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中华临床医师杂志(电子版)

中华临床医师杂志(电子版) ›› 2021, Vol. 15 ›› Issue (03) : 171 -176. doi: 10.3877/cma.j.issn.1674-0785.2021.03.003

临床研究

中性粒细胞/淋巴细胞比值、血小板/淋巴细胞比值与2型糖尿病合并冠心病患者动脉粥样硬化程度的相关性
郭姣姣1, 龚开政2,†()   
  1. 1. 225000　江苏扬州，扬州大学医学院
    2. 225000　江苏扬州，扬州大学附属医院心内科
  • 收稿日期:2020-10-12 出版日期:2021-03-15
  • 通信作者: 龚开政
  • 基金资助:
    国家自然科学基金资助项目(81770262)

Relationship of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio with degree of atherosclerosis in patients with type 2 diabetes and coronary heart disease

Jiaojiao Guo1, Kaizheng Gong2,†()   

  1. 1. Medical College of Yangzhou University, Yangzhou 225000, China
    2. Department of Cardiology, Affiliated Hospital of Yangzhou University, Yangzhou 225000, China
  • Received:2020-10-12 Published:2021-03-15
  • Corresponding author: Kaizheng Gong
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引用本文：

郭姣姣, 龚开政. 中性粒细胞/淋巴细胞比值、血小板/淋巴细胞比值与2型糖尿病合并冠心病患者动脉粥样硬化程度的相关性[J]. 中华临床医师杂志(电子版), 2021, 15(03): 171-176.

Jiaojiao Guo, Kaizheng Gong. Relationship of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio with degree of atherosclerosis in patients with type 2 diabetes and coronary heart disease[J]. Chinese Journal of Clinicians(Electronic Edition), 2021, 15(03): 171-176.

目的

探讨2型糖尿病合并冠心病患者中性粒细胞/淋巴细胞比值（NLR）、血小板/淋巴细胞比值（PLR）与冠状动脉病变程度的关系。

方法

选取2015年6月至2016年7月于扬州大学附属医院心内科就诊的144例2型糖尿病合并冠心病患者，冠脉病变程度根据Gensini积分将患者分为高危组（Gensini积分≥64分）75例、中低危组（Gensini积分＜64分）69例。比较不同组别患者一般资料、实验室检查指标；采用多因素Logistic回归方法分析患者冠状动脉病变程度的影响因素；PLR、NLR与患者Gensini积分的相关性分析采用Pearson相关分析；绘制ROC曲线以评价PLR、NLR对患者高危冠状动脉复杂病变的预测价值。

结果

不同程度的冠状动脉病变组体质量指数（BMI）、收缩压（SBP）、糖化血红蛋白（HbA1c）、NLR、PLR之间差异有统计学意义（P＜0.05）。多因素Logistic回归分析显示，脂蛋白a、NLR、PLR为冠状动脉病变程度的独立危险因素（P＜0.05）。相关性分析显示，冠状动脉病变程度与NLR、PLR呈正相关关系（r=0.386，P＜0.001；r=0.487，P＜0.001）。NLR预测2型糖尿病合并冠心病患者高危冠状动脉复杂病变的曲线下面积为0.843，95%CI 0.78~0.907，最佳截断值为2.566，敏感度为82.6%，特异度为73.3%；PLR曲线下面积为0.72，95%CI 0.778~0.909，最佳截断值为107.054，敏感度为84.1%，特异度为78.7%。

结论

NLR、PLR是2型糖尿病合并冠心病患者的独立危险因素，与患者的Gensini积分呈正相关。NLR、PLR可作为预测2型糖尿病合并冠心病患者冠状动脉病变严重程度的经济且易测的实验室指标。

关键词: 2型糖尿病, 冠状动脉粥样硬化性心脏病, 中性粒细胞/淋巴细胞比值, 血小板/淋巴细胞比值
Objective

To investigate the relationship of platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR) with the degree of atherosclerosis in patients with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD).

