摘要
目的:探讨临界病变冠心病患者中性粒细胞淋巴细胞比值(NLR)与冠状动脉血流储备分数(FFR)的相关性及其临床价值。方法:回顾性分析2022年1月至2023年8月在温州医科大学附属第五医院心内科住院的105例稳定性冠心病患者的临床资料,冠状动脉造影术前采集外周静脉血,计算NLR,冠状动脉造影术中同时行FFR检查。根据FFR结果分为FFR<0.8组(47例)和FFR≥0.8组(58例),比较两组患者资料。采用Pearson相关分析、限制性立方样条图(RCS)分析、多因素Logistic回归分析及ROC曲线评估临界病变冠心病患者NLR与FFR的相关性及NLR预测冠状动脉生理性缺血的临床价值。结果:FFR<0.8组患者糖尿病史、白细胞总数、中性粒细胞计数、NLR、hsCRP明显高于FFR≥0.8组,而FFR<0.8组患者淋巴细胞计数显著低于FFR≥0.8组,差异有统计学意义(均P<0.05)。Pearson相关分析显示NLR与FFR值之间存在负相关(r=-0.447,P<0.001)。RCS分析显示NLR与是否存在冠状动脉生理性缺血之间存在总体相关(P=0.001),但不存在非线性相关(P=0.123)。校正其他混杂因素影响后,多因素Logistic回归分析显示NLR是临界病变冠心病患者冠状动脉生理性缺血的独立预测因子(OR=4.101,95%CI=2.002~8.403,P<0.001)。ROC曲线分析显示预测冠状动脉生理性缺血的最佳NLR截点为2.34,灵敏度为80.90%,特异度为79.30%,ROC曲线下面积为0.814(95%CI=0.734~0.894)。结论:临界病变冠心病患者NLR与FFR之间具有负相关关系。NLR可以很好地预测临界病变冠心病患者是否存在冠状动脉生理性缺血,对此类病变治疗方案的选择具有较高的参考价值。
Objective:To investigate the correlation between neutrophil-lymphocyte ratio(NLR)and fractional llow reserve(FFR)in patients with coronary intermediate lesions and to assess the clinical value of NLR in predicting coronary artery ischemia.Methods:The clinical data from 105 stable coronary heart disease patients with coronary intermediate lesions(50%-70%stenosis)confirmed by coronary angiography at the Fifth Affiliated Hospital of Wenzhou Medical University from January 2022 to August 2023 was retrospectively analyzed.Peripheral venous blood was collected before coronary angiography to calculate NLR,and FFR was measured during coronary angiography.Based on FFR results,patients were categorized into FFR<0.8(indicating physiological ischemia)and FFR≥0.8 group.General clinical and laboratory data were compared between the two groups.Pearson correlation analysis,restricted cube spline(RCS),multivariate Logistic regression analysis,and ROC curve were employed to assess the correlation between NLR and FFR and the predictive clinical value of NLR for coronary physiological ischemia.Results:Patients in the FFR<0.8 group exhibited significantly higher rate of diabetes history,total white blood cell count,neutrophil count,NLR,and hsCRP compared with the FFR≥0.8 group.Meanwhile,lymphocyte count in the FFR<0.8 group was notably lower(all P<0.05).Pearson correlation analysis revealed a negative correlation between NLR and FFR(r=-0.447,P<0.001).RCS analysis demonstrated an overall association between NLR and the presence or absence of coronary physiological ischemia(P=0.001),without non-linear correlation(P=0.123).After adjusting for confounding factors,multivariate Logistic regression analysis indicated that NLR independently predicted FFR<0.8 in patients with coronary intermediate lesions(OR=4.101,95%CI=2.002-8.403,P<0.001).ROC curve analysis identified the optimal NLR cut-off point for FFR<0.8 as 2.34,with a sensitivity of 80.90%,specificity of 79.30%,and an area under the curve of 0.814(95%CI=0.734-0.894).Conclusion:NLR demonstrates a negative correlation with FFR,offering valuable predictive insights into the physiological ischemia of coronary intermediate lesions.It holds high reference value for guiding therapeutic planning in such cases.
作者
叶士勇
吕玲春
胡武明
徐剑
沈珈谊
胡琼尹
YE Shiyong;LYU Lingchun;HU Wuming;XU Jian;SHENG Jiayi;HU Qiongyi(Department of Cardiology,the Fifth Affiliated Hospital of Wenzhou Medical University,Lishui Municipal Central Hospital,Lishui 323000,China)
出处
《温州医科大学学报》
CAS
2024年第9期725-731,共7页
Journal of Wenzhou Medical University
基金
浙江省医学会临床医学科研专项(2023ZYC-Z29)。
关键词
临界病变冠心病
中性粒细胞淋巴细胞比值
血流储备分数
炎症反应
稳定性冠心病
coronary intermediate lesions
neutrophil-lymphocyte ratio
fractional flow reserve
inflammatory reaction
stable coronary disease
作者简介
第一作者:叶士勇,副主任医师,Email:271268390@qq.com。;通信作者:吕玲春,主任医师,Email:lvlingchuno@medmail.com.cn。
