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

姜金彤; 卓杨; 赵倩; 顾俊; 张俊峰; 王长谦; 张绘莉

doi:10.13201/j.issn.1001-1439.2023.01.009

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

- 上海交通大学医学院附属第九人民医院心内科(上海，200001)
基金项目:
上海市科委医学引导类项目(No：19411963300)；上海九院冠心病生物样本库项目(No：YBKA201910)

详细信息

通讯作者: 张绘莉，E-mail：huilizhang815@163.com

中图分类号: R541.1

收稿日期: 2022-07-21

刊出日期: 2023-01-13

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

- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200001, China

More Information

Corresponding author: ZHANG Huili, E-mail: huilizhang815@163.com

Received Date: 21 July 2022

Publish Date: 13 January 2023

摘要

摘要: 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。
- 急性冠状动脉综合征 /
- 斑块破裂 /
- 中性粒细胞/淋巴细胞比值 /
- 光学相干断层扫描
Abstract: 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.
- acute coronary syndrome /
- plaque rupture /
- neutrophil to lymphocyte ratio /
- optical coherence tomography

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图 1 NLR预测ACS患者斑块破裂的ROC曲线

Figure 1. ROC curve for plaque rupture predicting in ACS patients by NLR

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表 1 斑块破裂组和非斑块破裂组患者的基线临床特征

Table 1. Baseline clinical characteristics of patients with or without plaque rupture X±S, M(P₂₅, P₇₅)

项目	斑块破裂组(41例)	非斑块破裂组(166例)	P值
年龄/岁	65.65±9.92	61.02±12.26	0.012
男性/例(%)	35(85.4)	114(68.7)	0.033
吸烟/例(%)	26(63.8)	66(39.8)	0.006
高血压/例(%)	27(65.9)	115(69.3)	0.672
糖尿病/例(%)	6(14.6)	41(24.7)	0.168
心血管疾病家族史/例(%)	12(29.3)	60(36.1)	0.408
抗血小板药物应用/例(%)	12(85.7)	60(88.2)	0.793
β受体阻滞剂应用/例(%)	4(28.6)	16(23.5)	0.689
ACEI/ARB应用/例(%)	6(42.9)	26(38.2)	0.859
他汀类应用/例(%)	8(57.1)	35(51.5)	0.699
BMI /(kg·m^-2)	24.86±3.07	25.22±3.78	0.528
TG/(mmol·L^-1)	4.02(3.74，4.71)	3.83(3.24，4.62)	0.112
TC/(mmol·L^-1)	1.32(1.03，1.88)	1.48(1.02，2.12)	0.293
LDL-C/(mmol·L^-1)	2.85(2.36，3.32)	2.52(1.98，3.18)	0.019
HDL-C/(mmol·L^-1)	0.99(0.79，1.21)	1.00(0.86，1.18)	0.688
TnI/(ng·mL^-1)	0.07(0.00，0.84)	0.01(0.00，0.02)	< 0.001
BNP/(pg·mL^-1)	43.00(23.50，101.50)	49.50(25.00，100.75)	0.704
CRP/(mg·L^-1)	1.29(1.28，2.09)	1.33(1.28，2.17)	0.044

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表 2 斑块破裂组和非斑块破裂组患者的血常规指标

Table 2. Hematological indexes of patients with or without plaque rupture X±S, M(P₂₅, P₇₅)

指标	斑块破裂组(41例)	非斑块破裂组(166例)	P值
红细胞计数/(×10¹²·L^-1)	4.54±0.50	4.51±0.55	0.772
Hb/(g·L^-1)	140.32±16.85	136.68±17.89	0.240
MCH/pg	30.80(29.70，31.60)	30.40(29.48，31.40)	0.198
MCV/fL	90.20(87.65，93.80)	90.30(87.55，93.55)	0.694
RDW/%	13.30(12.75，13.75)	13.00(12.50，13.50)	0.065
白细胞计数/(×10⁹·L^-1)	8.20(6.75，9.55)	6.30(5.20，7.61)	< 0.001
中性粒细胞计数/(×10⁹·L^-1)	5.90(4.06，8.47)	3.80(3.00，4.93)	< 0.001
淋巴细胞/(×10⁹·L^-1)	1.50(1.13，1.90)	1.67(1.30，2.10)	0.187
单核细胞/(×10⁹·L^-1)	0.49(0.38，0.66)	0.45(0.35，0.57)	0.165
NLR	3.33(1.94，6.34)	2.26(1.70，2.92)	< 0.001
血小板计数/(×10⁹·L^-1)	227.00(202.00，266.50)	209.50(179.75，243.75)	0.096
MPV/fL	10.20(9.80，10.90)	10.30(9.70，10.90)	0.906
PDW/%	12.20(11.60，14.40)	12.45(11.10，14.23)	0.858
PLR	150.00(111.45，186.91)	128.58(97.88，165.00)	0.035

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表 3 斑块破裂影响因素的logistic回归分析

Table 3. Influencing factors of plaque rupture analyzed by logistic regression analysis

指标	单因素			多因素
指标	OR	95%CI	P值	OR	95%CI	P值
年龄>65岁	0.447	0.220~0.907	0.026	0.503	0.219~1.155	0.105
男性	2.661	1.054~6.717	0.038	1.711	0.532~5.503	0.368
吸烟史	2.626	1.295~5.328	0.007	1.813	0.737~4.463	0.195
LDL-C	1.438	1.013~2.042	0.042	1.105	0.714~1.708	0.655
TnI	1.168	1.041~1.311	0.008	1.130	1.010~1.265	0.033
CRP	0.949	0.832~1.082	0.433
NLR	1.348	1.170~1.553	< 0.001	1.360	1.092~1.695	0.006
PLR	1.006	1.001~1.011	0.013	0.996	0.987~1.006	0.430

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