合LDL-C/HDL-C比值预测ACS患者冠脉病变严重程度的预测价值;采用多因素线性回归分析建立NLR、LDL-C/HDL-C比值与Gensini评分之间的预测模型。结果:最终纳入944例ACS患者。对照组和研究组的性别、年龄、BMI、高血压、糖尿病、吸烟史、NEU、LYM、MON、EOS、RDW、TC、HDL-C、LDL-C、NLR、LDL-C/HDL-C比值比较差异均有统计学意义;低评分组和高评分组的BMI、高血压、糖尿病、吸烟史、NEU、LYM、MON、EOS、TG、TC、HDL-C、LDL-C、NLR、LDL-C/HDL-C比值比较差异均有统计学意义。线性回归分析显示,与其他指标相比,研究组NLR和LDL-C/HDL-C比值与Gensini评分之间的相关性更强(r值分别为0.634、0.663,均P<0.05)。将与Gensini评分相关的指标进行二元Logistic回归分析,结果显示,NEU、LYM、HDL-C和LDL-C是ACS患者冠脉狭窄的独立危险因素〔优势比(OR)分别为0.189、10.309、13.993、0.251,95%可信区间(95%CI)分别为0.114~0.313、4.679~22.714、3.402~57.559、0.121~0.519,均P<0.05〕。ROC曲线分析显示,NLR联合LDL-C/HDL-C比值预测ACS患者冠脉病变严重程度的预测价值更高〔ROC曲线下面积(AUC)为0.952,95%CI为0.935~0.969〕,当截断值为-3.15时,敏感度为98.20%,特异度为81.60%。根据多因素线性回归分析结果,建立NLR、LDL-C/HDL-C比值与Gensini评分之间的预测模型,其公式为Gensini评分=-7.772+15.675×LDL-C/HDL-C比值+8.288×NLR(R2=0.862)。结论:ACS患者入院时急诊NLR联合LDL-C/HDL-C比值与Gensini评分之间有明显相关性,对ACS患者冠脉严重程度有一定预测价值,可以成为评估ACS患者冠脉病变严重程度的预测因子。

Objective To investigate the correlation between neutrophil/lymphocyte ratio(NLR)combined with low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio(LDL-C/HDL-C)and severity of coronary lesions in patients with acute coronary syndrome(ACS).Methods Patients who were diagnosed with ACS due to chest pain and received emergency coronary angiography in the First Affiliated Hospital of University of Science and Technology of China and the Affiliated Hospital of Anhui Medical University from January 2017 to June 2020 were enrolled in the final analysis.The data of gender,age,body mass index(BMI),past history,emergency blood routine indicators[neutrophil(NEU),lymphocyte(LYM),monocyte(MON),eosinophil(EOS),basophil(BAS),red blood cell(RBC),mean corpuscular volume(MCV),blood red cell distribution width(RDW),mean platelet volume(MPV),platelet volume distribution width(PDW)],blood lipid index[triglyceride(TG),total cholesterol(TC),HDL-C,LDL-C,very low-density lipoprotein cholesterol(VLDL-C)],and coronary angiography were collected.The results of coronary angiography were evaluated by the Gensini score.According to the Gensini score,the patients were divided into the control group(Gensini score=0,55 cases)and the study group(Gensini score>0,889 cases),and then the patients in the study group were divided into the low-Gensini-score group(Gensini score<66,419 cases)and the high-Gensini-score group(Gensini score≥66,470 cases).The differences in the general baseline data of the four groups were compared,and the correlation between the statistically significant data and the Gensini score was linearly analyzed,and then the combined diagnostic factors(NLR combined with LDL-C/HDL-C ratio)were obtained by Logistic regression analysis.The receiver operator characteristic curve(ROC curve)was used to evaluate the predictive value of NLR combined with LDL-C/HDL-C ratio in predicting the severity of coronary artery lesions in patients with ACS.Finally,multivariate linear regression analysis was used to establish the predictive model between NLR combined with LDL-C/HDL-C ratio and Gensini score.Results A total of 944 patients were finally included.The differences in gender,age,BMI,hypertension,diabetes,smoking history,NEU,LYM,MON,EOS,RDW,TC,HDL-C,LDL-C,NLR,LDL-C/HDL-C ratio between the control group and the study group were statistically significant.The differences in BMI,hypertension,diabetes,smoking history,NEU,LYM,MON,EOS,TG,TC,HDL-C,LDL-C,NLR and LDL-C/HDL-C ratio between the low-Gensini-score group and the high-Gensini-score group were statistically significant.Linear regression analysis showed that compared with other indicators,the correlation between NLR,LDL-C/HDL-C ratio and Gensini score was stronger in the study group(r values were 0.634 and 0.663,respectively,both P<0.05).Binary Logistic regression analysis of the indicators related to Gensini score showed that NEU,LYM,HDL-C and LDL-C were independent risk factors for coronary stenosis in patients with ACS[odds ratio(OR)were 0.189,10.309,13.993,0.251,95%confidence intervals(95%CI)were 0.114-0.313,4.679-22.714,3.402-57.559,0.121-0.519,respectively,all P<0.05].ROC curve analysis showed that NLR combined with LDL-C/HDL-C ratio had higher predictive value in predicting the severity of coronary lesions in ACS patients[area under the ROC curve(AUC)was 0.952,95%CI was 0.93-0.969],when the cutoff value was-3.152,the sensitivity was 98.20%,and the specificity was 81.60%.According to the results of multivariate linear regression analysis,the prediction model between NLR,LDL-C/HDL-C ratio and Gensini score was established,and the formula was Gensini score=-7.772+15.675×LDL-C/HDL-C ratio+8.288×NLR(R2=0.862).Conclusion There is a significant correlation between emergency NLR combined with LDL-C/HDL-C ratio and Gensini score in patients with ACS at admission,which has a certain predictive value for the severity of coronary artery stenosis in patients with ACS,and can be used as a predictor for evaluating the severity of coronary artery disease.