稳定型冠心病的危险因素及与中性粒细胞/淋巴细胞比值的关系
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摘要
目的探讨稳定型冠心病的危险因素及与中性粒细胞/淋巴细胞比值(NLR)的相关性。方法回顾性分析2016年1~12月新疆伊犁州友谊医院收治的因胸痛入院拟诊为冠心病的患者600例,依据患者冠状动脉造影结果,将其分为冠心病组(n=300)及对照组(n=300)。比较两组患者一般资料作疾病危险因素的单因素分析,采用二分类Logistic回归分析筛选疾病的危险因素,比较不同NLR水平患者Gensini评分,绘制ROC曲线分析NLR对疾病诊断的价值。结果冠心病组和对照组吸烟史、高血压史、糖尿病史、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、血红蛋白、白细胞及NLR比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,吸烟(OR=2.331,95%CI:1.590~4.505,P<0.05),LDL-C(OR=1.737,95%CI:1.327~2.274,P<0.05),NLR(OR=1.552,95%CI:1.230~3.329,P<0.05)是冠心病的独立危险因素,HDL-C(OR=0.456,95%CI:0.261~0.798,P<0.05)是冠心病的独立保护因素。不同NLR水平冠心病患者Gensini评分差异有统计学意义(P<0.05),NLR高者Gensini评分显著增高(P<0.05);ROC曲线显示NLR的曲线下面积为0.834(95%CI:0.802~0.867),NLR切值取2.5时,其诊断效率最高,敏感性为77.0%,特异性为80.7%。结论NLR可能是稳定型冠心病的一个较好预测指标。
Objective To study the risk factors of stable coronary heart disease and relationship between neutrophil-tolymphocyte ratio(NLR) and it. Methods From January to December 2016, in Yili Youyi Hospital, 600 patients with chest pain and suspected as coronary heart disease were retrospectively analyzed. According to the results of coronary angiography, patients were divided into coronary heart disease(CAD) group(n = 300) and control group(n = 300). Disease risk factors of general data in two groups were compared by single factor analysis, disease risk factors were screened by two classification Logistic regression analysis, the Gensini scores of patients with different NLR levels were compared, the value of NLR in the diagnosis of disease was analyzed by drawing ROC curve. Results The smoking history, hypertension history, diabetes history, low density lipoprotein cholesterol(LDL-C), high density lipoprotein cholesterol(HDL-C),hemoglobin, WBC and NLR in CAD group and control group were compared, the differences were statistically significant(P < 0.05). Multivariate Logistic regression analysis showed that smoking(OR = 2.331, 95% CI: 1.590-4.505, P <0.05), LDL-C(OR = 1.737, 95% CI: 1.327-2.274, P < 0.05), NLR(OR = 1.552, 95% CI: 1.230-3.329, P < 0.05) were independent risk factor for CHD patients, and HDL-C(OR = 0.456, 95% CI: 0.261-0.798, P < 0.05) was the independent protective factors for CAD patients. Gensini scores stratified in different NLR of CAD group were compared, the difference was statistically significant(P < 0.05), Gensini scores was significantly higher in patients with higher NLR(P <0.05). ROC curve showed that the area under the curve was 0.834(95% CI: 0.802-0.867), and when the NLR value was 2.5, the diagnosis efficiency was highest, the sensitivity was 77.0%, and the specificity was 80.7%. Conclusion NLR may be a good predictor of stable coronary heart disease.
Objective To study the risk factors of stable coronary heart disease and relationship between neutrophil-tolymphocyte ratio(NLR) and it. Methods From January to December 2016, in Yili Youyi Hospital, 600 patients with chest pain and suspected as coronary heart disease were retrospectively analyzed. According to the results of coronary angiography, patients were divided into coronary heart disease(CAD) group(n = 300) and control group(n = 300). Disease risk factors of general data in two groups were compared by single factor analysis, disease risk factors were screened by two classification Logistic regression analysis, the Gensini scores of patients with different NLR levels were compared, the value of NLR in the diagnosis of disease was analyzed by drawing ROC curve. Results The smoking history, hypertension history, diabetes history, low density lipoprotein cholesterol(LDL-C), high density lipoprotein cholesterol(HDL-C),hemoglobin, WBC and NLR in CAD group and control group were compared, the differences were statistically significant(P < 0.05). Multivariate Logistic regression analysis showed that smoking(OR = 2.331, 95% CI: 1.590-4.505, P <0.05), LDL-C(OR = 1.737, 95% CI: 1.327-2.274, P < 0.05), NLR(OR = 1.552, 95% CI: 1.230-3.329, P < 0.05) were independent risk factor for CHD patients, and HDL-C(OR = 0.456, 95% CI: 0.261-0.798, P < 0.05) was the independent protective factors for CAD patients. Gensini scores stratified in different NLR of CAD group were compared, the difference was statistically significant(P < 0.05), Gensini scores was significantly higher in patients with higher NLR(P <0.05). ROC curve showed that the area under the curve was 0.834(95% CI: 0.802-0.867), and when the NLR value was 2.5, the diagnosis efficiency was highest, the sensitivity was 77.0%, and the specificity was 80.7%. Conclusion NLR may be a good predictor of stable coronary heart disease.
