【作者】 王敏；

【导师】 李瑾；

【作者基本信息】 山西医科大学 ， 内科学（心血管内科）（专业学位）， 2021， 硕士

【摘要】 目的:研究急性冠脉综合征(ACS)患者中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)及平均血小板体积(MPV)的水平变化及与冠状动脉病变严重程度的相关性,探究NLR、PLR、MPV对ACS患者的预测价值。方法:选取2019年7月至2020年7月于山西医科大学第二医院心血管内科行冠脉造影术的376例患者,结合其病程记录及相关检查,分为ACS组(n=249)和对照组(n=127),根据Gensini评分(GS)将ACS组患者分为3个亚组,即轻度病变组(GS<20分)81例、中度病变组(20≤GS<44分)83例、重度病变组(GS≥44分)85例,比较两组受试者一般资料、实验室检查指标等,建立多因素Logistic回归筛选ACS发生的独立危险因素,比较分析NLR、PLR、MPV在冠脉轻度、中度及重度病变组组间有无差异以及与ACS患者冠脉病变程度的相关性,并通过受试者工作特性(ROC)曲线得出诊断ACS的最佳参考值并比较不同指标的诊断价值。结果:(1)两组受试者在年龄、男性比例、吸烟史、高血压病史、糖尿病病史、白细胞计数、中性粒细胞计数、淋巴细胞计数、血小板计数、谷丙转氨酶、谷草转氨酶、肌酐、白蛋白、尿酸、肌钙蛋白I、Gensini评分、左室射血分数、肾小球滤过率、NLR、PLR、MPV方面差异有统计学意义(P<0.05);在甘油三酯、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、尿素氮、体质指数方面差异无统计学意义(P>0.05);(2)年龄、男性比例、吸烟史、高血压病史、糖尿病病史、Gensini评分、尿酸、肌钙蛋白I、左室射血分数、NLR、PLR、MPV均为ACS的独立危险因素(P<0.05);(3)NLR、PLR、MPV在冠脉轻度、中度和重度病变组中均有显著性差异(P<0.05),并且在组间多重比较时差异均有统计学意义(P<0.05);(4)NLR、PLR、MPV与ACS患者Gensini评分均呈正相关(r_n=0.783、r_p=0.745、r_m=0.682,P<0.05);(5)NLR预测ACS的最佳切点是2.57,敏感度61%,特异性88.2%,AUC为0.797(95%CI:0.753-0.841,P<0.05);PLR预测ACS的最佳切点是106.33,敏感度70.3%,特异性89.8%,AUC为0.859(95%CI:0.821-0.896,P<0.05);MPV预测ACS的最佳切点是8.65f L,敏感度54.6%,特异性83.5%,AUC为0.750(95%CI:0.700-0.799,P<0.05);PLR与NLR、MPV曲线下面积的差异均有统计学意义(P<0.05);NLR与MPV曲线下面积的差异无统计学意义(P>0.05)。结论:ACS组NLR、PLR和MPV水平均升高,与ACS冠脉病变严重程度呈正相关性,三个指标作为ACS的独立危险因素,均具有较好的诊断性能,且PLR诊断效能最高。更多还原

【Abstract】 Objective:To study the changes of neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR)and mean platelet volume(MPV)in patients with acute coronary syndrome(ACS)and their correlation with the severity of coronary artery disease,and to explore the predictive value of NLR、PLR、MPV for ACS patients.Methods:A total of 376 patients who underwent coronary angiography in the Department of Cardiology,the second hospital of Shanxi Medical University from July 2019 to July 2020were divided into ACS group(n=249)and control group(n=127).According to Gensini score(GS),ACS group was divided into three subgroups,there were 81 cases in mild lesions(GS<20 points),83 cases in moderate lesion group(20≤GS<44 points)and 85cases in severe lesion group(GS≥44 points).The independent risk factors of ACS were screened by multivariate logistic regression.The differences of NLR,PLR and MPV between mild,moderate and severe coronary lesions groups and the correlation between NLR,PLR and MPV and the severity of coronary lesions were compared between the two groups.The optimal reference value of the diagnostic ACS was obtained by the working characteristics(ROC)curve of the subjects and the diagnostic value of different indexes was compared.Results:(1)There were significant differences in age,male ratio,smoking history,hypertension history,diabetes history,white blood cell count,neutrophil count,lymphocyte count,platelet count,alanine aminotransferase,aspartate aminotransferase,creatinine,albumin,uric acid,troponin I,Gensini score,left ventricular ejection fraction,glomerular filtration rate,NLR,PLR,MPV(P<0.05).There was no significant difference in triglyceride,total cholesterol,low density lipoprotein cholesterol,high density lipoprotein cholesterol,urea nitrogen and body mass index(P>0.05).(2)Age,male ratio,smoking history,hypertension history,diabetes history,Gensini score,uric acid,troponin I,left ventricular ejection fraction,NLR,PLR and MPV were independent risk factors for ACS(P<0.05).(3)There were significant differences in NLR,PLR and MPV among mild,moderate and severe coronary lesions(P<0.05),and there were significant differences in multiple comparisons between groups(P<0.05).(4)NLR,PLR and MPV were positively correlated with Gensini score(r_n=0.783,r_p=0.745,r_m=0.682,P<0.05).(5)The best cut point of NLR for predicting ACS is 2.57,sensitivity is 61%,specificity is 88.2%,area under the curve(AUC)is 0.797(95%CI:0.753-0.841,P<0.05);The best cut point of PLR for predicting ACS is 106.33,sensitivity is 70.3%,specificity is 89.8%,and AUC is 0.859(95%CI:0.821-0.896,P<0.05);The best cut point for MPV to predict ACS is 8.65f L,sensitivity is 54.6%,specificity is 83.5%,and AUC is0.750(95%CI:0.700-0.799,P<0.05);The difference in the area under the curve between PLR and NLR and MPV was statistically significant(P<0.05);the difference in the area under the curve between NLR and MPV was not statistically significant(P>0.05).Conclusions:The NLR、PLR and MPV levels of ACS group were increased,which was positively correlated with the severity of coronary artery disease.The three indexes,as independent risk factors of ACS,had better diagnostic performance and the highest diagnostic efficacy of PLR.更多还原