1.重庆大学附属黔江医院检验科,重庆 409000
2.陆军特色医学中心神经内科,重庆 400042
3.重庆大学附属黔江医院心内科,重庆 409000
Received:01 March 2022,
Published:28 August 2022
移动端阅览
陈艺心,皮燕,王永红,等.AIP、WBC计数和NLR对急性冠脉综合征预测价值的研究[J].重庆医科大学学报,2022,47(8):903-909.
Chen Yixin,Pi Yan,Wang Yonghong,et al.Predictive value of atherosclerotic index of plasma, white blood cells count and neutrophil lymphocyte ratio in acute coronary syndrome[J].Journal of Chongqing Medical University,2022,47(8):903-909.
陈艺心,皮燕,王永红,等.AIP、WBC计数和NLR对急性冠脉综合征预测价值的研究[J].重庆医科大学学报,2022,47(8):903-909. DOI: 10.13406/j.cnki.cyxb.003071.
Chen Yixin,Pi Yan,Wang Yonghong,et al.Predictive value of atherosclerotic index of plasma, white blood cells count and neutrophil lymphocyte ratio in acute coronary syndrome[J].Journal of Chongqing Medical University,2022,47(8):903-909. DOI: 10.13406/j.cnki.cyxb.003071.
目的
2
探讨血浆动脉粥样硬化指数(atherosclerotic index of plasma,AIP)、白细胞(white blood cells,WBC)计数和中性粒细胞淋巴细胞比值(neutrophil lymphocyte ratio,NLR)对急性冠状动脉综合征(acute coronary syndrome,ACS)的风险预测和冠脉病变程度的评估价值。
方法
2
将2019年1月至2021年12月期间首次就诊的疑似冠心病患者分为ACS组(
n
=288)和非ACS组(
n
=93)进行对比研究。采用受试者工作特征(receiver operating characteristic,ROC)曲线、多因素logistic回归分析和Spearman秩相关分析方法评估AIP、WBC计数和NLR对ACS的预测价值及与Gensini评分的相关性。
结果
2
ACS组AIP、WBC计数和NLR高于非ACS组(
t/Z
=3.623、6.697、-6.165,
P
<
0.001)。多因素logistic回归分析结果显示,AIP、WBC计数和NLR 3个指标均是ACS的独立危险因素,排除混杂因素后,AIP、WBC、NLR每增加一个单位,ACS发生风险分别增加6.739倍(95%CI=2.829~21.169,
P<
0.001)、0.260倍(95%CI=1.113~1.426,
P<
0.001)和0.145倍(95%CI=1.036~1.265,
P=
0.008)。AIP、WBC计数和NLR预测ACS的曲线下面积(area under the curve,AUC)分别为0.627(95%CI=0.563~0.692,
P<
0.001)、0.696(95%CI=0.638~0.755,
P<
0.001)和0.713(95%CI=0.652~0.773,
P<
0.001),三指标联合预测的AUC为0.756(95%CI=0.700~0.813,
P<
0.001)。高AIP、高WBC、高NLR组发生完全闭塞、左主干/多支病变的比例和Gensini评分均高于低值组(均
P
<
0.05),三者与Gensini评分呈正相关(
r
=0.188、0.313、0.332,均
P
<
0.001)。
结论
2
AIP、WBC计数和NLR是ACS发生的独立危险因素,三者联合对ACS风险有一定预测价值,且与冠状动脉病变严重程度显著正相关,有望成为ACS风险预测及病情评估的潜在标志物。
Objective
2
To investigate the predictive value of atherosclerotic index of plasma(AIP), white blood cells(WBC) count and neutrophil lymphocyte ratio(NLR) to acute coronary syndrome(ACS) and the severity of coronary lesions.
Methods
2
Patients with suspected coronary heart disease who first visited the hospital from January 2019 to December 2021 were retrospectively enrolled. All patients were divided into two groups,ACS group(
n
=288) and non-ACS group(
n
=93). The receiver operating characteristic (ROC) curve and multivariate logistic regression were used to analyze the predictive value of AIP, WBC count and NLR in ACS. Spearman rank correlation was used to analyze the correlation between the indexes and Gensini score.