Methods

A total of 144 diabetic patients with CAD who visited the Department of Cardiology, Affiliated Hospital of Yangzhou University from June 2015 to July 2016 were selected. According to the degree of CAD, the patients were divided into a high-risk group (Gensini score ≥64 points) and a medium-low risk group (Gensini score ＜64 points). The general data and laboratory indexes were compared between groups. Multivariable Logistic regression analysis was performed to identify the factors influencing the degree of CAD. Correlation of PLR and NLR with Gensini score was assessed using Pearson correlation analysis. ROC curve analysis was performed to evaluate the value of PLR and NLR in predicting complex coronary artery lesions in patients with type 2 diabetes.

Results

There were statistically significant differences in body mass index, systolic blood pressure, hemoglobin A1c, NLR, and PLR between the two groups of patients with different degrees of CAD (P＜0.05). Multivariate Logistic regression analysis showed that lipoprotein a, NLR, and PLR were independent risk factors for the degree of CAD (P＜0.05).The degree of coronary artery lesions in diabetic patients with CAD was positively correlated with NLR and PLR (r=0.386, P＜0.001; r=0.487, P＜0.001). The area under the NLR curve was 0.843 (95%CI: 0.780-0.907), with the best cutoff value of 2.566, the sensitivity was 82.6%, and the specificity was 73.3%. The area under the PLR curve was 0.72 (95%CI: 0.778-0.909), with the best cutoff value of 107.054, the sensitivity was 84.1%, and the specificity was 78.7%.

Conclusion

NLR and PLR are independent risk factors for patients with type 2 diabetes mellitus complicated with CAD. NLR and PLR are positively correlated with Gensini score in patients with type 2 diabetes mellitus complicated with CAD. NLR and PLR can be used as economic and easily measured laboratory indicators to predict CAD severity in patients with type 2 diabetes complicated with CAD.

Key words: Type 2 diabetes, Coronary heart disease, Neutrophil-lymphocyte ratio, Platelet-lymphocyte ratio
表1 2型糖尿病合并冠心病患者不同冠状动脉病变程度组临床资料比较（
xˉ
±s）
项目 中低危组（75例） 高危组（69例） 统计值 P值
男性（%） 57.33 65.2 χ2=0.940 0.394
年龄（岁） 63.79±63.79 65.35±9.60 t=-0.982 0.328
BMI（kg/m2） 24.39±1.58 25.40±2.36 t=-3.055 0.003
收缩压（mmHg） 134.08±15.07 140.36±16.89 t=-2.359 0.020
MCV（fl） 91.30±5.08 90.46±3.96 t=1.107 0.270
TG（mmol/L） 3.09±1.43 1.62±0.19 t=-1.488 0.139
HDL-C（mmol/L） 1.11±0.28 1.04±0.27 t=1.415 0.159
LDL-C（mmol/L） 2.42±2.52 2.77±0.86 t=-1.109 0.269
脂蛋白a（mg/L） 137.47±167.90 211.04±253.42 t=-2.069 0.040
TBIL（μmol/L） 11.92±7.23 10.19±4.66 t=1.699 0.092
肌酐（μmol/L） 70.59±23.86 68.20±18.63 t=0.664 0.508
尿酸（μmol/L） 314.97±79.57 300.59±93.12 t=0.999 0.320
FPG（mmol/L） 7.86±2.34 8.644±3.20 t=-1.690 0.093
HbA1c 7.55±1.14 8.00±1.38 t=-2.104 0.037
NLR 2.17±0.96 4.36±3.74 t=-4.888 ＜0.001
PLR 94.25±38.60 171.65±102.71 t=-6.079 ＜0.001
Gensini积分（分） 34.78±19.97 91.29±22.21 t=-16.078 ＜0.001
表2 2型糖尿病合并冠心病患者冠状动脉病变程度影响因素的多因素Logistic回归分析
项目 OR值 95%CI P值
BMI 1.235 0.987~1.546 0.065
收缩压 1.005 0.977~1.033 0.752
脂蛋白a 1.003 1.001~1.005 0.015
糖化血红蛋白 0.965 0.671~1.389 0.848
NLR 2.008 1.222~3.301 0.006
PLR 1.018 1.005~1.031 0.005
图1 NLR与2型糖尿病合并冠心病患者Gensini积分相关性散点图
图2 PLR与2型糖尿病合并冠心病患者Gensini积分相关性散点图
图3 NLR和PLR预测2型糖尿病合并冠心病患者高Gensini积分的ROC曲线
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