血小板与淋巴细胞比值对冠状动脉病变及介入治疗预后的预测价值
|
摘要
目的探讨血小板与淋巴细胞比值(PLR)对老年急性冠状动脉综合征(ACS)患者冠状动脉病变及PCI预后的预测价值。方法选择2016年5月～2018年8月我院住院治疗的老年ACS患者344例,均接受PCI及冠状动脉造影,根据PCI术后有无主要不良心脑血管事件(MACCE)分为MACCE组95例和无MACCE组249例;根据PLR判断预后界值分为高PLR组247例(PLR≥137.6)和低PLR组97例(PLR<137.6)。回顾分析患者一般临床资料等,用ROC曲线确定PLR判断预后的界值,行logistic回归分析。结果 MACCE组吸烟、糖尿病、LDL-C、PLR及Gensini评分均较无MACCE组高(P<0.01);PLR和Gensini评分预测PCI预后不良的曲线下面积为0.898(95%CI:0.859～0.937)和0.842(95%CI:0.794～0.891);PLR水平与Gensini评分呈正相关(r=0.654,P<0.01)。高PLR组总MACCE发生率明显高于低PLR组(78.35%vs 7.69%,P<0.01),术前高PLR水平是预测老年ACS患者PCI术后发生MACCE的独立危险因素(OR=2.527,95%CI:1.058～6.039,P=0.037)。结论 PLR与老年ACS患者PCI术后发生MACCE有关。
Objective To study the value of platelet/lymphocyte ratio(PLR)in predicting coronary artery lesions and their outcome in acute coronary syndrome(ACS)patients after PCI.Methods Three hundred and forty-four elderly ACS patients who underwent PCI and CAG in our hospital from May 2016 to August 2018 were divided into MACCE group(n=95)and MACCE-free group(n=249).They were further divided into high PLR group(n=247)and low PLR group(n=97)according to the ROC curve for PLR.Their clinical data were analyzed,and the prognostic threshold of PLR was determined according to the ROC curve for PLR and logistic regression analysis respectively.Results The number of smokers was significantly greater,the incidence of DM,serum LDL-C level,PLR and Gensini score were significantly higher in MACCE group than in MACCE-free group(P<0.01).The area under the ROC curve for PLR in predicting the poor outcome in ACS patients after PCI was 0.898 and 0.842 respectively(95%CI:0.859-0.937,95%CI:0.794-0.891).The PLR was positively related with the Gensini score(r=0.654,P<0.01).The incidence of MACCE was significantly higher in high PLR group than in low PLR group(78.35%vs 7.69%,P<0.01).High PLR was an independent risk factor for MACCE in elderly ACS patients after PCI(OR=2.527,95%CI:1.058-6.039,P=0.037).Conclusion PLR is related with MACCE in elderly ACS patients after PCI.
Objective To study the value of platelet/lymphocyte ratio(PLR)in predicting coronary artery lesions and their outcome in acute coronary syndrome(ACS)patients after PCI.Methods Three hundred and forty-four elderly ACS patients who underwent PCI and CAG in our hospital from May 2016 to August 2018 were divided into MACCE group(n=95)and MACCE-free group(n=249).They were further divided into high PLR group(n=247)and low PLR group(n=97)according to the ROC curve for PLR.Their clinical data were analyzed,and the prognostic threshold of PLR was determined according to the ROC curve for PLR and logistic regression analysis respectively.Results The number of smokers was significantly greater,the incidence of DM,serum LDL-C level,PLR and Gensini score were significantly higher in MACCE group than in MACCE-free group(P<0.01).The area under the ROC curve for PLR in predicting the poor outcome in ACS patients after PCI was 0.898 and 0.842 respectively(95%CI:0.859-0.937,95%CI:0.794-0.891).The PLR was positively related with the Gensini score(r=0.654,P<0.01).The incidence of MACCE was significantly higher in high PLR group than in low PLR group(78.35%vs 7.69%,P<0.01).High PLR was an independent risk factor for MACCE in elderly ACS patients after PCI(OR=2.527,95%CI:1.058-6.039,P=0.037).Conclusion PLR is related with MACCE in elderly ACS patients after PCI.
引文
[1]Jiang Y,Xu H,Jiang H,et al.Pretreatment neutrophil-lymphocyte count ratio may associate with gastric cancer presence[J].Cancer Biomarkers,2016,16(4):523-528.DOI:10.3233/CBM-160593.
