The correlation between the monocyte-to-lymphocyte count ratio and the onset,progression and prognosis of common cardiovascular diseases

Background With the continuous exploration of cardiovascular diseases,research has found that inflammatory reactions play an important role in the pathogenesis of cardiovascular diseases.In recent years,the ratio of monocyte to lymphocyte counts(MLR)has attracted widespread attention as a novel inflammatory marker.Therefore,this article will focus on the value of MLR in terms of prevalence risk,severity and prognosis in common cardiovascular diseases.[S Chin J Cardiol 2024;25(3):200-206]

Monocyte-to-lymphocyte ratio as a prognostic factor in peripheral whole blood samples of colorectal cancer patients

BACKGROUND Colorectal cancer is the third most common malignancy worldwide.Therefore,it is critically important to identify new useful markers that can be easily obtained in routine practice.Inflammation is a crucial issue in the pathogenesis and development of cancer.AIM To evaluate the prognostic value of absolute monocyte count,monocyte to lymphocyte ratio(MLR),the combination of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio(NLR-PLR),and combined platelet and neutrophilto-lymphocyte ratio(PLT-NLR)in peripheral blood samples of patients with colorectal cancer undergoing surgery.METHODS We conducted a retrospective study of 160 patients with colorectal cancer who underwent surgery,and 42 healthy controls.The status of absolute monocyte count,MLR,NLR-PLR and PLT-NLR was calculated on the basis of blood samples obtained before and after surgery.Haematologic factors were examined in correlation with the type of tumour growth,tumour size,histological type,percentage of mucinous component,grade of malignancy,Tumour-Node-Metastasis stage,venous,lymphatic and perineural invasion of cancer cells,status of lymph node invasion and the presence of cancer cell deposits.The Kaplan-Meier method and the long-rank test were used to compare survival curves.To determine independent prognostic factors,univariate and multivariate Cox proportional hazards regression models were applied.RESULTS The PLT-NLR status was correlated with tumour size and the presence of perineural invasion(P=0.015;P=-0.174,P=0.037).Moreover,high NLR-PLR and PLR-NLR ratios in the blood samples obtained after surgery were positively associated with histological type of cancer and percentage of the mucinous component(NLR-PLR:P=0.002;P=0.009;PLR-NLR status:P=0.002;P=0.007).The analysis of 5-year disease-free survival showed that the MLR of whole blood obtained after surgery[HR=2.903,95%CI:(1.368-6.158),P=0.005]and the status of lymph node metastasis[HR=0.813,95%CI:(0.653-1.013),P=0.050]were independent prognostic factors in colorectal cancer patients.CONCLUSION The postoperative MLR in whole blood samples can be used as an independent prognostic factor in patients diagnosed with colorectal cancer.

Absolute monocyte and lymphocyte count prognostic score for patients with gastric cancer

AIM:To measure the prognostic significance of absolute monocyte count/absolute lymphocyte count prognostic score(AMLPS) in patients with gastric cancer.METHODS:We retrospectively examined the combination of absolute monocyte count(AMC) and absolute lymphocyte count(ALC) as prognostic variables in a cohort of 299 gastric cancer patients who underwent surgical resection between 2006 and 2013 and were followed at a single institution.Both AMC and ALC were dichotomized into two groups using cut-off points determined by receiving operator characteristic curve analysis.An AMLPS was generated,which stratified patients into three risk groups:low risk(both low AMC and high ALC),intermediate risk(either high AMC or low ALC),and high risk(both high AMC and low ALC).The primary objective of the study was to validate the impact of AMLPS on both disease-free survival(DFS) and overall survival(OS),and the second objective was to assess the AMLPS as an independent prognostic factor for survival in comparison with known prognostic factors.RESULTS:Using data from the entire cohort,the most discriminative cut-off values of AMC and ALC selected on the receiver operating characteristic curve were 672.4/μL and 1734/μL for DFS and OS.AMLPS risk groups included 158(52.8%) patients in the lowrisk,128(42.8%) in the intermediate-risk,and 13(4.3%) in the high-risk group.With a median followup of 37.2 mo(range:1.7-91.4 mo),five-year DFS rates in the low-,intermediate-,and high-risk groups were 83.4%,78.7%,and 19.8%,respectively.And fiveyear OS rates in the low-,intermediate-,and high-risk groups were 89.3%,81.1%,and 14.4%,respectively.On multivariate analysis performed with patient- and tumor-related factors,we identified AMLPS,age,and pathologic tumor-node-metastasis stage as the most valuable prognostic factors impacting DFS and OS.CONCLUSION:AMLPS identified patients with a poor DFS and OS,and it was independent of age,pathologic stage,and various inflammatory markers.

