NLR与急性冠状动脉综合征中OCT诊断的冠状动脉斑块破裂的关系研究

Association of neutrophil to lymphocyte ratio with plaque rupture in acute coronary syndrome patients diagnosed by optical coherence tomography

目的:分析中性粒细胞与淋巴细胞比值(NLR)与急性冠状动脉综合征(acute coronary syndrome, ACS)患者光学相干断层扫描(optical coherence tomography, OCT)发现的冠状动脉(冠脉)斑块破裂的相关性。方法:入选2016年6月—2021年5月在上海交通大学医学院附属第九人民医院接受冠脉介入治疗并应用OCT进行冠脉病变评估的207例ACS患者为研究对象。根据OCT结果将所有受试者分为斑块破裂组(41例)和非斑块破裂组(166例),分析和比较两组间年龄、性别、心血管危险因素、心血管家族史、血常规、血脂等指标,及其与OCT诊断的冠脉斑块破裂的关系。结果:斑块破裂组年龄>65岁、性别为男性、有吸烟史人群的比例显著高于非破裂组。斑块破裂组患者的炎症指标[白细胞计数、中性粒细胞计数、C反应蛋白(CRP)水平]、肌钙蛋白I、低密度脂蛋白胆固醇(LDL-C)、NLR、血小板/淋巴细胞比值(PLR)均明显高于非斑块破裂组。其中,斑块破裂组的NLR水平显著高于非斑块破裂组,两组比较差异有统计学意义[3.33(1.94,6.34) vs 2.26(1.70,2.92),P<0.001]。多因素logistic回归分析提示,NLR与ACS患者发生斑块破裂具有一定相关性(OR=1.360,95%CI:1.092~1.695,P=0.006)。ROC曲线分析发现,NLR>2.81是预测ACS患者冠脉斑块破裂的临界点,敏感度为65.9%,特异度为73.5%。结论:NLR与ACS冠脉病变发生斑块破裂密切相关,在预测斑块的不稳定性和ACS危险分层中具有一定临床价值。

Objective: To analyze the correlation between neutrophil to lymphocyte ratio(NLR) and plaque rupture in patients with acute coronary syndrome(ACS). Methods: A total of 207 ACS patients who received coronary interventional procedures and optical coherence tomography(OCT) evaluations of coronary lesions at Shanghai Ninth People’s Hospital from June 2016 to May 2021 were enrolled in the present study. According to the findings of OCT, all the subjects were divided into a non-plaque rupture group(n=166) and plaque rupture group(n=41). The differences in clinical characteristics such as age, sex, risk factors of cardiovascular diseases and the family history of coronary artery disease and laboratory parameters including blood routine examination and blood lipid levels between the two groups were compared. The correlation between hematological indices and plaque rupture in ACS was also analyzed. Results: The proportion of patients aged>65, male and current smoking in plaque rupture group was significantly higher than that in non-rupture group. The inflammatory biomarkers(white blood cell count, neutrophil count, CRP level), troponin I, low density lipoprotein cholesterol(LDL-C), NLR and platelet to lymphocyte ratio(PLR) in plaque rupture group also significantly increased in comparison to non-rupture group. The NLR level in plaque rupture group was significantly higher than that in non-rupture group. The difference between the two groups was statistically significant[3.33(1.94, 6.34) vs 2.26(1.70, 2.92), P<0.001]. Multivariate Logistic regression analysis showed that NLR was closely correlated with plaque rupture in ACS patients(OR=1.360, 95%CI: 1.092—1.695, P=0.006). ROC curve analysis found a cutoff point of NLR>2.81 for plaque rupture with 65.9% sensitivity and 73.5% specificity. Conclusion: NLR is closely related to plaque rupture events in coronary lesions, and is associated with plaque rupture events in patients with acute coronary syndrome and can be used to predict plaque stability, early identification of vulnerable plaques, and risk stratification.