血小板与淋巴细胞比值和青年冠状动脉粥样硬化性心脏病患者冠状动脉病变严重程度的相关性研究
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摘要
目的探讨血小板与淋巴细胞比值(PLR)和青年冠状动脉粥样硬化性心脏病(冠心病)患者冠状动脉病变严重程度的相关性。方法入选2016年1月至2017年6月于首都医科大学附属北京安贞医院造影诊断为冠心病的378例青年患者,应用SYNTAX评分评定冠状动脉病变严重程度,SYNTAX评分≤22分299例(低危组),>22分99例(中高危组)。比较2组患者入院造影及临床基线资料,分析PLR与冠状动脉病变SYNTAX评分的相关性,评估PLR预测冠状动脉病变严重程度的价值。结果中高危组糖尿病比例、空腹血糖、糖化血清白蛋白、PLR、中性粒细胞与淋巴细胞比值显著高于低危组,差异均有统计学意义(均P <0.05)。相关性分析显示PLR与青年冠心病患者冠状动脉病变SYNTAX评分呈正相关(r=0.235,P<0.001)。在此基础上通过二元Logistic回归分析,矫正空腹血糖、糖化血清白蛋白、中性粒细胞与淋巴细胞比值等混杂因素影响发现,PLR仍可独立预测冠状动脉病变严重程度(比值比=1.010,95%置信区间:1.003～1.017,P=0. 005)。经进一步计算约登指数发现,以PLR=132.97为界值点预测冠状动脉病变严重程度最佳(P=0.005),其敏感度和特异度分别为43.0%及78.6%。结论在青年冠心病患者中,PLR与冠状动脉病变复杂程度密切相关,其预测冠状动脉病变严重程度的特异度相对较好。
Objective To investigate the relation between platelet to lymphocyte ratio(PLR) and severity of coronary heart disease(CHD) in young patients. Methods A total of 378 young patients diagnosed of CHD in Beijing Anzhen Hospital, Capital Medical University from January 2016 to July 2017 were included. According to the SYNTAX score, the patients were divided into low risk group( SYNTAX score ≤22, n= 299) and high risk group(SYNTAX score >22, n = 99). Coronary angiography results, clinical records, the relation between PLR and CHD severity were analyzed. Results Diabetes ratio, fasting blood glucose, glycated albumin, PLR and neutrophil to lymphocyte ratio in high risk group were significantly higher than those in low risk group( P < 0.05).PLR was positively related to the SYNTAX score( r = 0. 235, P < 0. 001). Logistic regression showed that PLR was an independent predictive factor of CHD severity( odds ratio = 1. 010, 95% confidence interval: 1. 003-1. 017,P =0. 005). Receiver operating characteristic curve showed that PLR = 132. 97 was an optimal predictor of CHD severity(P = 0.005); the sensitivity was 43.0% and the specificity was 78.6%. Conclusion PLR is an independent predictor of the severity of CHD in young patients.
Objective To investigate the relation between platelet to lymphocyte ratio(PLR) and severity of coronary heart disease(CHD) in young patients. Methods A total of 378 young patients diagnosed of CHD in Beijing Anzhen Hospital, Capital Medical University from January 2016 to July 2017 were included. According to the SYNTAX score, the patients were divided into low risk group( SYNTAX score ≤22, n= 299) and high risk group(SYNTAX score >22, n = 99). Coronary angiography results, clinical records, the relation between PLR and CHD severity were analyzed. Results Diabetes ratio, fasting blood glucose, glycated albumin, PLR and neutrophil to lymphocyte ratio in high risk group were significantly higher than those in low risk group( P < 0.05).PLR was positively related to the SYNTAX score( r = 0. 235, P < 0. 001). Logistic regression showed that PLR was an independent predictive factor of CHD severity( odds ratio = 1. 010, 95% confidence interval: 1. 003-1. 017,P =0. 005). Receiver operating characteristic curve showed that PLR = 132. 97 was an optimal predictor of CHD severity(P = 0.005); the sensitivity was 43.0% and the specificity was 78.6%. Conclusion PLR is an independent predictor of the severity of CHD in young patients.
引文
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[2] Hansson GK. Inflammation, atherosclerosis, and coronary artery disease[J]. N Engl J Med, 2005,352(16):1685-1695.
[3] Gurm HS, Bhatt DL, Lincoff AM, et al. Impact of preprocedural white blood cell count on long term mortality after percutaneous coronary intervention:insights from the EPIC, EPILOG, and EPISTENT trials[J]. Heart, 2003,89(10):1200-1204.
[4] Home 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.
[5] Ly HQ, Kirtane AJ, Murphy SA, et al. Association of platelet counts on presentation and clinical outcomes in ST-elervation myocardial infarction(from the TIMI Trials)[J]. Am J Cardiol,2006,98(1):1-5.
[6] Azab B, Shah N, Akerman M, et al. Value of platelet/lymphocyte ratio as a predictor of all-cause mortality after non-ST-elevation myocardial infarction[J]. J Thromb Thrombolysis, 2012,34(3):326-334.
[7] Serruys PW, Morice MC, Kappetein AP, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease[J]. N Engl J Med, 2009,360(10):961-972. DOI:10.1056/NEJMoa0804626.
[8] Verdecchia P, Angeli F. The seventh report of the joint national committee on the prevention, detection, evaluation and treatment of high blood pressure:the weapons are ready[J]. Rev Esp Cardiol, 2003,56(9):843-847.
[9] Cai A, Li G, Chen J, et al. Glycated hemoglobin level is signifi-cantly associated with the severity of coronary artery disease in non-diabetic adults[J]. Lipids Health Dis, 2014(13):181. DOI:10.1186/1476-511X-13-181.
[10] Lindemann S,Kr(a|¨)mer B, Seizer P, et al. Platelets, inflammation and atherosclerosis[J]. J Thromb Haemost,2007(5 Suppl 1):203-211.
[11] Gawaz M, Langer H, May AE. Platelets in inflammation and atherogenesis[J]. J Clin Invest, 2005,115(12):3378-3384.
[12] Thaulow E, Erikssen J, Sandvik L, et al. Blood platelet count and function are related to total and cardiovascular death in apparently healthy men[J]. Circulation, 1991,84(2):613-617.
[13] Ommen SR, Gibbons RJ, Hodge DO, et al. Usefulness of the lymphocyte concentration as a prognostic marker in coronary artery disease[J]. Am J Cardiol, 1997,79(6):812-814.