Elevated peripheral blood lymphocyte- to-monocyte ratio predicts a favorable prognosis in the patients with metastatic nasopharyngeal carcinoma

Introduction:Patients with metastatic nasopharyngeal carcinoma(NPC)have variable survival outcomes.We have previously shown that an elevated peripheral blood lymphocyte-to-monocyte ratio(LMR)is associated with an increased metastatic risk in patients with primary NPC.The present study aimed to investigate the prognostic value of pretreatment LMR in a large cohort of metastatic NPC patients.Methods:Clinical data of 672 patients with metastatic NPC diagnosed between January 2003 and December2009 were analyzed.The peripheral lymphocyte and monocyte counts were retrieved,and LMR was calculated.Receiver operating characteristic(ROC)curve analysis and univariate and multivariate COX proportional hazards analyses were performed to evaluate the association of LMR with overall survival(OS).Results:Univariate analysis revealed that an elevated absolute lymphocyte count(≥1.390×109/L)and LMR(≥2.475)as well as a decreased monocyte count(<0.665×109/L)were significantly associated with prolonged OS.Multivariate Cox proportional hazard analysis showed that LMR(hazard ratio[HR]=0.50,95%confidence interval[CI]=0.41–0.60,P<0.001),absolute lymphocyte count(HR=0.77,95%CI=0.64–0.93,P=0.007),and monocyte count(HR=1.98,95%CI=1.63–2.41,P<0.001)were independent prognostic factors.By stratification analyses,only LMR remained a significant predictor of prognosis.Conclusion:We identified pretreatment LMR as an independent prognostic factor for patients with metastatic NPC.Independent validation of our findings is needed.

Diagnostic value of biomarkers for sepsis in adult patients in the emergency department: Don't forget the neutrophil-lymphocyte count ratio

Objective: To determine and compare the diagnostic efficiency of various biomarkers [C-reactive protein, neutrophil percentage, neutrophil-lymphocyte ratio (NLCR), lactate, procalcitonin, blood culture] in the identification of septic patients in emergency department (ED), and to assess the predictive value of combination of markers. Methods: This was a prospective, single centre study conducted in the ED of an urban, tertiary care hospital. We included patients who were admitted to the ED with symptoms of a possible infection. Blood cultures and serum measurement of the biomarkers were collected from 131 patients. Patients were determined to be septic or non-septic, based on the systemic inflammatory response syndrome criteria and the diagnosis was made at the ED. Sensitivity, specificity, positive predictive value, negative predictive value and area under curves (AUC) were calculated. Results: A total of 126 patients, 61 with sepsis and 65 without sepsis were eventually included in the study. Neutrophil to lymphocyte ratio displayed the highest accuracy in diagnosing sepsis (AUC 0.735, 95% CI=0648-0.822, P<0.001). The best combination of markers in predicting sepsis was NLCR and white blood cell (AUC: 0.801, 95% CI=0.724-0.878, P<0.001). Conclusions: The results of this small study showed that NLCR outperforms other markers in diagnosing sepsis in ED. It is readily available, cost efficient, non invasive and independent. It may be insufficient to rely on this single marker to diagnose sepsis, so some other diagnostic utilities should be taken into account as one part of the overall assessment. Our study also showed that combination of NLCR and white blood cell provides the highest diagnostic accuracy. More large scale studies across different population groups will be needed to confirm this finding.

The Lower Peripheral Blood Lymphocyte to Monocyte Ratio Following Completion of First Line Chemotherapy Is a Risk Factor for Predicting Relapse in Patients with Diffuse Large B-Cell Lymphoma

Background and objective: During routine follow up, there is no specific predictor to ascertain relapse after standard first line chemotherapy in diffuse large cell lymphoma. Therefore, this study was designed to assess the prognostic significance of the ratio between absolute lymphocyte and monocyte counts (LMR) in the peripheral blood to verify relapse in diffuse large B cell lymphoma. Patients and methods: A total of 139 patients with newly diagnosed diffuse large B cell lymphoma (DLBCL) were evaluated and treated with CHOP or R-CHOP between the years 2009 and 2016. Three months following completion of first line therapy, Lymphocyte/monocyte ratio (LMR) was calculated from the routine automated complete blood cell count (CBC) attained a plateau after the bone marrow recovery after first line chemotherapy. The absolute lymphocyte count/absolute monocyte count ratio (LMR) was calculated by dividing the ALC by the AMC. Results: ROC curve analysis of 139 patients established 2.8 as cutoff point of LMR for relapse with AUC of 0.97 (95% CI 0.93 - 0.99, P ≤ 0.001). Cox regression analysis was performed to identify factors predicting relapse. In univariate regression analysis, ALC (95% CI 0.003 - 0.03, p ≤ 0.001), AMC (95% CI 15.4 - 128.8, p ≤ 0.001), LMR (95% CI 0.001 - 0.01, p ≤ 0.001), and LDH (95% CI 0.1 - 0.5, p ≤ 0.001) following completion of therapy are significant factors for relapse. Other significant factors for relapse are Ann Arbor stage (95% CI 1.1 - 6.9, P = 0.03), extranodal sites (95% CI 1.2 - 6.1, P = 0.01), age (95% CI 1.3 - 6.5, P = 0.01) and treatment of CHOP protocol (95% CI 0.05 - 0.6, P = 0.007). In a multivariate analysis LMR following completion of therapy was predictive for relapse (95% CI 0.001 - 0.2, P = 0.005). ALC was also significant in multivariate analysis (95% CI 0.01 - 0.8, P = 0.03). LDH following completion of therapy (95% CI 0.2 - 14.9, P = 0.5), AMC following completion of therapy (95% CI 0.3 - 43.1, P = 0.3), age (95% CI 0.9 - 205.4, P = 0.06), extra-nodal sites (95% CI 0.04 - 9.8, P = 0.8), Ann Arbor stage (95% CI 0.3 - 28.7, P = 0.3), and Treatment of CHOP protocol (95% CI 0.01 - 2.4, P = 0.2) were not statistically significant. Conclusion: This study observed that LMR assessed after first line chemotherapy during routine follow up is an independent predictor of relapse and clinical outcome in DLBCL patients. LMR at follow up can be used a simple inexpensive biomarker to alert clinicians for relapse during follow up after standard first line chemotherapy in DLBCL patients.

