血小板/淋巴细胞比值、纤维蛋白原/白蛋白比值在非阻塞性心肌梗死患者预后评估中的应用价值

张娜; 刘娜; 袁蓉曼; 刘东升; 孙亚召; 王倩

doi:10.13201/j.issn.1001-1439.2024.04.009

血小板/淋巴细胞比值、纤维蛋白原/白蛋白比值在非阻塞性心肌梗死患者预后评估中的应用价值

- 1.
  沧州市人民医院(河北沧州，061000)
- 2.
  承德医学院
基金项目:
沧州市重点研发计划指导项目(No：213106041)

详细信息

通讯作者: 刘东升，E-mail：759971070@qq.com

中图分类号: R542.2

收稿日期: 2023-11-08

刊出日期: 2024-04-13

The application value of platelet/lymphocyte ratio, fibrinogen/albumin ratio in the prognosis evaluation of patients with myocardial infarction with non-obstructive coronary arteries

- 1.
  Cangzhou People's Hospital, Cangzhou, Hebei, 061000, China
- 2.
  Chengde Medical College

More Information

Corresponding author: LIU Dongsheng, E-mail: 759971070@qq.com

Received Date: 08 November 2023

Publish Date: 13 April 2024

摘要

摘要: 目的评估入院时血小板/淋巴细胞比值(PLR)、纤维蛋白原/白蛋白比值(FAR)及两者联合在冠状动脉非阻塞性心肌梗死(MINOCA)患者预后的应用价值。方法回顾性收集2018年5月—2022年12月于沧州市人民医院诊断为MINOCA的438例患者的临床资料。根据随访期间是否发生主要不良心脑血管事件(MACCE)，将患者分为MACCE组(116例)和非MACCE组(322例)。采用logistic回归分析MINOCA患者预后的影响因素。运用ROC曲线评估PLR、FAR及两者联合对随访期间MACCE的预测价值。结果两组男性占比、糖尿病占比、淋巴细胞、中性粒细胞、白蛋白、高密度脂蛋白胆固醇、尿酸、左心室射血分数、PLR及FAR比较存在显著差异(均P＜0.05)。多因素logistic回归分析显示，中性粒细胞、尿酸、左心室射血分数、PLR、FAR的升高和糖尿病均为MINOCA患者MACCE的危险因素。PLR、FAR及两者联合预测MACCE的ROC曲线下面积(AUC)分别为0.656、0.691、0.762。结论 PLR和FAR是MINOCA患者MACCE的影响因素。
- 冠状动脉非阻塞性心肌梗死 /
- 血小板/淋巴细胞比值 /
- 纤维蛋白原/白蛋白比值 /
- 主要不良心脑血管事件 /
- 相关性
Abstract: Objective The aim of this study was to evaluate the prognostic value of platelet/lymphocyte ratio(PLR), fibrinogen/albumin ratio(FAR) and their combination in patients with myocardial infarction with non-obstructive coronary arteries(MINOCA).Methods The clinical data of 438 patients diagnosed with MINOCA in Cangzhou People 's Hospital from May 2018 to December 2022 were retrospectively collected. Patients were divided into MACCE group(n=116) and non-MACCE group(n=322) according to whether major adverse cardiovascular and cerebrovascular events(MACCE) occurred during follow-up. Logistic regression was used to analyze the prognostic factors of MINOCA patients. ROC curve was used to evaluate the predictive value of PLR, FAR and their combination for MACCE during follow-up.Results There were significant differences in the proportion of diabetes, lymphocytes, neutrophils, albumin, high-density lipoprotein cholesterol, uric acid, left ventricular ejection fraction, PLR and FAR between the two groups(all P < 0.05). Multivariate logistic regression analysis showed that diabetes, neutrophils, uric acid, left ventricular ejection fraction, PLR and FAR were independent influencing factors of MACCE in MINOCA patients. The area under the ROC curve(AUC) of PLR, FAR and their combination in predicting MACCE was 0.656, 0.691 and 0.762, respectively.Conclusion High PLR and high FAR are associated with an increased risk of MACCE in MINOCA patients, which may help to improve the clinical management strategy of MINOCA patients.
- myocardial infarction with non-obstructive coronary arteries /
- platelet/lymphocyte ratio /
- fibrinogen/albumin ratio /
- major adverse cardiac and cerebrovascular events /
- correlation

