血小板/淋巴细胞比值对急性心肌梗死合并2型糖尿病患者住院期间的死亡预测价值
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摘要
目的探讨血小板/淋巴细胞比值对急性心肌梗死(AMI)合并2型糖尿病住院期间的死亡预测价值。方法选取AMI患者206例,根据血糖测量结果分为2型糖尿病AMI组(70例)、糖耐量异常AMI组(63例)、糖耐量正常AMI组(73例),同时选健康体检者58例作为对照组,计算血小板/淋巴细胞比值并进行简单相关分析,绘制血小板/淋巴细胞比值和GRACE评分的ROC曲线。结果与对照组比较,糖耐量正常AMI组、糖耐量异常AMI组、2型糖尿病AMI组PLR、FBG、HbA1c、三酰甘油、肌钙蛋白I和GRACE均增加,LDL-C降低(P<0.05)。4组PLR与GRACE评分和肌钙蛋白I呈正相关(P<0.05)。3组AMI组住院期间死亡ROC曲线下面积PLR和GRACE依次分别为0.760、0.728、0.799、0.778、 0.836、0.809,PLR和GRACE对AMI的住院期间预后有预测价值(P<0.05),PLR与GRACE比较均无差异(P>0.05)。老年(≥60岁)2型糖尿病AMI组患者PLR和GRACE评分均高于非老年组(<60岁)(P<0.05);不同性别2型糖尿病AMI患者PLR和GRACE差异无统计学意义(P>0.05);死亡组PLR和GRACE评分高于生存组(P<0.05)。结论 PLR比值可作为预测AMI合并2型糖尿病患者近期预后的良好指标,为制定合适的治疗提供理论依据。
Objective To investigate the value of platelet/lymphocyte ratio(PLR) in predicating short-term prognosis of patients with acute myocardial infarction(AMI) complicated by type 2 diabetes mellitus. Methods A total of 206 patients with AMI were enrolled in the study.According to the results of blood glucose examination,these patients were divided into diabetes+AMI group(DM-AMI group,n=70), impaired glucose tolerance+AMI group(IGT-AMI group,n=63) and AMI+normal glucose tolerance group(NGT-AMI group,n=73).At the same time,the other 58 subjects who underwent healthy physical examination in our hospital were enrolled as control group.The general clinical data were analyzed and the PLR was calculated to perform a simple correlation analysis.Moreover the ROC curve of the PLR and the GRACE score was plotted to calculate the area under the curve.Results As compared with those in control group,the levels of PLT,FBG,HbA1 C,triglyceride and GRACE in NGT-AMI group,IGT-AMI group and DM-AMI group were significantly increased,however the levels of LDL-C were significantly decreased(P<0.05). The PLR and GRACE scores of each group were positively correlated with troponin I(P<0.05); The ROC curve of PLR and GRACE in three AMI groups were 0.760,0.728,0.799,0.778,0.836 and 0.809, respectively,which suggested that the PLR and GRACE had a certain diagnostic value in the short-term prognosis of AMI(P<0.05). The paired comparison of the ROC curve showed that the PLR and GRACE had no difference(P>0.05).The PLR and GRACE scores in elderly patients(over 60 years) with type 2 diabetes mellitus in AMI group were higher than those of patients(<60 years) with type 2 diabetes mellitus in AMI group(P<0.05),and there were no significant differences in PLR and GRACE between males and females(P>0.05).Inaddition the GRACE and PLR scores in death group were significantly higher than those in survival group(P<0.05).Conclusion PLR can be regarded as a potential predictive index to predict the short-term prognosis of patients with AMI complicated by type 2 diabetes mellitus,which can provide theoretical basi fot determining appropriate treatment strategies.
Objective To investigate the value of platelet/lymphocyte ratio(PLR) in predicating short-term prognosis of patients with acute myocardial infarction(AMI) complicated by type 2 diabetes mellitus. Methods A total of 206 patients with AMI were enrolled in the study.According to the results of blood glucose examination,these patients were divided into diabetes+AMI group(DM-AMI group,n=70), impaired glucose tolerance+AMI group(IGT-AMI group,n=63) and AMI+normal glucose tolerance group(NGT-AMI group,n=73).At the same time,the other 58 subjects who underwent healthy physical examination in our hospital were enrolled as control group.The general clinical data were analyzed and the PLR was calculated to perform a simple correlation analysis.Moreover the ROC curve of the PLR and the GRACE score was plotted to calculate the area under the curve.Results As compared with those in control group,the levels of PLT,FBG,HbA1 C,triglyceride and GRACE in NGT-AMI group,IGT-AMI group and DM-AMI group were significantly increased,however the levels of LDL-C were significantly decreased(P<0.05). The PLR and GRACE scores of each group were positively correlated with troponin I(P<0.05); The ROC curve of PLR and GRACE in three AMI groups were 0.760,0.728,0.799,0.778,0.836 and 0.809, respectively,which suggested that the PLR and GRACE had a certain diagnostic value in the short-term prognosis of AMI(P<0.05). The paired comparison of the ROC curve showed that the PLR and GRACE had no difference(P>0.05).The PLR and GRACE scores in elderly patients(over 60 years) with type 2 diabetes mellitus in AMI group were higher than those of patients(<60 years) with type 2 diabetes mellitus in AMI group(P<0.05),and there were no significant differences in PLR and GRACE between males and females(P>0.05).Inaddition the GRACE and PLR scores in death group were significantly higher than those in survival group(P<0.05).Conclusion PLR can be regarded as a potential predictive index to predict the short-term prognosis of patients with AMI complicated by type 2 diabetes mellitus,which can provide theoretical basi fot determining appropriate treatment strategies.