Activated systemic inflammatory response at diagnosis reduces lymph node count in colonic carcinoma

AIM: To investigate a link between lymph node yield and systemic inflammatory response in colon cancer. METHODS: A prospectively maintained database was interrogated. All patients undergoing curative colonic resection were included. Neutrophil lymphocyte ratio(NLR) and albumin were used as markers of SIR. In keeping with previously studies, NLR ≥ 4, albumin < 35 was used as cut off points for SIR. Statistical analysis was performed using 2 sample t-test and χ~2 tests where appropriate.RESULTS: Three hundred and two patients were included for analysis. One hundred and ninety-five patients had NLR < 4 and 107 had NLR ≥ 4. There was no difference in age or sex between groups. Patients with NLR of ≥ 4 had lower mean lymph node yields than patients with NLR < 4 [17.6 ± 7.1 vs 19.2 ± 7.9(P = 0.036)]. More patients with an elevated NLR had node positive disease and an increased lymph node ratio(≥ 0.25, P = 0.044). CONCLUSION: Prognosis in colon cancer is intimately linked to the patient’s immune response. Assuming standardised surgical technique and sub specialty pathology, lymph node count is reduced when systemic inflammatory response is activated.

LMR联合hs-CRP对急性胰腺炎患者并发急性肾损伤的诊断价值

目的探讨淋巴细胞计数与单核细胞计数比值(LMR)联合超敏C反应蛋白(hs-CRP)对急性胰腺炎(AP)患者并发急性肾损伤(AKI)的诊断价值。方法选取2019年10月至2023年11月该院收治的226例AP患者作为研究对象,根据住院期间是否并发AKI分为AKI组(62例)和非AKI组(164例)。采用血液分析仪检测淋巴细胞计数和单核细胞计数,计算LMR;采用特定蛋白免疫分析仪检测hs-CRP水平。收集所有研究对象入院时肝功能、血脂等生化指标。采用Pearson相关分析AP患者LMR与hs-CRP水平的相关性。采用受试者工作特征(ROC)曲线分析LMR联合hs-CRP对AP患者并发AKI的诊断价值。采用多因素Logistic回归分析AP患者并发AKI的影响因素。结果AKI组低密度脂蛋白胆固醇、血肌酐、丙氨酸转氨酶、天冬氨酸转氨酶水平均高于非AKI组,差异均有统计学意义(P<0.05)。AKI组LMR低于非AKI组,hs-CRP水平高于非AKI组,差异均有统计学意义(P<0.05)。Pearson相关分析结果显示,AP患者LMR与hs-CRP水平呈负相关(r=-0.645,P<0.001)。LMR联合hs-CRP检测对诊断AP患者并发AKI的曲线下面积(AUC)高于LMR、hs-CRP单独检测的AUC(Z=2.531,P=0.011;Z=3.244,P=0.001)。多因素Logistic回归分析结果显示,血肌酐、LMR、hs-CRP是AP患者并发AKI的影响因素(P<0.05)。结论AP并发AKI患者LMR水平明显降低,hs-CRP水平明显升高,二者联合检测对AP患者并发AKI有一定诊断价值。

