急性冠状动脉综合征患者血清中性粒细胞百分比与白蛋白比值与冠状动脉分层斑块的相关性

Association between serum neutrophil percentage to albumin ratio and coronary arterylayered plaque in patients with acute coronary syndrome

[目的]研究血清中性粒细胞百分比与白蛋白比值(NPAR)水平与急性冠状动脉综合征(ACS)患者冠状动脉分层斑块的相关性。[方法]选取2018年1月—2023年1月于新疆医科大学第一附属医院心脏中心行冠状动脉造影(CAG)和造影后即刻对罪犯血管行光学相干断层成像(OCT)检查并确诊为ACS的患者222例作为研究对象,根据图像结果分为分层斑块组111例和非分层斑块组111例。比较分层斑块组和非分层斑块组血清NPAR水平,采用多因素Logistic回归分析法分析冠状动脉分层斑块的影响因素。[结果]与非分层斑块组比较,分层斑块组的饮酒史、管腔狭窄率、中性粒细胞百分比水平、NPAR水平高于非分层斑块组,白蛋白水平低于非分层斑块组,差异均有统计学意义(P<0.05)。OCT特性比较,分层斑块组脂质弧更大、纤维帽厚度更薄、巨噬细胞浸润率更高、易损斑块、斑块破裂、胆固醇结晶、滋养血管、血栓、钙化小结、钙化斑块检出率更高,纤维斑块检出率更低,差异均有统计学意义(P<0.05)。Spearman相关分析显示,血清NPAR与斑块破裂、薄纤维帽粥样斑块(TCFA)表现为正相关(r=0.436、r=0.622,均P<0.05)。多因素Logistic回归分析显示,高水平的NPAR是ACS患者罪犯血管发生分层斑块的独立危险因素(OR=10.186,95%CI:3.242~31.999,P<0.001)。[结论]分层斑块与斑块不稳定特性相关,血清NPAR水平在ACS罪犯血管分层斑块患者中升高,是ACS患者冠状动脉分层斑块的独立危险因素。

Aim To explore the association between serum neutrophil percentage to albumin ratio(NPAR)level and coronary artery layered plaque in patients with acute coronary syndrome(ACS).Methods 222 patients who underwent coronary angiography(CAG)and optical coherence tomography(OCT)examination of culprit vessels immediately after angiography at the Heart Center of the First Affiliated Hospital of Xinjiang Medical University from January 2018 to January 2023 and diagnosed with ACS were selected as the study subjects,and they were classified into 111 cases of layered plaque and 111 cases of non-layered plaque according to the OCT image results.Serum NPAR level was compared between the layered plaque group and the non-layered plaque group,and the influencing factors of coronary artery layered plaque were analyzed by multivariate Logistic regression analysis.Results Comparing the clinical and biochemical index data between the layered plaque group and the non-layered plaque group,the history of alcohol consumption,lumen stenosis rate,neutrophil percentage level,NPAR level was higher in the layered plaque group than that in the non-layered plaque group, and the albumin level was lower than that in the non-layered plaque group, the differences were statisticallysignificant (P<0. 05). Comparison of the OCT characteristics showed that lipid arcs were larger and fibrous cap thicknesswas thinner, macrophage infiltration rate was higher, vulnerable plaques, plaque rupture, cholesterol crystals, microvessels,thrombus, calcified nodules, calcified plaques were detected at a higher rate, and fibrous plaques were detected at alower rate in the layered plaque group, and the differences were all statistically significant (P<0. 05). Spearman correlationanalysis showed that the serum NPAR a positive correlation with the rupture of plaques, and the TCFA (r =0. 436 andr =0. 622, respectively, both P<0. 05). Multivariate Logistic regression analysis showed that high level of NPAR was anindependent risk factor for the development of layered plaque in culprit vessels in ACS patients (OR=10. 186, 95% CI:3. 242 ~31. 999, P<0. 001). Conclusion Layered plaque is associated with plaque vulnerability characteristics, andserum NPAR level is elevated in patients with layered plaque in culprit vessels with ACS, which is an independent risk factorfor coronary layered plaque in ACS patients.