Results
2
AIP, WBC count and NLR in ACS group were significantly higher than those in non-ACS group(
t/Z
=3.623,6.697,-6.165,
P
<
0.001). Logistic regression analysis showed that AIP,WBC count and NLR were independent risk factors for ACS. After excluding confounding factors, with the increase of each additional unit of AIP,WBC and NLR,the risk of ACS increased by 6.739 times(95%CI=2.829-21.169,
P<
0.001),0.260 times(95%CI=1.113-1.426,
P<
0.001),and 0.145 times(95%CI=1.036-1.265,
P=
0.008). The area under the curve(AUC) for predicting ACS with AIP,WBC count and NLR was 0.627(95%CI=0.563-0.692,
P<
0.001),0.696(95%CI=0.638-0.755,
P<
0.001),and 0.713(95%CI=0.652-0.773,
P<
0.001),respectively. The larger AUC of 0.756(95%CI=0.700-0.813,
P<
0.001)
was observed when the combination of the three indicators was used to predict ACS. The proportions of complete vascular occlusion,left main coronary artery or multiple vascular branch lesions and Gensini score in high AIP, high WBC and high NLR groups were significantly higher than those in low value groups(all
P
<
0.05). The three indicators were significantly positively correlated with Gensini score(
r
=0.188,0.313, 0.332,all
P
<
0.001).
Conclusion
2
AIP,WBC count and NLR are independent risk factors for ACS,and their combination has better predictive value for ACS. Moreover,they are positively correlated with the severity of coronary lesions significantly,which may have potential to be biomarkers for ACS risk prediction and condition evaluation.
Moore KJ , Koplev S , Fisher EA , et al . Macrophage trafficking,inflammatory resolution,and genomics in atherosclerosis:JACC macrophage in CVD series(part 2) [J ] . J Am Coll Cardiol , 2018 , 72 ( 18 ): 2181 - 2197 .
Zhang GY , Chen M , Yu ZM , et al . Relation between neutrophil-to-lymphocyte ratio and severity of coronary artery stenosis [J ] . Genet Mol Res , 2014 , 13 ( 4 ): 9382 - 9389 .
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 [J ] . Clin Appl Thromb Hemost , 2015 , 21 ( 4 ): 383 - 388 .
Huang HM , Yu XL , Li LM , et al . Atherogenic index of plasma is related to coronary atherosclerotic disease in elderly individuals:a cross-sectional study [J ] . Lipids Health Dis , 2021 , 20 ( 1 ): 1 - 9 .
Ma XT , Sun Y , Cheng YJ , et al . Prognostic impact of the atherogenic index of plasma in type 2 diabetes mellitus patients with acute coronary syndrome undergoing percutaneous coronary intervention [J ] . Lipids Health Dis , 2020 , 19 ( 1 ): 240 .
中华医学会心血管病学分会 , 中华心血管病杂志编辑委员会 . 非ST段抬高型急性冠状动脉综合征诊断和治疗指南(2016) [J ] . 中华心血管病杂志 , 2017 , 45 ( 5 ): 359 - 376 .
Chinese Society of Cardiology of Chinese Medical Association , Editorial Board of Chinese Journal of Cardiology . Guideline and consensus for the management of patients with non-ST-elevation acute coronary syndrome(2016) [J ] . Chin J Cardiol , 2017 , 45 ( 5 ): 359 - 376 .
中华医学会心血管病学分会 , 中华心血管病杂志编辑委员会 . 急性ST段抬高型心肌梗死诊断和治疗指南 [J ] . 中华心血管病杂志 , 2015 , 43 ( 5 ): 380 - 393 .
Chinese Society of Cardiology of Chinese Medical Association , Editorial Board of Chinese Journal of Cardiology . Chinese Society of Cardiology (CSC) guidelines for the diagnosis and management of patients with ST-segment elevation myocardial infarction [J ] . Chin J Cardiol , 2015 , 43 ( 5 ): 380 - 393 .
Gasior M , Gierlotka M , Pyka Ł , et al . Temporal trends in secondary prevention in myocardial infarction patients discharged with left ventricular systolic dysfunction in Poland [J ] . Eur J Prev Cardiol , 2018 , 25 ( 9 ): 960 - 969 .
北京高血压防治协会 , 北京糖尿病防治协会 , 北京慢性病防治与健康教育研究会 , 等 . 基层心血管病综合管理实践指南2020 [J ] . 中国医学前沿杂志 (电子版), 2020 , 12 ( 8 ): 1 - 73 .
Beijing Hypertension Association, Beijing Diabetes Prevention and Treatment Association . Practise guideline ( 2020 ) for integrated management of cardiovascular diseases in primary hospitals [J ] . Chin J Front Med Sci (Elec) ,2020, 12 ( 8 ): 1 - 73 .
国家心血管病中心 . 中国心血管健康与疾病报告2020 [J ] . 心肺血管病杂志 , 2021 , 40 ( 9 ): 885 - 889 .
Chinese Cardiovascular Disease Center . Annual report on cardiovascular health and diseases in China 2020 [J ] . J Cardiovasc Pulm Dis , 2021 , 40 ( 9 ): 885 - 889 .