细菌性肺炎患者血清LTB4、NLCR及CRP/PA变化及其与肺损伤程度的关系

目的探讨细菌性肺炎患者血清白三烯B4(LTB4)、中性粒细胞/淋巴细胞计数比值(NLCR)及C-反应蛋白与前白蛋白(CRP/PA)比值变化及其与肺损伤程度的关系。方法回顾性选取172例细菌性肺炎患者(观察组)和同期140例健康体检者(对照组)的临床资料,根据肺损伤程度,将患者分为轻中度组和重度组。比较各组LTB4、NLCR及CRP/PA水平,分析LTB4、NLCR及CRP/PA联合评估患者肺损伤程度的价值。结果与对照组比较,观察组LTB4、NLCR及CRP/PA水平更高(P<0.05);与轻中度组比较,重度组LTB4、NLCR及CRP/PA水平更高(P<0.05);ROC结果显示,LTB4、NLCR和CRP/PA评估患者肺损伤程度的AUC为0.793、0.717、0.758,三者联合评估患者肺损伤程度的AUC为0.933,高于单项评估(P<0.05)。结论LTB4、NLCR及CRP/PA在细菌性肺炎患者中表达水平均会升高,且其均与肺损伤程度有关,其联合评估肺损伤程度的价值较高。

MHR和SII早期联合检测对急性一氧化碳中毒患者病情及预后的评估

目的分析单核细胞与高密度脂蛋白胆固醇比值(MHR)、系统性免疫炎症指数(SII)在急性一氧化碳中毒(ACOP)患者中变化,探讨其早期联合检测对ACOP患者的病情及预后的评估。方法选取2019年1月—2023年1月在河北医科大学哈励逊国际和平医院急救医学部收治的ACOP患者120例,根据患者病情严重程度将其分为轻度中毒组30例、中度中毒组35例和重度中毒组55例;根据患者是否发生急性一氧化碳中毒迟发性脑病(DEACMP)情况分为DEACMP组17例和预后良好组103例;同期健康体检者30例作为对照组。所有患者均在入院时,对照组于体检时,检测MHR、SII、白细胞介素-18(IL-18)和C反应蛋白(CRP)的变化,记录患者60 d内DEACMP发生情况。通过Logistic回归分析ACOP发生DEACMP的独立危险因素。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估MHR和SII对ACOP患者发生DEACMP的预测价值。结果入院时,不同中毒程度患者MHR、SII、IL-18和CRP水平均高于对照组,中度高于轻度,重度高于中度、轻度,均有统计学差异(P<0.05)。3组患者DEACMP发生率分别为0,5.71%和27.27%,有统计学差异(χ^(2)=14.777,P=0.001)。相关分析结果显示,ACOP患者中毒程度与DEACMP发生率呈正相关(r=0.648,P=0.000)。Logistic回归分析结果显示,MHR、SII水平升高均是ACOP患者发生DEACMP的危险因素(OR=7.757、5.169,均P<0.01)。入院时MHR、SII、IL-18、CRP及MHR+SII预测发生DEACMP的AUC分别为0.840、0.862、0.771、0.706和0.899,MHR和SII联合应用预测能力优于MHR、SII、IL-18和CRP(P<0.05)。结论MHR和SII是ACOP患者发生DEACMP的独立危险因素,MHR和SII早期联合检测有助于ACOP患者病情和预后的评估。

急性冠状动脉综合征患者入院早期白细胞计数与平均血小板体积比值和血小板与淋巴细胞比值与冠状动脉狭窄程度及院内主要不良心血管事件的评估价值

目的 分析急性冠状动脉综合征(ACS)患者的白细胞计数与平均血小板体积比值(WMR)和血小板与淋巴细胞比值(PLR)与冠状动脉病变严重程度的相关性,并探究WMR、PLR对冠状动脉狭窄程度及院内主要不良心血管事件(MACE)的预测价值。方法 本研究为回顾性分析,收集了2020年12月至2022年11月在新疆医科大学第一附属医院急诊抢救室因胸痛、胸闷首次诊断为ACS并接受经皮冠状动脉介入(PCI)治疗的391例患者数据。根据临床分型,将患者分为不稳定型心绞痛(UA)组147例,非ST段抬高型心肌梗死(NSTEMI)组114例,及ST段抬高型心肌梗死(STEMI)组130例。进一步按照是否出现院内MACE分为MACE组106例和无MACE组285例。依据Gensini评分中位数将患者分为重度病变组(Gensini评分≥53分)196例和轻度病变组(Gensini评分<53分)195例。比较各组患者的基本资料及实验室检查指标,使用二元多因素logistic回归模型筛选冠状动脉狭窄程度及院内MACE的影响因素,分析WMR、PLR与冠状动脉狭窄程度的相关性,并通过ROC曲线分析WMR、PLR及其联合对冠状动脉狭窄程度及院内MACE的预测诊断价值。结果 WMR和PLR与ACS患者冠状动脉狭窄程度均呈正相关(r=0.336,P<0.001;r=0.374,P<0.001)。二元多因素logistic回归分析表明,WMR和PLR均为冠状动脉狭窄程度和院内MACE的独立危险因素。ROC曲线结果显示,WMR、PLR及两者联合预测院内MACE的AUC分别为0.748、0.722和0.792;预测冠状动脉狭窄程度的AUC分别为0.694、0.716和0.770。结论 ACS患者入院早期WMR和PLR与冠状动脉狭窄程度呈正相关,并且具有预测院内MACE及冠状动脉狭窄程度的临床价值,其联合使用在诊断效果上更为优越。