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图 1 PLR、FAR、PLR+FAR诊断MINOCA院外发生MACCE的ROC曲线

Figure 1. ROC curves

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表 1 两组患者基线临床资料比较

Table 1. General data 例(%), X±S, M(P₂₅, P₇₅)

项目	MACCE组(116例)	非MACCE组(322例)	检验值	P值
男性	65(56.0)	218(67.7)	5.077	0.024
年龄/岁	58.87±10.78	60.51±11.13	1.371	0.171
吸烟	38(32.8)	101(31.4)	0.076	0.782
高血压病	73(62.9)	195(60.7)	0.171	0.679
糖尿病	28(24.1)	44(13.7)	6.810	0.009
脑血管疾病	9(7.8)	45(14.0)	2.958	0.085
白细胞/(×10⁹/L)	7.85(6.02，10.07)	7.17(5.93，9.27)	1.690	0.091
血小板/(×10⁹/L)	227.32±67.40	219.53±61.06	0.961	0.282
淋巴细胞/(×10⁹/L)	1.40±0.75	1.74±0.71	4.435	＜0.001
中性粒细胞/(×10⁹/L)	7.16(4.91，8.23)	5.04(3.68，6.83)	4.242	＜0.001
C反应蛋白/(mg/L)	8.10(0.62，26.62)	2.80(0.52，12.62)	1.538	0.069
白蛋白/(g/L)	38.92±4.19	41.99±4.51	3.201	＜0.001
纤维蛋白原/(g/L)	4.17±1.07	3.32±0.82	0.634	0.660
D-二聚体/(ng/mL)	112(58，218)	100(57，203)	0.851	0.357
PLR	159.34(141.06，226.51)	142.25(105.98，217.11)	5.772	＜0.001
FAR	11.32±2.16	8.53±1.51	3.701	＜0.001
总胆固醇/(mmol/L)	4.51±1.19	4.27±1.07	1.896	0.059
甘油三酯/(mmol/L)	1.09(0.92，1.87)	1.27(0.90，1.78)	0.009	0.993
高密度脂蛋白胆固醇/(mmol/L)	1.19±0.29	1.27±0.38	2.337	0.020
低密度脂蛋白胆固醇/(mmol/L)	2.67±0.94	2.46±0.91	1.938	0.053
肌酐/(μmol/L)	64(55，77)	62(54，85)	0.848	0.397
尿酸/(μmol/L)	342.91±55.98	303.13±69.91	2.230	0.027
空腹血糖/(mmol/L)	5.94(5.19，8.18)	5.57(5.19，6.78)	0.172	0.864
糖化血红蛋白/%	5.8(5.5，6.3)	5.7(5.5，6.3)	0.317	0.751
左心室射血分数/%	55.5(51.5，61.0)	59.0(56.0，62.0)	4.843	＜0.001
肌钙蛋白I/(μg/L)	0.62±0.15	0.58±0.13	1.670	0.097

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表 2 MINOCA患者发生MACCE的危险因素分析

Table 2. Logistic regression analysis

变量	单因素分析		多因素分析
变量	P值	OR(95%CI)	P值	OR(95%CI)
男性	0.025	1.008(1.005~1.010)	0.276	0.706(0.377~1.322)
糖尿病	0.010	2.046(1.079~3.881)	0.028	1.910(1.282~2.419)
淋巴细胞	＜0.001	0.443(0.306~0.641)	0.716	0.882(0.449~1.734)
高密度脂蛋白胆固醇	0.040	0.516(0.275~0.970)	0.138	0.574(0.276~1.194)
白蛋白	＜0.001	0.972(0.958~0.987)	0.060	0.973(0.946~1.001)
中性粒细胞	＜0.001	1.197(1.099~1.303)	0.041	1.109(1.004~1.224)
尿酸	0.041	1.005(1.002~1.008)	0.049	1.003(1.000~1.005)
左心室射血分数	＜0.001	1.020(1.080~1.039)	＜0.001	1.009(0.974~1.146)
PLR	＜0.001	1.008(1.045~1.225)	0.017	1.007(1.001~1.013)
FAR	＜0.001	1.240(1.015~1.063)	＜0.001	1.025(1.045~1.073)

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