中性粒细胞/淋巴细胞比值与绝经后女性冠心病患者冠状动脉病变程度的关系
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摘要
目的了解中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)与绝经后女性冠状动脉粥样硬化性心脏病(coronary artery disease,CAD)的关系,并探讨NLR对绝经后女性CAD的预测价值。方法回顾性分析于2017年1月到2018年2月入住河北省人民医院心内科且经冠状动脉造影术(CAG)确诊的绝经后女性CAD患者226例,将同时期疑诊CAD入住心内科并通过冠状动脉造影术或冠状动脉计算机断层扫描血管造影(CTA)除外CAD的绝经后女性159例作对照。结果 CAD组原发性高血压(高血压)、糖尿病患者比例比对照组高,差异有统计学意义(P<0.01)。CAD组年龄更大,绝经时间更长,差异有统计学意义(P<0.01)。CAD组患者的NLR、白细胞计数、天冬氨酸转氨酶、三酰甘油比对照组高,差异有统计学意义(P<0.05)。CAD组红细胞压积、高密度脂蛋白胆固醇、载脂蛋白A、纤维蛋白原较对照组更低,差异有统计学意义(P<0.05)。把NLR与Gensini积分行Spearman相关分析,结果显示NLR与冠状动脉狭窄Gensini积分呈正相关(r=0.212,P<0.01)。依据Gensini积分将CAD组分为3组,重度组NLR较轻、中度组NLR明显升高,差异有统计学意义(P<0.05)。受试者工作特征曲线(receiver operating characteristicu crve,ROC)分析结果显示,NLR的曲线下面积为0.608(95%CI:0.551～0.664)。当NLR诊断临界值取2.53时,其诊断效能最高,敏感性为0.482,特异性为0.704。二分类Logistic回归分析结果示NLR是绝经后女性CAD的独立危险因素。结论 NLR可以在一定程度上预测绝经后女性CAD及评估冠状动脉严重程度。
Objectives To explore the relationship between neutrophil to lymphocyte ratio(NLR)and coronary artery lesions in postmenopausal female patients with coronary artery disease(CAD),then to evaluate the clinical value of NLR in predicting postmenopausal female patients with CAD. Methods Data were collected from female patients with CAD diagnosed by coronary angiography(CAG) in Hebei General Hospital from January 2017 to February 2018.Totally 159 postmenopausal female patients without CAD in the same period were selected as control group. Results Percentages of patients with hypertension,diabetes mellitus in CAD group were significantly higher than those in control group(P<0.05). Patients in CAD group had older age,longer menopause time than patients in control group(P<0.01). NLR,white blood cellcount,aspartate transaminase,triacylglycerol in CAD group were significantly higher than those in control group(P<0.05). Hematocrit,high density lipoprotein cholesterol,apolipoprotein A,fibrinogen in CAD group were significantly lower than those in control group(P<0.05). Spearman correlation analysis indicated that NLR positively correlated with Gensini scores(r=0.212,P<0.01). According to Gensini scores,patients in CAD group were divided into 3 subgroups,NLR in severe subgroup was significantly higher than that in moderate subgroup and mild subgroup(P<0.05). Receiver operating characteristic curve(ROC)results indicated that area under the curve of NLR was 0.608(95%CI:0.551-0.664). The optimal cutoff value of NLR in predicting CAD was 2.53 with sensitivity of 54.4% and specificity of 70.4%. Binary Logistic regression analysis after multivariable adjustment showed that NLR was an independent risk factor in postmenopausal female patients with CAD. Conclusions To some extent,NLR can predict CAD and assess the severity of coronary in postmenopausal women.
Objectives To explore the relationship between neutrophil to lymphocyte ratio(NLR)and coronary artery lesions in postmenopausal female patients with coronary artery disease(CAD),then to evaluate the clinical value of NLR in predicting postmenopausal female patients with CAD. Methods Data were collected from female patients with CAD diagnosed by coronary angiography(CAG) in Hebei General Hospital from January 2017 to February 2018.Totally 159 postmenopausal female patients without CAD in the same period were selected as control group. Results Percentages of patients with hypertension,diabetes mellitus in CAD group were significantly higher than those in control group(P<0.05). Patients in CAD group had older age,longer menopause time than patients in control group(P<0.01). NLR,white blood cellcount,aspartate transaminase,triacylglycerol in CAD group were significantly higher than those in control group(P<0.05). Hematocrit,high density lipoprotein cholesterol,apolipoprotein A,fibrinogen in CAD group were significantly lower than those in control group(P<0.05). Spearman correlation analysis indicated that NLR positively correlated with Gensini scores(r=0.212,P<0.01). According to Gensini scores,patients in CAD group were divided into 3 subgroups,NLR in severe subgroup was significantly higher than that in moderate subgroup and mild subgroup(P<0.05). Receiver operating characteristic curve(ROC)results indicated that area under the curve of NLR was 0.608(95%CI:0.551-0.664). The optimal cutoff value of NLR in predicting CAD was 2.53 with sensitivity of 54.4% and specificity of 70.4%. Binary Logistic regression analysis after multivariable adjustment showed that NLR was an independent risk factor in postmenopausal female patients with CAD. Conclusions To some extent,NLR can predict CAD and assess the severity of coronary in postmenopausal women.
引文
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[13]赵心,白小涓,汉雯,等.绝经后女性雌激素水平与骨质疏松症和动脉粥样硬化风险相关性研究[J].中华老年心脑血管病杂志,2017,19(10):1033-1038.
[14]刘海伟,韩雅玲,马颖艳,等. 2303例女性冠心病患者临床表现及冠状动脉造影病变特点的相关性分析[J].医学与哲学(B),2013,34(9):35-37,49.