引文
[1]Heart Disease and Stroke Statistics-2014 Update:A Report from the American Heart Association[J].Circulation,2014,129(3):e28.
[2]李民凤,罗秋林,唐前梅,等.联合应用辛伐他汀和依折麦布治疗冠心病的调脂效果[J].中国医药导报,2017,14(23):48-51.
[3]Wu F,Narimatsu H,Li X,et al.Non-communicable diseases control in China and Japan[J].Global Health,2017,20,13(1):91.
[4]Pello AM,Cristóbal C,Tarín N,et al.Differential profile in inflammatory and mineral metabolism biomarkers in patients with ischemic heart disease without classical coronary risk factors[J].J Cardiol,2015,66(1):22-27.
[5]兰行远,徐尚华.替米沙坦对冠心病合并高血压患者血管内皮功能及炎症因子的影响[J].中国医药导报,2015,12(33):142-145.
[6]Li MX,Liu XM,Zhang XF,et al.Prognostic role of neutrophil-to-lymphocyte ratio in colorectal cancer:a systematic review and meta analysis[J].Int J Cancer,2014,134(10):2403-2413.
[7]Demirci NS,Erdem GU.Prognostic role of the neutrophilto-lymphocyte ratio(NLR)in patients with operable ampullary carcinoma[J].Bosn J Basic Med Sci,2017.doi:10.17305/bjbms.2017.2530.
[8]Onat D,Brillon D,Colombo PC,et al.Human vascular endothelial cells L:a model system for studying vascular in flammation in diabetes and atherosclerosis[J].Curr Diab Rep,2011,11:193-202.
[9]郑俊华,刘艳阳.血清炎性因子与急性冠状动脉综合征易损斑块相关性的研究进展[J].医学综述,2017,23(1):129-133.
[10]Istelmaier K,Winter MP,Dragschitz,et al.Prognostic value of culprit site neutrophils in acute coronary syndrome[J].Eur J Clin Invest,2014,44(3):257-265.
[11]Papa A,Emdin M,Passino C,et al.Predictive value of elevated neutrophil-lymphocyte ratio on cardiac mortality in patients with stable coronary artery disease[J].Clin Chim Acta,2008,395(1-2):27-31.
[12]何茜,谭洪文,于瑞萍,等.老年2型糖尿病并发冠心病患者血中性粒细胞与淋巴细胞比值的变化及意义[J].中华老年医学杂志,2016,35(3):252-255.
[13]蔡军,尹杰,宋建宁,等.胃癌患者外周血中性粒细胞与淋巴细胞比值的临床意义研究[J].临床和实验医学杂志,2014,13(12):102-112.
[14]Chen J,Chen MH,Li S,et al.Usefulness of the neutrophilto-lymphocyte ratio in predicting the severity of coronaryartery disease:a Gensini score assessment[J].J Atheroscler Thromb,2014,21(12):1271-1282.
[15]Zhang GY,Chen M,Yu ZM,et al.Relation between neutrophil-tolymphocyte ratio and severity of coronary artery stenosis[J].Genet Mol Res,2014,13(4):9382-9389.
[16]Kurtu S,Sarli B,Baktir AO,et al.Neutrophil to lymphocyte ratio predicts SYNTAX score in patients with nonST segment elevationmyocardial infarction[J].Int Heart J,2015,56(1):18-21.
[17]Zernecke A,Bot I,Djalali-Talab Y,et al.Protective role of CXC receptor 4/CXC ligand 12 unveils the importance of neutrophils inatheroselerosis[J].Circ Res,2008,102(2):209-217.
[18]Weber C,Zerneeke A,Libby P.The muhifaceted contributions of leu-kocyte subsets to atherosclerosis:lessons from mouse models[J].Nat Rev Immunol,2008,8(10):802-815.
