中性粒细胞/淋巴细胞比值对冠状动脉临界病变严重程度 及斑块稳定性的预测价值

Correlation of peripheral neutrophil-to-lymphocyte ratio（NLR） to severity and plaque stability in coronary intermediate stenosis

摘要:

目的：探究外周静脉血中性粒细胞/淋巴细胞比值（neutrophil-to-lymphocyte ratio，NLR）与冠状动脉临界病变严重程度及斑块稳定性的关系。方法：将51例冠状动脉临界病变患者按NLR绝对值分为高NLR组（NLR＞2.73）23例和低NLR组（NLR≤2.73）28例，采集两组患者有关临床资料和实验室指标。通过冠状动脉造影（coronary angiography，CAG）及血管内超声（intravascular ultrasound，IVUS）比较2组病变严重程度和斑块组成。结果：（1）高NLR组非ST段抬高型急性冠状动脉综合征（non-ST-segment elevation acute coronary syndrome，NSTE-ACS）发生率明显高于低NLR组（70% vs. 39%，P=0.031）；（2）高NLR组的最小管腔直径小于低NLR组{（1.28±0.04） mm vs. （1.44±0.03） mm，P=0.002}，而其狭窄百分比高于低NLR组{（61.69± 1.37）% vs. （55.03±0.91）%，P=0.000}；（3）高NLR组斑块负荷及病变长度均明显高于低NLR组{（74.51±1.16）% vs （69.90± 1.22）%，P=0.010；（22.33±1.24） mm vs. （19.34 ± 0.55） mm，P=0.023}；且高NLR组薄帽纤维斑块（thin-cap fibroatheroma，TC－FA）发生率及斑块坏死核心（Necrotic core，NC）比例明显高于低NLR组{57% vs. 25%，P=0.022；（24.70±0.70）% vs. （21.11± 0.74）%，P=0.001}；（4）NLR与冠状动脉直径狭窄率（r=0.48，P=0.000）、斑块负荷（r=0.38，P=0.000）、病变长度（r=0.52，P=0.000）及斑块NC比例（r=0.28，P=0.047）呈正相关。结论：NLR与冠状动脉临界病变严重程度呈正相关，NLR可能可作为预测临界病变斑块稳定性的指标，对于冠状动脉临界病变治疗方案的选择有一定参考价值。

Abstract:

Objective：To investigate the correlation of peripheral neutrophil-to-lymphocyte ratio（NLR） to the severity of atherosclerosis and plaque stability in patients with coronary intermediate stenosis. Methods：Totally 51 patients with coronary intermediate stenosis were divided into two groups according to the absolute value of NLR：high NLR group（NLR>2.73，n=23） and low NLR group（NLR≤2.73，n=28）. Basic clinical history and related laboratory parameters were collected. The severity of coronary artery stenosis and plaque components were analyzed by coronary angiography（CAG） and intravascular ultrasound（IVUS）. Results：（1）The incidence of Non-ST-segment elevation acute coronary syndrome（NSTE-ACS） was significantly higher in high NLR group than in low NLR group（70% vs. 39%，P=0.031）；（2）The degree and ratio of coronary artery stenosis were remarkably higher in patients of high NLR group compared with those in patients of low NLR group according to the measurements of coronary minimal lumen diameter [（1.28 ± 0.04） mm vs. （1.44±0.03） mm，P=0.002] and diameter stenosis percentage[（61.69±1.37）% vs. （55.03± 0.91）%，P=0.000）]；（3）The plaque burden and the length of lesions in high NLR group was significantly heavier than that in low NLR group[（74.51 ± 1.16）% vs. （69.90±1.22）%，P=0.010；（22.33±1.24） mm vs. （19.34±0.55） mm，P=0.023]. The incidence of thin-cap fibroatheroma（TCFA） and the percentage of necrotic core area were also higher in high NLR group than in low NLR group[For TCFA incidence，57% vs. 25%，P=0.022；for the percentage of necrotic core area，（24.70±0.70） % vs. （21.11±0.74）%，P=0.001]. Conclusion：NLR is posi－tively correlative to the severity of coronary intermediate stenosis，which might be a novel biomarker predicting the instability of atherosclerotic plaques，and helping for therapy planning in patients with coronary intermediate stenosis.