稳定型冠心病患者外周血中性粒细胞/淋巴细胞计数比值与冠脉斑块易损性的相关性分析  

Association of neutrophil to lymphocyte ratio with coronary plaque vulnerability in patients with stable coronary artery disease

作　　者：刘洋[1] 周叶[2] 吕侣[1] 刘宏斌[1] LIU Yang ZHOU Ye LYU Lyu LIU Hongbin(Department of Geriatric Cardiology Department of Cardiology Chinese PLA General Hospital, Beijing 100853, China)

机构地区：[1]解放军总医院老年心血管内科,北京100853 [2]解放军总医院心血管内科,北京100853

出　　处：《解放军医学院学报》2017年第8期711-715,共5页Academic Journal of Chinese PLA Medical School

基　　金：中央保健重点课题([2015]13号)~~

摘　　要：目的探讨稳定型冠心病患者外周血中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)与斑块内组织成分的关系,并评价其对易损斑块的预测价值。方法选取2013年10月-2016年6月于本院心内科住院的243例稳定型冠心病(stable coronary artery disease,SCAD)患者。入院行血常规检查获得NLR值,通过血管内超声(intravascular ultrasound,IVUS)对冠状动脉内斑块的形态及组织成分进行评估。分析NLR与斑块内各种组织成分百分比的相关性。并根据IVUS得到的数据,将纳入研究的斑块分为易损斑块组及非易损斑块组,通过ROC曲线评价NLR对易损斑块的预测价值。结果单因素线性回归分析表明,斑块内脂质成分含量(r=0.32,P<0.001)及纤维成分含量(r=-0.43,P<0.001)与NLR具有相关性。通过多元回归分析发现高NLR是斑块内脂质增加(β=0.59,P=0.034)和纤维成分减少(β=-0.22,P=0.004)的独立相关因素。NLR>2.78对于SCAD患者易损斑块预测的敏感性为77.6%,特异性为74%(AUC:0.789,95%CI:0.731~0.846,P<0.001)。结论 SCAD患者NLR与斑块内脂质及纤维成分含量具有独立的线性相关性,NLR可能成为SCAD患者斑块易损性的简易预测指标。Objective To investigate the association of neutrophil to lymphocyte ratio （NLR） with coronary plaque composition assessed by intravascular ultrasound （IVUS） in patients with stable coronary artery disease （SCAD） and evaluate its predictive value on the vulnerable plaques. Methods A total of 243 patients with SCAD hospitalized in Chinese PLA General Hospital were included in the study from October 2013 to June 2016. Routine blood test was performed on admission and NLR value was calculated before coronary angiography. IVUS was performed on the culprit vessels to evaluate the component of coronary artery plaques. The correlations between NLR and the volume percentage of the main component of plaques were analyzed. According to the data from IVUS, the enrolled plaques were divided into two groups： vulnerable group and invulnerable group. The value of NLR in predicting the vulnerability of plaques was assessed by ROC curve. Results Univariate linear regression analysis showed lipid volume （r=0.32, P 〈 0.001） and fibrous volume （r=-0.43, P 〈 0.001） were correlated with NLR. In multiple regression analysis, NLR were independently associated with lipid volume （β =0.59, P=0.034） and fibrous volume （β = -0.22, P=0.004） in coronary plaques. A NLR=2.78 as optimal cut-off value had sensitivity of 77.6% and specificity of 74% （AUC： 0.789, 95% CI： 0.731- 0.846, P 〈 0.001） in predicting vulnerable plaques. Conclusion This study indicates NLR is linearly correlated with lipid and fibrous contents with larger plaque burden, which suggests that NLR can be used as a useful tool to predict plaque vulnerability in patients with SCAD.

关 键 词：中性粒细胞/淋巴细胞比值 斑块 稳定型冠心病 血管内超声 

分 类 号：R541.4[医药卫生—心血管疾病]