C反应蛋白高密度脂蛋白胆固醇比值、中性粒细胞淋巴细胞比值对冠心病的预测价值研究

doi:10.12114/j.issn.1007-9572.2020.00.262

摘要/Abstract

摘要： 背景　我国冠心病发病率和致死率仍较高。在分级诊疗制度下，早期、无创评估冠状动脉病变严重程度有助于减少并发症发生，改善患者预后。目的　探讨C反应蛋白高密度脂蛋白胆固醇比值（CHR）、中性粒细胞淋巴细胞比值（NLR）对冠心病的预测价值。方法　选取2014年1月—2018年8月首次于南方医院行冠状动脉造影的患者651例为研究对象，其中冠心病患者480例（73.7%，冠心病组），非冠心病患者171例（26.3%，非冠心病组）。冠心病组再根据临床分型分为急性冠脉综合征（ACS）组（n=306）和稳定型心绞痛（SAP）组（n=174）。比较各组间的危险因素、血脂、炎性指标等差异，评估CHR、NLR对冠心病的预测价值。采用SPSS 20.0统计软件对数据进行分析并绘制受试者工作特征（ROC）曲线并采用DeLong非参数检验分析不同指标对冠心病的预测价值。结果　冠心病组和非冠心病患者CHR、NLR比较，差异有统计学意义（P<0.05）。非冠心病组、ACS组、SAP组NLR、CHR比较，差异有统计学意义（P<0.05），进一步两两比较结果显示，ACS组NLR、CHR高于非冠心病组、SAP组，差异有统计学意义（P<0.017）。CHR预测冠心病的ROC曲线下面积（AUC）（95%CI）为0.640（0.568，0.712）；NLR预测冠心病的AUC（95%CI）为0.681（0.617，0.745）；CHR联合NLR预测冠心病的AUC（95%CI）为0.691（0.625，0.757）。CHR预测ACS的AUC（95%CI）为0.676（0.615，0.738），NLR预测ACS的AUC（95%CI）为0.746（0.734，0.829），CHR联合NLR预测ACS的AUC（95%CI）为0.752（0.697，0.807）。Spearman秩相关分析结果显示，CHR、NLR与冠心病患者的Gensini评分呈正相关（rs=0.163、0.172，P<0.05）。将冠心病组按CHR中位数（4.14）分为高CHR组和低CHR组，按NLR中位数（3.00）分为高NLR组和低NLR组，结果显示，高CHR、高NLR组多支病变比例、Gensini评分分别高于低CHR、低NLR组（P<0.05）。结论　CHR、NLR与冠状动脉病变严重程度、冠心病临床稳定性相关，其值越高，病变程度越重，冠状动脉不稳定事件发生可能性越大，可作为冠心病辅助诊断、病情评估的参考指标。且该指标简便易获取，在基层医生临床应用中有重要价值。

关键词: 冠心病；C反应蛋白质；胆固醇, HDL；中性粒细胞；淋巴细胞；诊断

Abstract: Background　The incidence and mortality of coronary atherosclerotic heart disease（CAD） in China are still high. Under the hierarchical diagnosis and treatment system，early and noninvasive assessment of the severity of coronary artery lesions is helpful to reduce complications and improve the prognosis of patients. Objective　To explore the value of C-reactive protein to high density lipoprotein cholesterol ratio（CHR） and neutrophil to lymphocyte ratio（NLR） in the diagnosis and prediction of coronary heart disease. Methods　A total of 651 patients who underwent coronary angiography for the first time in Nanfang Hospital were selected as the research subjects from January 2014 to August 2018，including 480 CAD patients（CAD group） and 171 non-CAD patients（non-CAD group）. Patients in CAD group were divided into acute coronary syndrome（ACS） group（n=306） and stable angina pectoris（SAP） group（n=174） according to clinical classification.The risk factors，blood lipid and inflammatory indexes were compared among groups，and the diagnostic and predictive value of CHR and NLR on CAD was evaluated.SPSS 20.0 statistical software was used to analyze the data and draw the receiver operating characteristic（ROC） curve，and DeLong nonparametric test was used to analyze the predictive value of different indicators for coronary heart disease. Results　The difference in CHR and NLR between CAD group and non-CAD group was statistically significant（P<0.05）. There was significant difference in NLR and CHR among non-CAD group，ACS group and SAP group（P<0.05），and further comparison results showed that compared with the ACS group，NLR and CHR of non-CAD group and SAP group decreased significantly（P<0.017）. The AUC（95%CI） of CAD predicted by CHR was 0.640（0.568，0.712），by NLR was 0.681（0.617，0.745），and by CHR combined with NLR was 0.691（0.625，0.757）. The AUC（95%CI） of ACS predicted by CHR was 0.676（0.615，0.738），by NLR was 0.746（0.734，0.829），and by CHR combined with NLR was 0.752（0.697，0.807）. Spearman correlation analysis showed that CHR and NLR were positively correlated with the Gensini score（rs=0.163，0.172，P<0.05）. Patients in CAD group were divided into high CHR group and low CHR group according to the median of CHR（4.14），and high NLR group and low NLR group according to the median of NLR（3.00）. The results showed that the proportion of multivessel lesions and Gensini scores in high CHR group and high NLR group were higher than those of low CHR group and low NLR group（P<0.05）. Conclusion　CHR and NLR are related to the severity of CAD and the clinical stability of coronary heart disease. The higher the value of CHR and NLR are，the more serious the lesions are and the more likely the unstable events of coronary artery will occur，which can be used as a reference index for the auxiliary diagnosis and condition evaluation of coronary heart diseases. And these indexes are easy to obtain and have important value in the clinical practice of grassroots doctors.

Key words: Coronary disease；C-reactive protein；Cholesterol, HDL；Neutrophils；Lymphocytes；Diagnosis

薛雅芝,曾晓容,林子祥,等. C反应蛋白高密度脂蛋白胆固醇比值、中性粒细胞淋巴细胞比值对冠心病的预测价值研究[J]. 中国全科医学, 2020, 23(25): 3194-3199. DOI: 10.12114/j.issn.1007-9572.2020.00.262.
XUE Yazhi,ZENG Xiaorong,LIN Zixiang, et al. Predictive Value of C-reactive Protein to High Density Lipoprotein Cholesterol Ratio and Neutrophil to Lymphoid Ratio in Coronary Heart Disease　[J]. Chinese General Practice, 2020, 23(25): 3194-3199. DOI: 10.12114/j.issn.1007-9572.2020.00.262.

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