引文
1 Semenkovich K,Brown ME,Svrakic DM,et al.Depression in type 2 diabetes mellitus:prevalence,impact,and treatment.Drugs,2015,75:577-587.
2 Li XM,Ji H,Li CJ,et al.Chemerin expression in Chinese pregnant women with and without gestational diabetes mellitus.Annales Dendocrinologie,2015,76:19-25.
3 Mota M,Popa SG,Mota E,et al.Prevalence of diabetes mellitus and prediabetes in the adult Romanian population:PREDATORR study.Journal of Diabetes,2016,8:336-344.
4 胡丹丹,李江,傅华.亚洲人群2型糖尿病非侵入性筛查方法研究进展.中国预防医学杂志,2016,17:148-151.
5 刘欢,李艳,许淑文,等.急性心肌梗死合并心功能不全患者的相关危险因素分析.中国热带医学,2016,16:244-247.
6 Lindau ST,Abramsohn E,Bueno H,et al.Sexual activity and function in the year after an acute myocardial infarction (AMI)among younger women and men in the U.S.and Spain.Jama Cardiology,2016,1:754-761.
7 庞工力,王敬萍,柴晓红,等.血糖控制对急性心肌梗死合并2型糖尿病患者阿司匹林反应性及预后的影响.中国心血管病研究,2015,13:252-255.
8 Zhang S,Wan Z,Zhang Y,et al.Neutrophil count improves the GRACE risk score prediction of clinical outcomes in patients with ST-elevation myocardial infarction.Atherosclerosis,2015,241:723-728.
9 杜玥,雷红.血小板/淋巴细胞比值与冠状动脉狭窄程度的关系探讨.中西医结合心脑血管病杂志,2015,13:2103-2106.
10 金玫.急性ST段抬高型心肌梗死诊断和治疗指南.中华心血管病杂志,2015,43:675-690.
11 Alberti KG,Zimmet PZ.Definition,diagnosis and classification of diabetes mellitus and its complications.Part 1:diagnosis and classification of diabetes mellitus.Provisional report of a WHO Consultation.Diabet Med,1998,15:539-553.
12 Moscucci M,Fox KA,Cannon CP,et al.Predictors of major bleeding in acute coronary syndromes:the Global Registry of Acute Coronary Events (GRACE).European Heart Journal,2003,13:1815-1823.
13 田大斌,蒋祖辉.血清肌红蛋白、cTnI检测在急性心肌梗死的临床诊断价值及炎症因子水平.国际检验医学杂志,2017,38:953-955.
14 王彦雯,王玲.血小板在炎症及动脉粥样硬化中的作用.世界最新医学信息文摘:电子版,2015,15:175-178.
15 Hu H,Yao X,Xie X,et al.Prognostic value of preoperative NLR,dNLR,PLR and CRP in surgical renal cell carcinoma patients.World Journal of Urology,2016,35:1-10.
16 Qin B,Ma N,Tang Q,et al.Neutrophil to lymphocyte ratio (NLR)and platelet to lymphocyte ratio (PLR)were useful markers in assessment of inflammatory response and disease activity in SLE patients.Modern Rheumatology,2016,26:372-376.
17 方钊,蒋学俊,陶波,等.血小板淋巴细胞比率与急性冠脉综合征的相关性分析.医学研究杂志,2016,45:48-51.
18 杨溶海,梁建光,汪学军.血小板-淋巴细胞比率预测非ST段抬高型急性心肌梗死患者左心室收缩功能障碍的准确性.中国动脉硬化杂志,2015,23:802-806.
19 洪骏,戴雯,吴嘉,等.急性冠脉综合症患者中性粒细胞与淋巴细胞比值与Grace评分的相关性.临床检验杂志,2016,34:432-435.