[19]Horne BD,Anderson JL,John JM,et al.Which white blood cell subtypes predict increased cardiovascular risk?[J].J Am Coll Cardiol,2005,45(10):1638-1643.
[20]徐林,陶波.中性粒细胞淋巴细胞比值与急性心肌梗死的相关性研究[J].中国心血管病研究,2017,15(8):692-695.
[2]李民凤,罗秋林,唐前梅,等.联合应用辛伐他汀和依折麦布治疗冠心病的调脂效果[J].中国医药导报,2017,14(23):48-51.
[3]Wu F,Narimatsu H,Li X,et al.Non-communicable diseases control in China and Japan[J].Global Health,2017,20,13(1):91.
[4]Pello AM,Cristóbal C,Tarín N,et al.Differential profile in inflammatory and mineral metabolism biomarkers in patients with ischemic heart disease without classical coronary risk factors[J].J Cardiol,2015,66(1):22-27.
[5]兰行远,徐尚华.替米沙坦对冠心病合并高血压患者血管内皮功能及炎症因子的影响[J].中国医药导报,2015,12(33):142-145.
[6]Li MX,Liu XM,Zhang XF,et al.Prognostic role of neutrophil-to-lymphocyte ratio in colorectal cancer:a systematic review and meta analysis[J].Int J Cancer,2014,134(10):2403-2413.
[7]Demirci NS,Erdem GU.Prognostic role of the neutrophilto-lymphocyte ratio(NLR)in patients with operable ampullary carcinoma[J].Bosn J Basic Med Sci,2017.doi:10.17305/bjbms.2017.2530.
[8]Onat D,Brillon D,Colombo PC,et al.Human vascular endothelial cells L:a model system for studying vascular in flammation in diabetes and atherosclerosis[J].Curr Diab Rep,2011,11:193-202.
[9]郑俊华,刘艳阳.血清炎性因子与急性冠状动脉综合征易损斑块相关性的研究进展[J].医学综述,2017,23(1):129-133.
[10]Istelmaier K,Winter MP,Dragschitz,et al.Prognostic value of culprit site neutrophils in acute coronary syndrome[J].Eur J Clin Invest,2014,44(3):257-265.
[11]Papa A,Emdin M,Passino C,et al.Predictive value of elevated neutrophil-lymphocyte ratio on cardiac mortality in patients with stable coronary artery disease[J].Clin Chim Acta,2008,395(1-2):27-31.
[12]何茜,谭洪文,于瑞萍,等.老年2型糖尿病并发冠心病患者血中性粒细胞与淋巴细胞比值的变化及意义[J].中华老年医学杂志,2016,35(3):252-255.
[13]蔡军,尹杰,宋建宁,等.胃癌患者外周血中性粒细胞与淋巴细胞比值的临床意义研究[J].临床和实验医学杂志,2014,13(12):102-112.
[14]Chen J,Chen MH,Li S,et al.Usefulness of the neutrophilto-lymphocyte ratio in predicting the severity of coronaryartery disease:a Gensini score assessment[J].J Atheroscler Thromb,2014,21(12):1271-1282.
[15]Zhang GY,Chen M,Yu ZM,et al.Relation between neutrophil-tolymphocyte ratio and severity of coronary artery stenosis[J].Genet Mol Res,2014,13(4):9382-9389.
[16]Kurtu S,Sarli B,Baktir AO,et al.Neutrophil to lymphocyte ratio predicts SYNTAX score in patients with nonST segment elevationmyocardial infarction[J].Int Heart J,2015,56(1):18-21.
[17]Zernecke A,Bot I,Djalali-Talab Y,et al.Protective role of CXC receptor 4/CXC ligand 12 unveils the importance of neutrophils inatheroselerosis[J].Circ Res,2008,102(2):209-217.
[18]Weber C,Zerneeke A,Libby P.The muhifaceted contributions of leu-kocyte subsets to atherosclerosis:lessons from mouse models[J].Nat Rev Immunol,2008,8(10):802-815.
[19]Horne BD,Anderson JL,John JM,et al.Which white blood cell subtypes predict increased cardiovascular risk?[J].J Am Coll Cardiol,2005,45(10):1638-1643.
[20]徐林,陶波.中性粒细胞淋巴细胞比值与急性心肌梗死的相关性研究[J].中国心血管病研究,2017,15(8):692-695.