MLR与冠心病和冠状动脉病变程度相关性分析

doi:10.3969/j.issn.1673-8640.2024.05.013

摘要/Abstract

摘要：

目的探讨单核细胞/淋巴细胞比值（MLR）与冠心病（CHD）和冠状动脉病变程度的相关性。方法选取2022年6—12月上海交通大学医学院附属瑞金医院北部院区200例冠状动脉造影阳性（主要血管直径≥50%）的CHD患者（CHD组），以同期131例造影结果为阴性的患者为对照组。比较CHD组和对照组MLR、中性粒细胞/淋巴细胞比值（NLR）、血小板/淋巴细胞比值（PLR）的差异。采用Pearson或Spearman相关分析评估CHD患者MLR与肌酸激酶（CK）、乳酸脱氢酶（LDH）和Gensini积分的相关性。采用Logistic回归分析评估CHD的影响因素。采用受试者工作特征（ROC）曲线评估MLR诊断CHD的效能。结果 CHD组MLR、NLR、PLR均高于对照组（P<0.001）；CHD患者治疗后MLR水平与对照组差异无统计学意义（P>0.05）。MLR与CHD患者CK、LDH、Gensini积分均呈正相关（r值分别为0.150 0、0.290 0、0.545 1，P<0.05）。Logistic回归分析结果显示，CK、MLR、NLR、PLR均是CHD的影响因素；调整混杂因素后，多因素Logistic回归分析结果显示，MLR>0.25时，发生CHD的风险是MLR≤0.17时的1.6倍[比值比（OR）值为1.609，95%可信区间（CI）为1.213~2.133]。ROC曲线分析结果显示，MLR诊断CHD的曲线下面积为0.674 3，敏感性为62.00%，特异性为62.60%。结论 MLR与CHD和冠状动脉病变程度有关，可能是CHD患者冠状动脉病变严重程度的独立预测因子，可帮助临床判断是否需要进行进一步的侵入性诊疗。

关键词: 单核细胞/淋巴细胞比值, 冠心病, 冠状动脉病变, Gensini积分

Abstract:

Objective To investigate the correlation of monocyte-to-lymphocyte ratio（MLR） with coronary heart disease（CHD） and the extent of coronary atherosclerosis. Methods A total of 200 CHD patients with positive coronary angiography results（major vessel diameter ≥50%） in North Branch of Ruijin Hospital of Shanghai Jiao Tong University School of Medicine from June to December 2022 were enrolled as CHD group，and 131 patients with negative coronary angiography results during the same period were enrolled as control group. The difference of MLR，neutrophil-to-lymphocyte ratio（NLR） and platelet-to-lymphocyte ratio（PLR） was evaluated between CHD and control groups. The correlations between MLR and creatine kinase（CK），lactate dehydrogenase（LDH） and Gensini scores were evaluated by Pearson or Spearman correlation analysis. Logistic regression analysis was used to evaluate the influencing factors of CHD. Receiver operating characteristic（ROC） curve was used to evaluate the efficacy of MLR in diagnosing CHD. Results MLR，NLR and PLR in CHD group were higher than those in control group（P<0.001）. There was no statistical significance in MLR between CHD group and control group after therapy（P>0.05）. MLR was positively correlated with CK，LDH and Gensini scores in CHD patients（r values were 0.150 0，0.290 0 and 0.545 1，P<0.05）. CK，MLR，NLR and PLR were all influencing factors of CHD. After adjusting for confounding factors，the risk of CHD was 1.6 times higher when MLR>0.25 than when MLR≤0.17 [odds ratio（OR）=1.609，95% confidence interval（CI） 1.213-2.133]. The area under curve of MLR for diagnosing CHD was 0.674 3，the sensitivity was 62.00%，and the specificity was 62.60%. Conclusions MLR is related with CHD and the extent of coronary atherosclerosis，and it may be an independent predictor of the extent of coronary atherosclerosis in CHD patients，which can help clinical judgement whether to proceed with further invasive treatment.

Key words: Monocyte-to-lymphocyte ratio, Coronary heart disease, Coronary atherosclerosis, Gensini score

中图分类号:

R446.11

刘琳, 王天凯, 秦康春凤, 丁宁. MLR与冠心病和冠状动脉病变程度相关性分析[J]. 检验医学, 2024, 39(5): 485-490.

LIU Lin, WANG Tiankai, QIN Kangchunfeng, DING Ning. Correlations between monocyte-to-lymphocyte ratio with coronary heart disease and the extent of coronary atherosclerosis[J]. Laboratory Medicine, 2024, 39(5): 485-490.

图/表 9

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狭窄程度	积分/分	病变部位	病变系数
≤25%	1	左主干	5.0
26%~50%	2	前降支或回旋支近段	2.5
51%~75%	4	前降支中段	1.5
76%~90%	8	回旋支中远段和前降支远段	1.0
91%~99%	16	右冠状动脉	1.0
100%	32	其他分支	0.5

狭窄程度	积分/分	病变部位	病变系数
≤25%	1	左主干	5.0
26%~50%	2	前降支或回旋支近段	2.5
51%~75%	4	前降支中段	1.5
76%~90%	8	回旋支中远段和前降支远段	1.0
91%~99%	16	右冠状动脉	1.0
100%	32	其他分支	0.5

组别	例数	性别		年龄/岁	MLR	NLR	PLR
组别	例数	男/[例（%）]	女/[例（%）]	年龄/岁	MLR	NLR	PLR
对照组	131	92（70.23）	39（29.77）	60.32±8.16	0.20 （0.17，0.25）	2.05 （1.55，2.68）	100.98 （80.20，129.87）
CHD组	200	144（72.00）	56（28.00）	61.87±10.95	0.26 （0.19，0.35）	2.65 （1.83，3.82）	126.47 （102.09，158.90）
统计值		0.12		1.38	4.92	4.67	3.26
P值		0.728 0		0.168 0	<0.000 1	<0.000 1	0.001 2

组别	例数	性别		年龄/岁	MLR	NLR	PLR
组别	例数	男/[例（%）]	女/[例（%）]	年龄/岁	MLR	NLR	PLR
对照组	131	92（70.23）	39（29.77）	60.32±8.16	0.20 （0.17，0.25）	2.05 （1.55，2.68）	100.98 （80.20，129.87）
CHD组	200	144（72.00）	56（28.00）	61.87±10.95	0.26 （0.19，0.35）	2.65 （1.83，3.82）	126.47 （102.09，158.90）
统计值		0.12		1.38	4.92	4.67	3.26
P值		0.728 0		0.168 0	<0.000 1	<0.000 1	0.001 2

项目	OR值（95%CI）	P值
TG	1.275（1.055 ~ 1.542）	0.012
TC	0.866（0.721 ~ 1.039）	0.121
HDL-C	0.845（0.620 ~ 1.151）	0.286
LDL-C	0.794（0.614 ~ 1.027）	0.078
LDH	1.005（1.002 ~ 1.008）	<0.001
CK	1.003（1.001 ~ 1.005）	0.001
MLR	6.052（4.661 ~ 7.857）	<0.001
NLR	1.565（1.293 ~ 1.893）	<0.001
PLR	1.009（1.004 ~ 1.014）	0.001