中性粒细胞与淋巴细胞比值和急性冠状动脉综合征的相关性及其对急性心肌梗死的诊断价值

目的 探讨中性粒细胞与淋巴细胞比值（NLR）与急性冠状动脉综合征（ACS）患者冠脉严重程度之间的关 系，并分析NLR对急性心肌梗死的诊断价值。方法 回顾性分析2016年11月—2017年3月于我院行冠状动脉造影 检查的259例ACS患者的临床资料，其中不稳定型心绞痛组（UA组）148例、急性非ST段抬高型心肌梗死组（NSTEMI组）46例、急性ST段抬高型心肌梗死组（STEMI组）65例。比较3组的白细胞计数（WBC）、中性粒细胞计数（N）、淋巴细胞计数（L）、NLR、高敏C反应蛋白（hs-CRP）、心肌酶谱、血脂、血糖、肝功能等指标的差异。根据冠状动脉造影结果将患者按照冠状动脉病变支数分为单支病变组（70例）、双支病变组（70例）和三支病变组（119例），比较不同病变支数组间炎性细胞的差异。同时绘制NLR的受试者工作特征（ROC）曲线，评价NLR对急性心肌梗死的预测价值。结果 UA组、NSTEMI组及STEMI组间WBC、N、NLR、hs-CRP、cTnT、CK、CK-MB水平依次升高，STEMI组L值低于UA组，差异有统计学意义（P＜0.05）；WBC、NLR随冠状动脉病变支数的增加而呈上升趋势，但仅三支病变组与单支病变组间差异有统计学意义；NLR诊断急性心肌梗死的ROC曲线下面积（AUC）为0.865（95%CI：0.814~0.916）。当NLR=4.22时，其对急性心肌梗死的诊断效能最高，敏感度为72.1％，特异度为95.3％。结论 NLR水平与ACS患者病情严重程度呈正相关，并对诊断急性心肌梗死具有较高的诊断价值，可作为ACS患者病情的预测因素。

Relation between neutrophil-to-lymphocyte ratio and acute coronary syndrome and its value in the diagnosis of acute myocardial infarction

Objective To investigate the association between neutrophil to lymphocyte ratio (NLR) and the severity of coronary artery disease in patients with acute coronary syndrome (ACS), and analyze the value of NLR in the diagnosis of acute myocardial infarction. Methods The clinical data of 259 ACS patients with coronary angiography at our hospital from November 2016 to March 2017 were retrospectively analyzed. Among them, there were 148 cases of unstable angina (UA group), 46 cases of acute non-ST elevation myocardial infarction (NSTEMI group), and 65 cases of acute ST-elevation myocardial infarction (STEMI group). The differences of white blood cell count (WBC), neutrophil counts (N), lymphocyte count (L), NLR, hypersensitive c-reactive protein (hs-CRP), myocardial enzyme spectrum, blood lipids, blood glucose, and liver function were compared between the three groups. According to the results of coronary angiography, patients were divided into single-vessel disease group (n=70), double-vessel disease group (n=70) and three-vessel disease group (n=119) in the basis of the number of coronary lesions, and the differences in inflammatory cells were compared between the different-number vessel lesion groups. At the same time, the receiver operating characteristic (ROC) curves of NLR were drawn to evaluate the predictive values of NLR for acute myocardial infarction. Results The levels of WBC, N, NLR, hsCRP, cTnT, CK and CK-MB were significantly higher in turn in UA group, NSTEMI group and STEMI group (P＜0.05).NLR increased gradually with the increased numbers of stenosed coronary artery. The ROC curve showed that the area under the curve of NLR was 0.865 (95%CI: 0.814-0.916)． In addition, the optimal cutoff value of NLR in predicting acute myocardial infarction was 4.22 with sensitivity of 72.1% and specificity of 95.3%. Conclusion NLR levels are positively correlated with the severity of ACS, and which have high value for the diagnosis of acute myocardial infarction, and can be used as a predictor of the condition of ACS patients.