炎症指标对冠状动脉狭窄程度的预测价值

Predictive Value of Inflammation Indicators for the Severity of Coronary Artery Stenosis

目的评估炎症指标对冠状动脉狭窄程度的预测价值,寻找一种简单经济且特异性强的方法,及时、准确评估冠状动脉粥样硬化性心脏病(coronary heart disease,CHD)患者冠状动脉狭窄的发展和严重程度。方法回顾性收集2019年7月至2020年8月在重庆医科大学附属第一医院疑似CHD患者共212例的临床资料,根据冠状动脉造影将其分为CHD组(n=124)和非CHD组(n=88)。采用受试者工作特征曲线(receiver operating char⁃acteristic curve,ROC)分析炎症指标C-反应蛋白(C-reactive protein,CRP)、系统免疫炎症指数(systemic immune inflammatory index,SⅡ)、中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)和单核细胞/高密度脂蛋白胆固醇比值(monocyte to high-density lipoprotein cholesterol ratio,MHR)预测冠状动脉狭窄程度的性能。结果CHD组患者血清中的炎症指标CRP、SⅡ、NLR和MHR的水平均显著高于非CHD组患者,差异有统计学意义(P<0.05)。通过ROC分析结果可知,MHR预测冠状动脉狭窄的预测价值最好,ROC曲线下面积(area under the curve,AUC)最高[AUC=0.782(95%CI:0.718~0.846,P<0.001]。其次是SⅡ,AUC=0.780(95%CI:0.720~0.840,P<0.001);NLR和CRP的AUC分别为0.692(95%CI:0.623~0.762,P<0.001)和0.659(95%CI:0.586~0.732,P<0.001)。选择9.96作为MHR的最佳临界值时,MHR预测冠状动脉狭窄程度的灵敏度为78.2%,特异度为69.3%,阳性预测值为0.78,阴性预测值为0.69,约登指数为0.475。选择523.97作为SⅡ的最佳临界值时,SⅡ预测冠状动脉狭窄发生的灵敏度为69.4%,特异度为68.2%,阳性预测值为0.75,阴性预测值为0.61,约登指数为0.376。结论炎症指标SⅡ和MHR具有预测冠状动脉狭窄的价值,其中MHR的预测性能最好。

Objectives To evaluate the predictive value of inflammation indicators for the severity of coronary artery stenosis,and to find a simple,economical and highly specific method to timely and accurately assess the development and severity of coronary artery stenosis in patients with coronary heart disease(CHD).Methods The clinical data of 212 patients with suspected CHD in the First Affiliated Hospital of Chongqing Medical University from July 2019 to August 2020 were collected and divided into CHD group(n=124)and non-CHD group(n=88)according to coronary angiography.The performance of inflammatory markers C-reactive protein(CRP),systemic immune inflammatory index(SⅡ),neutrophil to lymphocyte ratio(NLR)and monocyte to high-density lipoprotein cholesterol ratio(MHR)in pre⁃dicting the severity of coronary artery stenosis was analyzed by receiver operating characteristic curve(ROC).Results The levels of serum inflammation indicators CRP,SⅡ,NLR and MHR in CHD group were significantly higher than those in non-CHD group,with statistical significance(P<0.05).According to the results of ROC analysis,MHR had the best predictive value in predicting coronary artery stenosis,and the area under the ROC curve(AUC)was the highest[AUC=0.782(95%CI:0.718-0.846,P<0.001)].Second by SⅡwith the AUC=0.780(95%CI:0.720-0.840,P<0.001).The AUC of NLR and CRP were 0.692(95%CI:0.623-0.762,P<0.001)and 0.659(95%CI:0.586-0.732,P<0.001),respectively.When 9.96 was selected as the optimal critical value of MHR,the sensitivity,specificity,positive predictive value,negative predictive value and Yauden index of MHR were 78.2%,69.3%,0.78,0.69,and 0.475,respectively.When 523.97 was selected as the optimal critical value of SⅡ,the sensitivity,specificity,positive predictive value,negative predictive value and Youten index of SⅡin predicting the occurrence of coronary artery stenosis were 69.4%,68.2%,0.75,0.61 and 0.376 respectively.Conclusions Inflammation indicators SⅡand MHR have the value of predict⁃ing coronary artery stenosis,between which MHR has the best predictive performance.