[2]Yilmaz M,Tenekecioglu E,Arslan B,et al.White blood cell subtypes and neutrophil-lymphocyte ratio in prediction of coronary thrombus formation in non-ST-segment elevated acute coronary syndrome[J].Clin Appl Thromb Hemost,2015,21(5):446-452.DOI:10.1177/1076029613507337.
[3]刘涛,周鹏.血小板淋巴细胞比率与急性心肌梗死患者行经皮冠脉介入术预后相关性研究进展[J].心血管病学进展,2018,39(1):123-126.DOI:10.16806/j.cnki.issn.1004-3934.2018.01.030.
[4]孙静,任法新,孙晓健,等.血小板-淋巴细胞聚集体和血小板/淋巴细胞比值在预测急诊经皮冠状动脉介入治疗术后心肌无复流中的作用[J].中国循环杂志,2018,33(9):869-872.DOI:10.3969/j.sn.00-3614.201.09.010.
[5]Sunbul M,Gerin F,Durmus E,et al.Neutrophil to lymphocyte and platelet to lymphocyte ratio in patients with dipper versus non-dipper hypertension[J].Clin Exp Hypertens 2014,36(4):217-221.DOI:10.3109/10641963.2013.804547.
[6]Budzianowski J,Pieszko K,Burchardt P,et al.The role of hematological indices in patients with acute coronary syndrome[J].Dis Markers,2017,2017(3):3041565.DOI:10.1155/2017/3041565.
[7]Lisman T.Platelet-neutrophil interactions as drivers of inflammatory and thrombotic disease[J].Cell Tissue Res,2018,371(3):567-576.DOI:10.1007/s00441-017-2727-4.
[8]Kawai Y,Miyoshi T,Nakamura K,et al.Association between changes in platelet reactivity during elective percutaneous coronary intervention and periprocedural myocardial infarction:a pilot study[J].J Cardiol,2019,73(2):134-141.DOI:10.1016/j.jjcc.2018.07.006.
[9]Kounis NG,Soufras GD,Tsigkas G,et al.White blood cell counts,leukocyte ratios,and eosinophils as inflammatory markers in patients with coronary artery disease[J].Clin Appl Thromb Hemost,2015,21(2):139-143.DOI:10.1177/1076029614531449.
[10]Xu N,Tang XF,Xu JJ,et al.Predictive value of neutrophil to lymphocyte ratio on long-term outcomes of acute myocardial infarction patients with multivessel disease[J].Zhonghua Xin Xue Guan Bing Za Zhi,2019,47(1):42-48.DOI:10.3760/cma.j.issn.0253-3758.2019.01.005.
[11]汪小丁,张光宇,朱红玲,等.高敏C反应蛋白和中性粒细胞及淋巴细胞比值与急性冠状动脉综合征的相关性研究[J].中华老年心脑血管病杂志,2014,16(7):698-701.DOI:10.3969/j.issn.1009-0126.2014.07.007.
[12]Wang X,Xie Z,Liu X,et al.Association of platelet to lymphocyte ratio with non-culprit atherosclerotic plaque vulnerability in patients with acute coronary syndrome:an optical coherence tomography study[J].BMC Cardiovasc Disord,2017,17(1):175.DOI:10.1186/s12872-017-0618-y.
[13]Yildiz A,Yuksel M,Oylumlu M,et al.The utility of the platelet-lymphocyte ratio for predicting no reflow in patients with ST-segment elevation myocardial infarction[J].Clin Appl Thromb Hemost,2015,21(3):223-228.DOI:10.1177/1076029613519851.
[14]Ozcan Cetin EH,Cetin MS,Aras D,et al.Platelet to lymphocyte ratio as a prognostic marker of in-hospital and longterm major adverse cardiovascular events in ST-segment elevation myocardial infarction[J].Angiology,2016,67(4):336-345.DOI:10.1177/0003319715591751.
[15]Altintas O,Altintas MO,Tasal A,et al.The relationship of platelet-to-lymphocyte ratio with clinical outcome and final infarctcore inacute ischemic stroke patients who have undergone endovascular therapy[J].Neurol Res,2016,38(9):759-765.DOI:10.1080/01616412.2016.1215030.
[16]Pilgrim T,Vranckx P,Valgimigli M,et al.Risk and timing of recurrent ischemic events among patients with stable ischemic heart disease,non-ST-segment elevation acute coronary syndrome,and ST-segment elevation myocardial infarction[J].Am Heart J,2016,175(5):56-65.DOI:10.1016/j.ahj.2016.01.021.
