AIP、WBC计数和NLR对急性冠脉综合征预测价值的研究

Predictive value of atherosclerotic index of plasma, white blood cells count and neutrophil lymphocyte ratio in acute coronary syndrome

摘要:

目的 探讨血浆动脉粥样硬化指数（atherosclerotic index of plasma，AIP）、白细胞（white blood cells，WBC）计数和中性粒细胞淋巴细胞比值（neutrophil lymphocyte ratio，NLR）对急性冠状动脉综合征（acute coronary syndrome，ACS）的风险预测和冠脉病变程度的评估价值。方法 将2019年1月至2021年12月期间首次就诊的疑似冠心病患者分为ACS组（n=288）和非ACS组（n=93）进行对比研究。采用受试者工作特征（receiver operating characteristic，ROC）曲线、多因素logistic回归分析和Spearman秩相关分析方法评估AIP、WBC计数和NLR对ACS的预测价值及与Gensini评分的相关性。结果 ACS组AIP、WBC计数和NLR高于非ACS组（t/Z=3.623、6.697、-6.165，P<0.001）。多因素logistic回归分析结果显示，AIP、WBC计数和NLR 3个指标均是ACS的独立危险因素，排除混杂因素后，AIP、WBC、NLR每增加一个单位，ACS发生风险分别增加6.739倍（95%CI=2.829~21.169，P<0.001）、0.260倍（95%CI=1.113~1.426，P<0.001）和0.145倍（95%CI=1.036~1.265，P=0.008）。AIP、WBC计数和NLR预测ACS的曲线下面积（area under the curve，AUC）分别为0.627（95%CI=0.563~0.692，P<0.001）、0.696（95%CI=0.638~0.755，P<0.001）和0.713（95%CI=0.652~0.773，P<0.001），三指标联合预测的AUC为0.756（95%CI=0.700~0.813，P<0.001）。高AIP、高WBC、高NLR组发生完全闭塞、左主干/多支病变的比例和Gensini评分均高于低值组（均P<0.05），三者与Gensini评分呈正相关（r=0.188、0.313、0.332，均P<0.001）。结论 AIP、WBC计数和NLR是ACS发生的独立危险因素，三者联合对ACS风险有一定预测价值，且与冠状动脉病变严重程度显著正相关，有望成为ACS风险预测及病情评估的潜在标志物。

Abstract:

Objective To investigate the predictive value of atherosclerotic index of plasma（AIP）， white blood cells（WBC） count and neutrophil lymphocyte ratio（NLR） to acute coronary syndrome（ACS） and the severity of coronary lesions.Methods Patients with suspected coronary heart disease who first visited the hospital from January 2019 to December 2021 were retrospectively enrolled. All patients were divided into two groups，ACS group（n=288） and non-ACS group（n=93）. The receiver operating characteristic （ROC） curve and multivariate logistic regression were used to analyze the predictive value of AIP， WBC count and NLR in ACS. Spearman rank correlation was used to analyze the correlation between the indexes and Gensini score.Results AIP， WBC count and NLR in ACS group were significantly higher than those in non-ACS group（t/Z=3.623，6.697，-6.165，P<0.001）. Logistic regression analysis showed that AIP，WBC count and NLR were independent risk factors for ACS. After excluding confounding factors， with the increase of each additional unit of AIP，WBC and NLR，the risk of ACS increased by 6.739 times（95%CI=2.829-21.169，P<0.001），0.260 times（95%CI=1.113-1.426，P<0.001），and 0.145 times（95%CI=1.036-1.265，P=0.008）. The area under the curve（AUC） for predicting ACS with AIP，WBC count and NLR was 0.627（95%CI=0.563-0.692，P<0.001），0.696（95%CI=0.638-0.755，P<0.001），and 0.713（95%CI=0.652-0.773，P<0.001），respectively. The larger AUC of 0.756（95%CI=0.700-0.813，P<0.001） was observed when the combination of the three indicators was used to predict ACS. The proportions of complete vascular occlusion，left main coronary artery or multiple vascular branch lesions and Gensini score in high AIP， high WBC and high NLR groups were significantly higher than those in low value groups（all P<0.05）. The three indicators were significantly positively correlated with Gensini score（r=0.188，0.313， 0.332，all P<0.001）.Conclusion AIP，WBC count and NLR are independent risk factors for ACS，and their combination has better predictive value for ACS. Moreover，they are positively correlated with the severity of coronary lesions significantly，which may have potential to be biomarkers for ACS risk prediction and condition evaluation.