20 Oncel RC,Ucar M,Karakas MS,et al.Relation of neutrophil-to-lymphocyte ratio with GRACE risk score to in-hospital cardiac events in patients with ST-Segment elevated myocardial infarction.Clin Appl Thromb Hemost,2015,21:383-388.
21 Acet H.The relationship of TIMI risk index with SYNTAX and Gensini risk scores in predicting the extent and severity of coronary artery disease in patients with STEMI undergoing primary percutaneous coronary intervention.Therapeutic Advances in Cardiovascular Disease,2015,9:336-337.
2 Li XM,Ji H,Li CJ,et al.Chemerin expression in Chinese pregnant women with and without gestational diabetes mellitus.Annales Dendocrinologie,2015,76:19-25.
3 Mota M,Popa SG,Mota E,et al.Prevalence of diabetes mellitus and prediabetes in the adult Romanian population:PREDATORR study.Journal of Diabetes,2016,8:336-344.
4 胡丹丹,李江,傅华.亚洲人群2型糖尿病非侵入性筛查方法研究进展.中国预防医学杂志,2016,17:148-151.
5 刘欢,李艳,许淑文,等.急性心肌梗死合并心功能不全患者的相关危险因素分析.中国热带医学,2016,16:244-247.
6 Lindau ST,Abramsohn E,Bueno H,et al.Sexual activity and function in the year after an acute myocardial infarction (AMI)among younger women and men in the U.S.and Spain.Jama Cardiology,2016,1:754-761.
7 庞工力,王敬萍,柴晓红,等.血糖控制对急性心肌梗死合并2型糖尿病患者阿司匹林反应性及预后的影响.中国心血管病研究,2015,13:252-255.
8 Zhang S,Wan Z,Zhang Y,et al.Neutrophil count improves the GRACE risk score prediction of clinical outcomes in patients with ST-elevation myocardial infarction.Atherosclerosis,2015,241:723-728.
9 杜玥,雷红.血小板/淋巴细胞比值与冠状动脉狭窄程度的关系探讨.中西医结合心脑血管病杂志,2015,13:2103-2106.
10 金玫.急性ST段抬高型心肌梗死诊断和治疗指南.中华心血管病杂志,2015,43:675-690.
11 Alberti KG,Zimmet PZ.Definition,diagnosis and classification of diabetes mellitus and its complications.Part 1:diagnosis and classification of diabetes mellitus.Provisional report of a WHO Consultation.Diabet Med,1998,15:539-553.
12 Moscucci M,Fox KA,Cannon CP,et al.Predictors of major bleeding in acute coronary syndromes:the Global Registry of Acute Coronary Events (GRACE).European Heart Journal,2003,13:1815-1823.
13 田大斌,蒋祖辉.血清肌红蛋白、cTnI检测在急性心肌梗死的临床诊断价值及炎症因子水平.国际检验医学杂志,2017,38:953-955.
14 王彦雯,王玲.血小板在炎症及动脉粥样硬化中的作用.世界最新医学信息文摘:电子版,2015,15:175-178.
15 Hu H,Yao X,Xie X,et al.Prognostic value of preoperative NLR,dNLR,PLR and CRP in surgical renal cell carcinoma patients.World Journal of Urology,2016,35:1-10.
16 Qin B,Ma N,Tang Q,et al.Neutrophil to lymphocyte ratio (NLR)and platelet to lymphocyte ratio (PLR)were useful markers in assessment of inflammatory response and disease activity in SLE patients.Modern Rheumatology,2016,26:372-376.
17 方钊,蒋学俊,陶波,等.血小板淋巴细胞比率与急性冠脉综合征的相关性分析.医学研究杂志,2016,45:48-51.
18 杨溶海,梁建光,汪学军.血小板-淋巴细胞比率预测非ST段抬高型急性心肌梗死患者左心室收缩功能障碍的准确性.中国动脉硬化杂志,2015,23:802-806.
19 洪骏,戴雯,吴嘉,等.急性冠脉综合症患者中性粒细胞与淋巴细胞比值与Grace评分的相关性.临床检验杂志,2016,34:432-435.
20 Oncel RC,Ucar M,Karakas MS,et al.Relation of neutrophil-to-lymphocyte ratio with GRACE risk score to in-hospital cardiac events in patients with ST-Segment elevated myocardial infarction.Clin Appl Thromb Hemost,2015,21:383-388.
21 Acet H.The relationship of TIMI risk index with SYNTAX and Gensini risk scores in predicting the extent and severity of coronary artery disease in patients with STEMI undergoing primary percutaneous coronary intervention.Therapeutic Advances in Cardiovascular Disease,2015,9:336-337.