[2]Yilmaz M,Tenekecioglu E,Arslan B,et al.White blood cell subtypes and neutrophil-lymphocyte ratio in prediction of coronary thrombus formation in non-ST-segment elevated acute coronary syndrome[J].Clin Appl Thromb Hemost,2015,21(5):446-452.DOI:10.1177/1076029613507337.
[3]刘涛,周鹏.血小板淋巴细胞比率与急性心肌梗死患者行经皮冠脉介入术预后相关性研究进展[J].心血管病学进展,2018,39(1):123-126.DOI:10.16806/j.cnki.issn.1004-3934.2018.01.030.
[4]孙静,任法新,孙晓健,等.血小板-淋巴细胞聚集体和血小板/淋巴细胞比值在预测急诊经皮冠状动脉介入治疗术后心肌无复流中的作用[J].中国循环杂志,2018,33(9):869-872.DOI:10.3969/j.sn.00-3614.201.09.010.
[5]Sunbul M,Gerin F,Durmus E,et al.Neutrophil to lymphocyte and platelet to lymphocyte ratio in patients with dipper versus non-dipper hypertension[J].Clin Exp Hypertens 2014,36(4):217-221.DOI:10.3109/10641963.2013.804547.
[6]Budzianowski J,Pieszko K,Burchardt P,et al.The role of hematological indices in patients with acute coronary syndrome[J].Dis Markers,2017,2017(3):3041565.DOI:10.1155/2017/3041565.
[7]Lisman T.Platelet-neutrophil interactions as drivers of inflammatory and thrombotic disease[J].Cell Tissue Res,2018,371(3):567-576.DOI:10.1007/s00441-017-2727-4.
[8]Kawai Y,Miyoshi T,Nakamura K,et al.Association between changes in platelet reactivity during elective percutaneous coronary intervention and periprocedural myocardial infarction:a pilot study[J].J Cardiol,2019,73(2):134-141.DOI:10.1016/j.jjcc.2018.07.006.
[9]Kounis NG,Soufras GD,Tsigkas G,et al.White blood cell counts,leukocyte ratios,and eosinophils as inflammatory markers in patients with coronary artery disease[J].Clin Appl Thromb Hemost,2015,21(2):139-143.DOI:10.1177/1076029614531449.
[10]Xu N,Tang XF,Xu JJ,et al.Predictive value of neutrophil to lymphocyte ratio on long-term outcomes of acute myocardial infarction patients with multivessel disease[J].Zhonghua Xin Xue Guan Bing Za Zhi,2019,47(1):42-48.DOI:10.3760/cma.j.issn.0253-3758.2019.01.005.
[11]汪小丁,张光宇,朱红玲,等.高敏C反应蛋白和中性粒细胞及淋巴细胞比值与急性冠状动脉综合征的相关性研究[J].中华老年心脑血管病杂志,2014,16(7):698-701.DOI:10.3969/j.issn.1009-0126.2014.07.007.
[12]Wang X,Xie Z,Liu X,et al.Association of platelet to lymphocyte ratio with non-culprit atherosclerotic plaque vulnerability in patients with acute coronary syndrome:an optical coherence tomography study[J].BMC Cardiovasc Disord,2017,17(1):175.DOI:10.1186/s12872-017-0618-y.
[13]Yildiz A,Yuksel M,Oylumlu M,et al.The utility of the platelet-lymphocyte ratio for predicting no reflow in patients with ST-segment elevation myocardial infarction[J].Clin Appl Thromb Hemost,2015,21(3):223-228.DOI:10.1177/1076029613519851.
[14]Ozcan Cetin EH,Cetin MS,Aras D,et al.Platelet to lymphocyte ratio as a prognostic marker of in-hospital and longterm major adverse cardiovascular events in ST-segment elevation myocardial infarction[J].Angiology,2016,67(4):336-345.DOI:10.1177/0003319715591751.
[15]Altintas O,Altintas MO,Tasal A,et al.The relationship of platelet-to-lymphocyte ratio with clinical outcome and final infarctcore inacute ischemic stroke patients who have undergone endovascular therapy[J].Neurol Res,2016,38(9):759-765.DOI:10.1080/01616412.2016.1215030.
[16]Pilgrim T,Vranckx P,Valgimigli M,et al.Risk and timing of recurrent ischemic events among patients with stable ischemic heart disease,non-ST-segment elevation acute coronary syndrome,and ST-segment elevation myocardial infarction[J].Am Heart J,2016,175(5):56-65.DOI:10.1016/j.ahj.2016.01.021.