冠心病患者血小板和淋巴细胞比值与冠脉斑块稳定性及预后的相关性

目的 研究冠心病(coronary heart disease,CHD)患者血小板与淋巴细胞比值(platelet lymphocyte ratio,PLR)对冠脉斑块稳定性和预后的影响。方法 测定62例CHD患者(CHD组)及30例健康体检者(对照组)的血细胞检测和血糖、血压、血脂、肝肾功等生化指标。根据斑块性质分为易损斑块组(n=35)和稳定斑块组(n=27); 根据入院时PLR值分为低PLR组(n=30)和高PLR组(n=32)。比较各组临床指标,分析PLR对CHD患者斑块稳定性和预后的影响。结果 各组高血压病史(0,40.74%,48.57%),糖尿病病史(0,18.52%,42.86%),CRP(8.54±1.57,9.39±1.84,10.70±2.56)mg/L,Scr(50.84±10.87,61.27±13.16,75.18±15.54)μmol/L,BUN(5.37±0.50,6.91±1.17,8.48±2.05)mmol/L,FIB(2.76±0.39,3.14±0.54,3.36±0.66)g/L,PLT(181.43±43.48,229.26±50.87,238.47±47.93)×10⁹/L,LYM(2.23±0.65,1.86±0.62,1.80±0.77)×10⁹/L和PLR(95.75±24.72,112.43±24.48,131.83±26.81)比较,差异均有统计学意义(t或χ2为3.46～62.96,均P<0.05)。多因素logistics回归分析显示,CRP(OR=2.29,95CI%:1.78～2.74),FIB(OR=2.03,95CI%:1.18～2.86)和PLR(OR=3.25,95CI%:1.88～4.61)均是CHD患者冠脉斑块不稳定的独立危险因素(P=0.007,0.004,0.000)。CRP,FIB和PLR联合预测CHD患者冠脉斑块稳定性的敏感度、特异度分别为83.1%和81.9%,均显著高于三个指标单独评估的敏感度、特异度(P<0.05)。高PLR组不良心血管事件(MACE)的发生率47.0%,显著高于低PLR组(20.00%),差异有统计学意义(χ2=4.09,P=0.043)。结论 PLR是CHD患者冠脉斑块稳定性的独立危险因素,且与预后密切相关,有助于指导临床决策。

Correlation between Ratio of Platelet to Lymphocytewith the Stability of Coronary Artery Plaque and Prognosisin Patients with Coronary Heart Disease

Objective To explore the effects of platelet-lymphocyte ratio(PLR)on the stability of coronary artery plaque and prognosis in patients with coronary heart disease(CHD).Methods Blood routine,blood glucose,blood pressure,blood lipids,liver and kidney function were determined in 62 CHD patients(CHD group)and 30 healthy subjects(control group).According to the nature of plaque,patients were divided into vulnerable plaque group(n=35)and stable plaque group(n=27).According to thePLR value on admission,patients were divided into low PLR group(n=30)andhigh PLR group(n=32).Clinical indicators of each group were compared,andthe influence of PLR on plaque stability and prognosis of CHD patients was analyzed.Results There was significant difference on historyof diabetes(0,40.74%,48.57%)and hypertension(0,18.52%,42.86%),CRP(8.54±1.57,9.39±1.84,10.70±2.56)mg/L,Scr(50.84±10.87,61.27±13.16,75.18±15.54)μmol/L,BUN(5.37±0.50,6.91±1.17,8.48±2.05)mmol/L,FIB(2.76±0.39,3.14±0.54,3.36±0.66)g/L,PLT(181.43±43.48,229.26±50.87,238.47±47.93)×10⁹/L,LYM(2.23±0.65,1.86±0.62,1.80±0.77)×10⁹/L and PLR(95.75±24.72,112.43±24.48,131.83±26.81),among each group(t/χ²=3.46～62.96,all P<0.05).Multiple logisticsregression analysis showed that CRP(OR=2.29,95CI%:1.78～2.74),FIB(OR=2.03,95CI%:1.18～2.86)and PLR(OR=3.25,95CI%:1.88～4.61)were independentrisk factors for coronary plaque instability in CHD patients(P=0.007,0.004,0.000).The sensitivity and specificity of combined detection of CRP,FIB and PLR to predict the stability of coronary artery plaque were 83.1% and 81.9%,respectively,which were significantly higher than separate detection(P<0.05).Theincidence of MACE in high PLR group was 47.0%,significantly higher than 20.00% in low PLR group(χ2=4.09,P=0.043),respectively.Conclusion PLR is independent risk factors for stability of coronary artery plaque in CHD patients,and closely related to the prognosis,it helps to guide the clinical decision.