外周血细胞计数比值及淋巴细胞亚群在类风湿关节炎病情评估中的价值

目的探讨外周血细胞计数比值及淋巴细胞亚群在类风湿关节炎(RA)及合并间质性肺病(ILD)病情评估中的价值。方法回顾性分析2020年6—12月50例住院RA患者的一般资料、外周血细胞计数比值及淋巴细胞亚群检测结果。按28个关节疾病活动度评分(DAS 28)分为高疾病活动度组(DAS 28>5.1分)及中低疾病活动度组(DAS 28≤5.1分)。另根据是否合并ILD,分为未合并ILD(RA-non-ILD)与合并ILD(RA-ILD)组。对比不同分组外周血细胞计数比值及淋巴细胞亚群的差异,并使用受试者工作特征(ROC)曲线评估外周血细胞计数比值及淋巴细胞亚群对RA的诊断评估价值。结果与中低疾病活动度组相比,RA高疾病活动度组的血小板-淋巴细胞比值(PLR)较高,淋巴细胞-单核细胞比值、总T淋巴细胞比率、总T淋巴细胞绝对计数、CD8^(+)T细胞及CD4^(+)T细胞绝对计数低于中低疾病活动度组(P<0.05)。PLR评估RA病情活动度的ROC曲线下面积(AUC)为0.722,95%CI为0.579~0.865。RA-non-ILD组与RA-ILD组外周血细胞计数比值及淋巴细胞亚群差异无统计学意义(P>0.05),各指标ROC曲线的AUC也均低于0.7。结论PLR对于RA疾病活动度的区分可能具有一定价值,其他各指标无论对于区分RA疾病活动度还是区分是否合并ILD都没有表现出明显潜力。

Predictive value of immune cell counts and neutrophil-to-lymphocyte ratio for 28-day mortality in patients with sepsis caused by intra-abdominal infection

Background:The current study aimed to evaluate the value of immune cell counts and neutrophilto-lymphocyte ratio(NLR)when attempting to predict 28-day mortality.Methods:We conducted an observational retrospective study that included consecutive septic patients.Severity scores on the first day and peripheral circulating immune cell counts(at day 1,day 3,day 5 and day 7 of admission)were collected during each patient’s emergency intensive care unit stay.We assessed the associations of peripheral circulating immune cell counts and NLR with the severity of illness.The relationships between 28-day mortality and peripheral circulating immune cell counts and NLR with were evaluated using Cox proportional cause-specific hazards models.Results:A total of 216 patients diagnosed with sepsis caused by IAI were enrolled.The lymphocyte counts(days 1,3,5 and 7)and monocyte counts(days 3,5 and 7)were significantly lower in nonsurvivors(n=72)than survivors(n=144).The NLR values at each time point were significantly higher in non-survivors.The day 1 lymphocyte counts,as well as the monocyte counts,were significantly lower in the highest-scoring group,when stratified by the Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores,than in the other groups(p<0.05).The day 1 NLR was significantly higher in the highest-scoring group than in the other groups(p<0.05).The day 5 and day 7 lymphocyte counts,day 3 and day 7 monocyte counts and day 7 NLR were significant predictors of 28-day mortality in the Cox proportional hazards models(day 5 lymphocyte count:hazard ratio,0.123(95%CI,0.055–0.279),p<0.001;day 7 lymphocyte count:hazard ratio,0.115(95%CI,0.052–0.254),p<0.001;day 3 monocyte count:hazard ratio,0.067(95%CI,0.005–0.861),p=0.038;day 7 monocyte count:hazard ratio,0.015(95%CI,0.001–0.158),p<0.001;day 7 NLR:hazard ratio,0.773(95%CI,0.659–0.905),p=0.001).Conclusions The results showed that circulating lymphocytes and monocytes were dramatically decreased within 7 days in non-survivors following sepsis from an IAI.Lymphocyte counts,monocyte counts and NLR appeared to be associated with the severity of illness,and they may serve as independent predictors of 28-day mortality in septic patients with IAIs.