Safiri S , Karamzad N , Singh K , et al . Burden of ischemic heart disease and its attributable risk factors in 204 countries and territories,1990-2019 [J ] . Eur J Prev Cardiol , 2022 , 29 ( 2 ): 420 - 431 .
Ayça B , Akın F , Celik O , et al . Neutrophil to lymphocyte ratio is related to stent thrombosis and high mortality in patients with acute myocardial infarction [J ] . Angiology , 2015 , 66 ( 6 ): 545 - 552 .
Franck G , Mawson TL , Folco EJ , et al . Roles of PAD4 and NETosis in experimental atherosclerosis and arterial injury:implications for superficial Erosion [J ] . Circ Res , 2018 , 123 ( 1 ): 33 - 42 .
Pertiwi KR , van der Wal AC , Pabittei DR , et al . Neutrophil extracellular traps participate in all different types of thrombotic and haemorrhagic complications of coronary atherosclerosis [J ] . Thromb Haemost , 2018 , 118 ( 6 ): 1078 - 1087 .
Soehnlein O , Steffens S , Hidalgo A , et al . Neutrophils as protagonists and targets in chronic inflammation [J ] . Nat Rev Immunol , 2017 , 17 ( 4 ): 248 - 261 .
Zhou D , Wan ZF , Fan Y , et al . A combination of the neutrophil-to-lymphocyte ratio and the GRACE risk score better predicts PCI outcomes in Chinese Han patients with acute coronary syndrome [J ] . Anatol J Cardiol , 2015 , 15 ( 12 ): 995 - 1001 .
Yang ZX , Zhang ZY , Lin F , et al . Comparisons of neutrophil-,monocyte-,eosinophil-,and basophil- lymphocyte ratios among various systemic autoimmune rheumatic diseases [J ] . APMIS , 2017 , 125 ( 10 ): 863 - 871 .
Wang J , Zhu QW , Cheng XY , et al . Assessment efficacy of neutrophil-lymphocyte ratio and monocyte-lymphocyte ratio in preeclampsia [J ] . J Reprod Immunol , 2019 , 132 : 29 - 34 .
Afari ME , Bhat T . Neutrophil to lymphocyte ratio (NLR) and cardiovascular diseases:an update [J ] . Expert Rev Cardiovasc Ther , 2016 , 14 ( 5 ): 573 - 577 .
Fan ZY , Li Y , Ji HH , et al . Prognostic utility of the combination of monocyte-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in patients with NSTEMI after primary percutaneous coronary intervention:a retrospective cohort study [J ] . BMJ Open , 2018 , 8 ( 10 ): e023459 .
van den Berg MJ , van der Graaf Y , de Borst GJ , et al . Low-density lipoprotein cholesterol,non-high-density lipoprotein cholesterol,triglycerides,and apolipoprotein B and cardiovascular risk in patients with manifest arterial disease [J ] . Am J Cardiol , 2016 , 118 ( 6 ): 804 - 810 .
Klempfner R , Erez A , Sagit BZ , et al . Elevated triglyceride level is independently associated with increased all-cause mortality in patients with established coronary heart disease:twenty-two-year follow-up of the bezafibrate infarction prevention study and registry [J ] . Circ Cardiovasc Qual Outcomes , 2016 , 9 ( 2 ): 100 - 108 .
Yunke Z , Guoping L , Zhenyue C . Triglyceride-to-HDL cholesterol ratio. Predictive value for CHD severity and new-onset heart failure [J ] . Herz , 2014 , 39 ( 1 ): 105 - 110 .
Cai GJ , Shi GW , Xue SL , et al . The atherogenic index of plasma is a strong and independent predictor for coronary artery disease in the Chinese Han population [J ] . Medicine (Baltimore) , 2017 , 96 ( 37 ): e8058 .
Fernández-Macías JC , Ochoa-Martínez AC , Varela-Silva JA , et al . Atherogenic index of plasma:novel predictive biomarker for cardiovascular illnesses [J ] . Arch Med Res , 2019 , 50 ( 5 ): 285 - 294 .
诸国华 , 孙希鹏 , 李 静 , 等 . 老年高血压患者致动脉粥样硬化指数与冠心病相关性研究 [J ] . 中华老年心脑血管病杂志 , 2021 , 23 ( 8 ): 807 - 810 .
Zhu GH , Sun XP , Li J , et al . Association between atherogenic index of plasma and CHD in elderly hypertension patients [J ] . Chin J Geriatr Heart Brain Vessel Dis , 2021 , 23 ( 8 ): 807 - 810 .
0
Views
3
下载量
1
CSCD
Publicity Resources
Related Articles
Related Author
Related Institution
京公网安备11010802024621
