中性粒细胞/淋巴细胞比值、胆红素与冠状动脉粥样硬化性心脏病的相关性分析

Correlation analysis of neutrophil-to-lymphocyte ratio and bilirubin with coronary atherosclerotic heart disease

摘要:

目的 分析淋巴细胞/中性粒细胞及胆红素与冠状动脉粥样硬化性心脏病（以下简称冠心病）的相关性。方法 选取2019年4月—2019年10月山西医科大学第二医院收治的经冠状动脉造影确诊的冠心病患者180例作为观察组，根据Gensini积分对观察组冠状动脉情况进行评分。另选取同期该院收治的冠状动脉造影未见明显异常的92例患者作为对照组。根据Gensini积分将观察组划分为不同的亚组，低危组（Gensini积分≤ 21），中危组（21<Gensini积分≤ 51），高危组（Gensini积分> 51），每组60例。比较各组患者外周血淋巴细胞（Lym）、中性粒细胞（NEU）、中性粒细胞/淋巴细胞（NLR）、单核细胞（MONO）、平均血小板体积（MPV）、血小板分布宽度（PDW）、血清胆红素水平。结果 观察组NEU、NLR、PDW高于对照组（P <0.05），Lym、TB、DB、IB低于对照组（P <0.05）。两组患者MONO、MPV比较，差异无统计学意义（P >0.05）。Lym与冠状动脉狭窄Gensini积分呈负相关（r =-0.249，P <0.05），NEU、NLR和PDW与冠状动脉狭窄Gensini积分呈正相关（r =0.416、0.342和0.292，均P <0.05），TB、DB、IB与冠状动脉狭窄Gensini积分无相关性（r =-0.082、-0.097和-0.084，P >0.05）。低危组、中危组及高危组Lym、NEU、NLR、PDW水平比较，差异有统计学意义（P <0.05）。低危组、中危组及高危组MONO、MPV、TB、DB及IB比较，差异无统计学意义（P >0.05）。NLR预测冠心病的特异性为87.0%（95% CI：0.779，0.928），敏感性为53.9%（95% CI：0.463，0.613），ROC曲线下面积为0.719（95% CI：0.660，0.778）。PDW预测冠心病的特异性为69.6%（95% CI：0.590，0.785），敏感性为50.6%（95% CI：0.430，0.580），ROC曲线下面积为0.607（95% CI：0.535，0.679）。TB预测冠心病的特异性为77.2%（95% CI：0.703，0.830），敏感性为43.9%（95% CI：0.337，0.546），ROC曲线下面积为0.611（95% CI：0.543，0.678）。结论 NLR、PDW和血清胆红素水平对冠心病有诊断价值，NLR和PDW对冠心病冠状动脉病变有一定的预测作用，且独立于传统的冠心病危险因素。

Abstract:

Objective To analyze the correlation of neutrophil-to-lymphocyte ratio (NLR) and bilirubin with coronary atherosclerotic heart disease.Methods A total of 180 patients with coronary atherosclerotic heart disease admitted to our hospital from April 2019 to October 2019 and diagnosed via coronary angiography were retrospectively enrolled as the observation group, and the severity of coronary stenosis was quantified using Gensini score. Another 92 patients without obvious abnormality in coronary angiography during the same period were selected as the control group. The observation group was further divided into low-risk group (Gensini score ≤ 21), moderate-risk group (21 < Gensini score ≤ 51) and high-risk group (Gensini score > 51), with 60 cases in each subgroup. The levels of lymphocytes (Lym), neutrophils (NEU), NLR, monocytes (MONO), mean platelet volume (MPV), and platelet distribution width (PDW) in the peripheral blood as well as serum bilirubin level were compared among the groups.Results The levels of NEU, NLR, and PDW were higher but those of Lym, total bilirubin (TB)(P < 0.05)., direct bilirubin (DB) and indirect bilirubin (IB) were lower in the observation group compared with the control group (P < 0.05). However, there was no difference in levels of MONO and MPV between the two groups (P < 0.05). The Gensini score was negatively correlated with the level of Lym (r = -0.249) (P < 0.05), but was positively correlated with levels of NEU (r = 0.416), NLR (r = 0.342) and PDW (r = 0.292) (P < 0.05). The levels of TB (r = -0.082), DB (r = -0.097) and IB (r = -0.084) were not correlated with the Gensini score (P > 0.05). The Lym, NEU, NLR and PDW levels were significantly different among the low-risk group, moderate-risk group and high-risk group (P < 0.05), while MONO, MPV, TB, DB and IB levels were not different among the subgroups (P > 0.05). The specificity, sensitivity and area under the receiver operating characteristic (ROC) curve of NLR in predicting coronary atherosclerotic heart disease were 87% (95% CI: 0.779, 0.928), 53.9% (95% CI: 0.463, 0.613) and 0.719 (95% CI: 0.660, 0.778), respectively (P < 0.05). PDW showed a specificity of 69.6% (95% CI: 0.590, 0.785), a sensitivity of 50.6% (95% CI: 0.430, 0.580) and an area under the ROC curve of 0.607 (95% CI: 0.535, 0.679) for predicting coronary atherosclerotic heart disease (P < 0.05). In addition, TB had a specificity of 77.2% (95% CI: 0.703, 0.830), a sensitivity of 43.9% (95% CI: 0.337, 0.546), and an area under the ROC curve of 0.611 (95% CI: 0.543, 0.678) for predicting coronary atherosclerotic heart disease (P < 0.05).Conclusions NLR, PDW and serum bilirubin levels are of certain value in the diagnosis of coronary atherosclerotic heart disease. Besides, NLR and PDW independently predict the severity of coronary stenosis determined via coronary angiography.