单核细胞计数/高密度脂蛋白胆固醇及促甲状腺激素对绝经期女性急性冠脉综合征患者预测价值及与冠状动脉病变相关性研究

背景既往研究发现单核细胞计数、高密度脂蛋白胆固醇(HDL-C)、促甲状腺激素(TSH)与急性冠脉综合征(ACS)相关,然而单核细胞计数/高密度脂蛋白胆固醇(MHR)与ACS发病的相关性研究较少,绝经期女性MHR、TSH与ACS发病是否存在关联仍不明确。目的探讨MHR、TSH对绝经期女性ACS患者发病的预测价值,并研究上述指标与患者冠状动脉狭窄程度的相关性。方法选择2020—2021年在苏北人民医院心血管内科住院诊治并行冠状动脉造影的325例绝经期女性作为研究对象。通过电子病历系统收集患者一般资料,研究对象入院后采集静脉血检测单核细胞计数、总胆固醇(TC)、三酰甘油(TG)、HDL-C、低密度脂蛋白胆固醇(LDL-C)、TSH等。以双平面Simpson法测量左心室射血分数(LVEF),通过冠状动脉造影术观察冠状动脉病变情况。采用Gensini评分标准统一衡量冠状动脉病变情况。符合ACS诊断标准的患者为ACS组(n=184),非ACS者为对照组(n=141)。同时依据Gensini评分三分位数将ACS组进行分组:≤36.5分为低危亚组(n=59),36.6~66.5分为中危亚组(n=64),>66.5分为高危亚组(n=61)。采用单因素及多因素Logistic回归分析探究ACS的影响因素。绘制受试者工作特征(ROC)曲线评估TSH、MHR及联合检测对ACS的诊断价值并计算ROC曲线下面积(AUC)。采用Spearman秩相关分析探究TSH、MHR及联合检测指标与Gensini积分的相关性。结果ACS组与对照组患者基线资料结果示,ACS组BMI、吸烟比例、高血压、糖尿病、LDL-C、单核细胞计数、TSH、MHR高于对照组,LVEF、HDL-C低于对照组(P<0.05)。多因素Logistic回归分析结果示,吸烟、高血压、BMI≥24.0 kg/m^(2)、LDL-C≥3.30 mmol/L、TSH≥2.1m U/L、MHR≥0.25是绝经期女性发生ACS的危险因素,HDL-C≥1.2 mmol/L为保护因素(P<0.05)。ROC曲线结果显示,MHR、TSH及联合预测指标诊断绝经期女性ACS的AUC分别为0.777(95%CI=0.725~0.830,P<0.001)、0.747(95%CI=0.694~0.800,P<0.001)、0.810(95%CI=0.764~0.857,P<0.001)。中危亚组、高危亚组MHR、TSH均高于低危亚组,高危亚组MHR、TSH高于中危亚组(P<0.05)。Spearman秩相关分析结果示,ACS组患者MHR(r_(s)=0.497,P<0.01)、TSH(r_(s)=0.498,P<0.01)及联合预测指标与Gensini评分均呈正相关(r_(s)=0.600,P<0.001)。结论TSH及MHR升高是绝经期女性发生ACS的独立危险因素,两指标及联合对病情预测具有较高的灵敏度和特异度,并与患者冠状动脉病变程度相关,对绝经期女性ACS的早期识别及风险评估具有一定的临床应用价值。

中性粒细胞与淋巴细胞比率、血小板计数联合D-二聚体对重症肺炎合并脓毒症患儿预后的预测价值

目的探讨中性粒细胞与淋巴细胞比率(neutrophil to lymphocyte ratio,NLR)、血小板(platelet,PLT)计数联合D-二聚体(D-dimer,D-D)对重症肺炎合并脓毒症患儿预后的预测价值。方法回顾性分析首都医科大学附属北京儿童医院急诊重症监护病房(emergency intensive care unit,EICU)2018年1月~2023年1月收治的310例重症肺炎合并脓毒症患儿的临床资料,对所有患儿治疗出院后进行门诊复查或电话随访并根据相关标准对患儿预后进行评估,根据预后情况分为预后良好组(n=198)和预后不良组(n=112)。利用医院电子病历系统,收集全部患儿年龄、性别等基本临床资料,记录入院时患儿早期预警评分[慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、序贯器官衰竭评分(sequential organ failure assessment,SOFA)],并收集诊断患儿入院24 h内的实验室指标。采用Logistic回归分析肺炎合并脓毒症患儿发生预后不良的相关影响因素,采用受试者工作特征(receiver operating characteristic,ROC)曲线分析NLR、PLT计数、D-D预测重症肺炎合并脓毒症患儿预后的灵敏度、特异度、准确度。结果两组患儿年龄、性别差异无统计学意义(P>0.05)。预后不良组APACHEⅡ、SOFA评分显著高于预后良好组(P<0.05)。预后良好组NLR、D-D水平均低于预后不良组,PLT计数水平高于预后不良组(P<0.05)。将单因素分析的结果中P≤0.05的变量纳入多因素Logistic回归确定影响预后的独立危险因素。调整年龄、性别、APACHEⅡ评分等混杂因素,连续变量原值收入,结果表明,NLR、D-D水平是预后的保护因素(OR<1,P<0.05),PLT计数水平是预后的危险因素(OR>1,P<0.05)。ROC曲线分析结果显示,三项指标联合预测的曲线下面积(area under the curve,AUC)为0.949,灵敏度为94.95%,特异度为82.14%,准确度为90.32%,三者联合预测效能价值高。结论重症肺炎合并脓毒症患儿的外周血NLR、PLT计数、D-D水平显著升高,三项联合检测在预测患儿28 d后的预后中具有重要的价值。