[15]蔡莉娜,杨文博,强红丽,等. 393例女性冠心病患者的临床特征及预后探讨[J].临床心血管病杂志,2018,34(9):876-879.
[16] CHEN L, LI Q, YANG Z, et al. Osteocalcin, glucose metabolism,lipid profile and chronic low-grade inflammation in middle-aged and elderly Chinese[J]. Diabet Med,2013,30(3):309-317.
[17]贺威,范继红,靳志涛,等.急性ST段抬高型心肌梗死患者入院早期中性粒细胞/淋巴细胞比值与院内主要不良心血管事件的相关性[J].中国循环杂志,2016,31(1):36-39.
[18] NELSON M D. Left ventricular diastolic dysfunction in women with nonobstructive ischemic heart disease:insights from magnetic resonance imaging and spectroscopy[J]. Am J Physiol Regul Integr Comp Physiol,2017,313(4):R322-R329.
[19] VERDOIA M,BARBIERI L,GIOVINE G D,et al. Neutrophil to lymphocyte ratio and the extent of coronary artery disease:results from a large cohort study[J]. Angiology,2016,67(1):75-82.
[20] S?NMEZ O, ERTA?G, BACAKSIZ A, et al. Relation of neutrophil-to-lymphocyte ratio with the presence and complexity of coronary artery disease:an observational study[J]. Anadolu Kardiyol Derg,2013,13(7):662-667.
[2] POKHAREL Y,SHARMA P P,QINTAR M,et al. Highsensitivity C-reactive protein levels and health status outcomes after myocardial infarction[J]. Atherosclerosis,2017,266:16-23.
[3] OGITA M,MIYAUCHI K,TSUBOI S,et al. Impact of combined C-reactive protein and high-density lipoprotein cholesterol levels on long-term outcomes in patients with coronary artery disease after a first percutaneous coronary intervention[J]. Am J Cardiol,2015,116(7):999-1002.
[4]张上仕,朱红艳,赵若池,等.中性粒细胞与淋巴细胞比值对介入治疗后ST段抬高型心肌梗死患者预后预测价值的荟萃分析[J].中华心血管病杂志,2015,43(3):264-268.
[5]陈燕,周丹,黄雨晴,等.中性粒细胞与淋巴细胞比值与H型高血压患者颈动脉粥样硬化的相关性分析[J].岭南心血管病杂志,2018,24(3):314-317.
[6]马小花,陈诚,李畅,等.红细胞分布宽度及中性粒细胞/淋巴细胞比值与急性前壁心肌梗死患者左心室收缩功能的关系[J].岭南心血管病杂志,2018,24(1):22-26.
[7]戴思平,陈建良,黄波,等.血浆三酰甘油浓度升高增加冠状动脉狭窄风险的横断面研究[J].岭南心血管病杂志,2018,24(3):275-278.
[8] YALAMUDI K. Study of comparison between autonomic dysfunction and dyslipidemia in healthy postmenopausal women[J]. J Midlife Health,2017,8(3):103-109.
[9]彭芬,丁文惠.女性绝经后雌激素与动脉粥样硬化[J].中华心血管病杂志,2015,43(2):130-133.
[10]董海秋,董梅,任法新.雌激素水平对绝经后女性急性心肌梗死发生的影响研究[J].临床心血管病杂志,2017(2):56-59.
[11] DOSI R,BHATT N,SHAH P,et al. Cardiovascular disease and menopause[J]. J Clin Diagn Res,2014,8(2):62-64.
[12]尔璐,侯曜曜,张永亮,等.绝经前后女性冠心病患者HDL及LDL颗粒与冠状动脉病变程度的相关性研究[J].中国动脉硬化杂志,2017,25(8):823-829.
[13]赵心,白小涓,汉雯,等.绝经后女性雌激素水平与骨质疏松症和动脉粥样硬化风险相关性研究[J].中华老年心脑血管病杂志,2017,19(10):1033-1038.
[14]刘海伟,韩雅玲,马颖艳,等. 2303例女性冠心病患者临床表现及冠状动脉造影病变特点的相关性分析[J].医学与哲学(B),2013,34(9):35-37,49.
[15]蔡莉娜,杨文博,强红丽,等. 393例女性冠心病患者的临床特征及预后探讨[J].临床心血管病杂志,2018,34(9):876-879.
[16] CHEN L, LI Q, YANG Z, et al. Osteocalcin, glucose metabolism,lipid profile and chronic low-grade inflammation in middle-aged and elderly Chinese[J]. Diabet Med,2013,30(3):309-317.
[17]贺威,范继红,靳志涛,等.急性ST段抬高型心肌梗死患者入院早期中性粒细胞/淋巴细胞比值与院内主要不良心血管事件的相关性[J].中国循环杂志,2016,31(1):36-39.
[18] NELSON M D. Left ventricular diastolic dysfunction in women with nonobstructive ischemic heart disease:insights from magnetic resonance imaging and spectroscopy[J]. Am J Physiol Regul Integr Comp Physiol,2017,313(4):R322-R329.
[19] VERDOIA M,BARBIERI L,GIOVINE G D,et al. Neutrophil to lymphocyte ratio and the extent of coronary artery disease:results from a large cohort study[J]. Angiology,2016,67(1):75-82.
[20] S?NMEZ O, ERTA?G, BACAKSIZ A, et al. Relation of neutrophil-to-lymphocyte ratio with the presence and complexity of coronary artery disease:an observational study[J]. Anadolu Kardiyol Derg,2013,13(7):662-667.