老年冠心病患者白细胞计数、血脂及血糖水平与发生急性心肌梗死的相关性研究

Research on the Correlation between White Blood Cell Count,Serum Lipid,Blood Glucose and the Occurrence of Acute Myocardial Infarction in Elderly Coronary Atherosclerotic Heart Disease

目的探讨白细胞计数、低密度脂蛋白胆固醇(low density lipoprotein-cholesterol,LDL-C)、空腹血糖对老年冠心病发生急性心肌梗死(acute myocardial infarction,AMI)的预测价值。方法选取老年冠心病患者210例,根据临床表现及辅助检查结果分为病例组及对照组,比较两组一般资料及入院时血常规、血脂、空腹血糖、生化指标等临床资料;应用Logistic回归分析探讨老年冠心病发生AMI的危险因素,并采用受试者工作特征(receiver operating characteristic curve,ROC)曲线评价白细胞计数、LDL-C、空腹血糖对单独以及联合对老年冠心病患者发生AMI的预测。结果病例组的吸烟率、白细胞计数、C反应蛋白、谷草转氨酶、谷丙转氨酶、D-二聚体、空腹血糖、总胆固醇(total cholesterol,TC)、LDL-C及Gensini评分均高于对照组,左心室射血分数(left ventricular ejection fraction,LVEF)则较低,差异有统计学意义(P<0.05)。Logistic回归分析显示,白细胞计数(β=0.859,P<0.001,OR=2.361)、LDL-C(β=1.003,P=0.009,OR=2.728)、空腹血糖(β=0.495,P=0.007,OR=1.641)为老年冠心病患者发生急性心肌梗死的独立危险因素。ROC曲线分析显示,当空腹血糖、白细胞计数、LDL-C分别取截断值为4.895mmol/L、7.19×10^(9)/L、2.635mmol/L时,预测老年冠心病患者发生AMI的曲线下面积最大,分别为0.734、0.859及0.735。将三者联合的ROC曲线下面积为0.902。结论白细胞计数、LDL-C、空腹血糖与老年冠心病患者发生AMI相关,较高白细胞计数、LDL-C、空腹血糖水平提示较高的AMI风险,三者联合可作为其预测指标,具有更高的预测价值。

Objective To investigate the predictive value of white blood cell count,LDL-C and fasting blood glucose on the occurrence of AMI in elderly patients with coronary atherosclerotic heart disease(CAD).Methods A total of 210 elderly patients with CAD were selected and divided into the AMI group as the case group and the chronic CAD group as the control group based on clinical manifestations and laboratory and coronary angiography results.The general data,laboratory data,coronary angiography results,and other clinical information of the two groups were retrospectively analyzed.We used the Logistic regression analysis to explore the risk factors for acute myocardial infarction in elderly CAD patients and the receiver operating characteristic curve(ROC)to evaluate the predictive efficacy of white blood cell count,LDL-C and fasting blood glucose on the occurrence of AMI in elderly CAD patients.Results Compared with the chronic CAD group,the AMI group had a higher smoking rate,white blood cell count,CRP,ALT,AST,D-D dimer,fasting blood glucose,total cholesterol,LDL-C and Gensini score and lower LVEF(P<0.05).The Logistic regression analysis showed that white blood cell count(β=0.859,P<0.001,OR=2.361),LDL-C(β=1.003,P=0.009,OR=2.728)and fasting blood glucose(β=0.495,P=0.007,OR=1.641)were independent risk factors for AMI in elderly CAD patients.The ROC curve analysis showed that when the cut-off values of fasting blood glucose,white blood cell count,and LDL-C were 4.895mmol/L,7.19×10^(9)/L and 2.635 mmol/L respectively,the area under the curve for predicting AMI was the largest,with values of 0.734,0.859 and 0.735.The area under the ROC curve of the combination of the three is 0.902.Conclusion White blood cell count,LDL-C and fasting blood glucose are associated with AMI in elderly patients with CAD.Higher levels of white blood cell count,LDL-C and fasting blood glucose indicate a higher risk of AMI.The combination of the three can serve as a more valuable predictive index.