AMI患者PLT、PDW、PLR水平及其与疾病严重程度的相关性研究

目的探讨急性心肌梗死(AMI)患者血小板计数(PLT)、血小板分布宽度(PDW)、血小板/淋巴细胞比值(PLR)水平及其与疾病严重程度的相关性。方法选取2017年1月至2020年12月苏州市相城区中医医院收治的200例AMI患者作为观察组,另选取同期150例常规体检健康者作为对照组。根据AMI患者随访结果又分为预后不良组和预后良好组。比较观察组和对照组,以及预后良好组和预后不良组PLT、PDW、PLR水平。采用多因素Logistic回归分析AMI患者预后的危险因素。采用Spearman相关分析Killip心功能分级与PLT、PDW、PLR水平的相关性;采用Pearson相关分析PLT、PDW、PLR水平的相关性。结果观察组PLT[(166.32±28.44)×10^(9)/L]高于对照组[(158.77±30.52)×10^(9)/L],PDW[(16.59±4.95)%]高于对照组[(15.54±3.01)%],PLR(162.40±78.85)高于对照组(114.74±12.34),差异均有统计学意义(P<0.05)。预后不良组和预后良好组性别、年龄、体质量指数、吸烟史、糖尿病、高血压、高血脂比较,差异均无统计学意义(P>0.05);预后不良组和预后良好组Killip心功能分级,PLT、PDW、PLR水平比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,PLT、PDW、PLR水平升高是AMI患者预后不良的独立危险因素(P<0.05)。Spearman相关分析结果显示,Killip心功能分级与PLT、PDW、PLR水平均呈正相关(r=0.702、0.664、0.302,P<0.05);Pearson相关分析结果显示,PLT水平与PDW、PLR水平均呈正相关(r=0.361、0.507,P<0.05),PDW水平与PLR水平呈正相关(r=0.596,P<0.05)。结论AMI患者PLT、PDW、PLR水平均升高,并且与AMI患者的Killip心功能分级均呈正相关,PLT、PDW、PLR可作为预测AMI患者预后的良好指标,对预防和治疗AMI有重要临床意义。

LMR与老年原发性高血压患者焦虑的关系研究

目的 探究淋巴细胞计数与单核细胞计数比值(LMR)与老年原发性高血压(EH)患者焦虑之间的关系。方法 收集2020年7月至2021年12月在该院心血管内科住院治疗的年龄≥60岁197例EH患者入院时的基本资料、实验室检查指标。以汉密尔顿焦虑量表(HAMA)评分≥14分为临界值,将患者分为焦虑组与无焦虑组,比较两组患者基本资料与入院时LMR等指标差异。采用二元Logistic回归分析老年EH患者发生焦虑的影响因素。采用受试者工作特征(ROC)曲线分析LMR对老年EH患者发生焦虑的预测价值。结果 两组患者在饮酒史、吸烟史、LMR方面比较,差异有统计学意义(P<0.05)。二元Logistic回归分析结果显示,LMR(OR=1.742,95%CI:1.414~2.146,P<0.01)是原发性老年高血压患者发生焦虑的独立危险因素。ROC曲线分析结果显示,LMR预测老年EH患者发生焦虑的曲线下面积(AUC)为0.803(95%CI:0.740~0.866,P<0.001),最佳截断值为4.52,此时的灵敏度和特异度分别是0.71、0.84。结论 LMR水平升高是老年EH患者发生焦虑的独立危险因素,LMR对于老年EH患者发生焦虑具有较好的预测价值。

血清炎性标志物与一线免疫抑制剂治疗晚期非小细胞肺癌患者预后的关系

目的探讨基线水平中性粒细胞-淋巴细胞比值(NLR)、血小板计数-淋巴细胞比值(PLR)、单核细胞-淋巴细胞比值(MLR)、泛免疫炎症值(PIV)在应用PD-1抑制剂联合化疗的晚期非小细胞肺癌(Non-small cell lung cancer,NSCLC)中的预测价值,并建立预后相关的列线图模型。方法回顾性分析2019年1月—2021年1月于哈尔滨医科大学附属肿瘤医院一线应用PD-1抑制剂联合化疗的77例驱动基因阴性的晚期NSCLC患者的临床资料。采用单因素及多因素Cox回归分析确定无进展生存期(Progression-free survival,PFS)的独立预后因素;建立预后相关的列线图模型,并通过一致性指数等评估模型预测的准确性。结果多因素Cox回归分析表明,MLR、PIV、脑转移、胸膜转移是驱动基因阴性的晚期NSCLC患者PFS的独立影响因素(P<0.05)。根据Cox回归结果构建的列线图预后模型预测能力较好(C-index值为0.786,95%CI:0.721~0.851)。ROC曲线表明MLR与PIV联合检测无进展生存期预后的效果(AUC=0.717,P=0.001)优于MLR(AUC=0.643)、PIV(AUC=0.640)。结论MLR、PIV、脑转移、胸膜转移可预测一线应用化疗联合PD-1抑制剂治疗的驱动基因阴性的晚期NSCLC患者的预后,建立的列线图模型具有较高的准确度和临床实用性。MLR与PIV联合检测的预测效能可能优于MLR、PIV单独检测。

基于血清HE4、PLR、RLX、KPNA2构建晚期卵巢上皮性癌术后复发风险预测模型的临床研究

目的探讨基于血清人附睾蛋白4(HE4)、血小板计数/淋巴细胞计数比值(PLR)、血清松弛素(RLX)、核转运蛋白α2(KPNA2)构建晚期卵巢上皮性癌术后复发风险预测模型。方法选取2016年1月至2019年1月苏州市立医院(东区)诊治的124例晚期卵巢上皮性癌患者作为研究对象,根据晚期卵巢上皮性癌患者是否复发分为复发组和无复发组。HE4水平采用电化学发光免疫分析法检测,根据血常规结果计算PLR,酶联免疫吸附试验检测RLX、KPNA2水平。晚期卵巢上皮性癌患者术后复发的影响因素采用多因素Logistic回归分析,并建立晚期卵巢上皮性癌术后复发风险预测模型。采用受试者工作特征(ROC)曲线评估晚期卵巢上皮性癌术后复发风险预测模型的预测效能,利用Hosmer-Lemeshow检验分析患者晚期卵巢上皮性癌术后复发风险预测模型的拟合度。结果复发组与无复发组在肿瘤国际妇产科联盟(FIGO)分期及血清糖类抗原125、HE4、PLR、RLX、KPNA2水平比较,差异有统计学意义(P<0.05)。肿瘤FIGO分期Ⅳ期及血清HE4、PLR、RLX、KPNA2升高是晚期卵巢上皮性癌患者术后复发的危险因素(P<0.05)。ROC曲线分析显示,晚期卵巢上皮性癌术后复发风险预测模型的曲线下面积为0.859,均明显高于HE4、PLR、RLX、KPNA2单一指标检测。通过Hosmer-Lemeshow检验分析,晚期卵巢上皮性癌术后复发风险预测模型有较好的拟合度(χ^(2)=7.869,P=0.437)。结论基于血清HE4、PLR、RLX、KPNA2及肿瘤FIGO分期构建的晚期卵巢上皮性癌术后复发风险预测模型对于评估患者晚期卵巢上皮性癌术后复发具有较高的预测价值,值得临床关注。

TyG指数、MHR与冠心病患者冠脉病变、心肌缺血程度相关性及联合检测价值

目的探讨三酰甘油葡萄糖(triglyceride glucose index,TyG)指数、单核细胞数/高密度脂蛋白胆固醇比值(monocyte to high-density lipo-protein cholesterol ratio,MHR)与冠心病(coronary heart disease,CHD)冠脉病变、心肌缺血程度的相关性,并分析二者对冠脉病变、心肌缺血程度的预测价值。方法选取中国人民解放军联勤保障部队第九二O医院2019年1月至2022年1月CHD患者作为研究组(n=150),另选取同期健康体检者作为对照组(n=75)。对比分析2组TyG指数、MHR。依据Gensini积分评估冠脉病变程度,并比较不同冠脉病变、心肌缺血程度患者TyG指数、MHR,并分析其与Gensini积分、心肌缺血程度相关性。受试者工作特征(receiver operating characteristic,ROC)曲线及曲线下面积(area under curve,AUC)评价TyG指数、MHR及两者联合检测对冠脉病变、心肌缺血程度的预测价值。结果研究组TyG指数、MHR分别为(4.12±0.35)、(0.26±0.08)×109,均高于对照组的(4.94±0.55)、(0.43±0.12)×109,且重度冠脉病变TyG指数、MHR>中度冠脉病变>轻度冠脉病变,急性心肌梗死TyG指数、MHR>不稳定型心绞痛>稳定型心绞痛(P<0.05);TyG指数、MHR与Gensini积分呈正相关(r=0.621、0.635,P<0.05),其与心肌缺血程度呈正相关(r=0.617、0.642,P<0.05)。TyG指数、MHR联合鉴别轻度冠脉病变与中度冠脉病变的AUC为0.917,大于两者单独鉴别0.749、0.832,联合鉴别轻中度冠脉病变与重度冠脉病变的AUC为0.935,大于两者单独鉴别0.770、0.767(P<0.05)。TyG指数、MHR联合鉴别稳定型心绞痛与不稳定型心绞痛的AUC为0.922,大于两者单独鉴别0.812、0.824,联合鉴别稳定型心绞痛不稳定型心绞痛与急性心肌梗死的AUC为0.913,大于两者单独鉴别0.708、0.714(P<0.05)。结论TyG指数、MHR均与Gensini积分、心肌缺血程度呈正相关,二者联合检测对冠脉病变、心肌缺血程度的评估具有更高应用价值。