| Background:In recent years,the prevalence of coronary heart disease(CHD)presents a younger trend due to the rapid economic development,the accelerated pace of life,the increasing pressure of work and life,the irregular daily routine and unhealthy diet and other factors.The world is increasingly interested in the identification and treatment of CHD risk factors in young and middle-aged people to reduce the frequency of CHD through risk adjustment and elevate the quality of life through early intervention.Invasive coronary angiography is the gold standard for diagnosing CHD but is costly and associated with risk of complications.Young and middle-aged people are also less willing to accept it.A non-invasive universal screening method needs to be solved urgently.The value of neutrophil to high density lipoprotein cholesterol ratio(NHR)combined with carotid Crouse score in predicting CHD and the severity degree of CHD for young and middle-aged people is unclear.Objective:To explore the relationship between NHR,carotid Crouse score and CHD,the severity of coronary artery stenosis in young and middle-aged people,and further explore whether NHR combined with Crouse score can provide meaningful information for predicting CHD and the severity of coronary artery stenosis in young and middle-aged people.Methods:The study is a single-center retrospective study,which included 303 young and middle-aged patients who underwent coronary angiography at the Qilu Hospital of Shandong University from January 2020 to October 2022(Age<65 years old).There were 157 males and 146 females.Among whom,203 patients were included in the CHD(+)group and 100 patients were included in the CHD(-)group according to degree of coronary artery stenosis.Patients with CHD(+)were further divided into the severe coronary artery stenosis group(106 patients)and the mild coronary artery stenosis group(97 patients).The clinical data of all patients were recorded in detail,and the data differences between groups were compared.The NHR was calculated using the following formula:neutrophils to high-density lipoprotein cholesterol(HDL-C)ratio.Crouse score:the maximal thickness of all isolated plaques in bilateral carotid arteries were added regardless of the plaque length.Logistic regression analysis and ROC curve were used to evaluate the predictive value of NHR,Crouse score and their combination for CHD and the severity degree of coronary artery stenosis in young and middle-aged patients.Delong test was used to compare the ROC curve of NHR,Crouse score and their combination.Results:The NHR and Crouse score in CHD(+)group were significantly higher than CHD(-)group,and the difference was statistically significant(P<0.001).The NHR and Crouse score in the severe coronary artery stenosis were significantly higher than mild coronary artery stenosis group,and the difference was statistically significant(P<0.001).Univariate and multivariate Logistic regression analysis showed that diabetes mellitus(OR:5.438;95%CI:1.563-18.920;P=0.008),NHR(OR:1.263;95%CI:1.092-1.462;P=0.002),Crouse score(OR:1.564;95%CI:1.368-1.788;P<0.001),triglyceride(OR:2.485;95%CI:1.541-4.008;P<0.001)and platelets(OR:1.008;95%CI:1.003-1.014;P=0.004)were independent risk factors for CHD in young and middle-aged patients.NHR(OR:1.532;95%CI:1.298-1.809;P<0.001)and Crouse score(OR:1.210;95%CI:1.093-1.339;P<0.001)were independent risk factors for severe coronary artery stenosis in young and middle-aged patients.Spearman rank correlation analysis showed that the Gensini score was positively correlated with NHR,Crouse score(r=0.486,P<0.001;r=0.500,P<0.001).The ROC analysis displayed that the critical value of NHR was 3.04 for predicting CHD among young and middle-aged patients,and the area under the ROC curve was 0.736(95%CI:0.676-0.795,P<0.001).The ROC analysis displayed that the critical value of Crouse score was 2.15 for predicting CHD among young and middle-aged patients,and the area under the ROC curve was 0.793(95%CI:0.739-0.847,P<0.001).Multiple Logistic regression model was used to predict CHD in young and middle-aged patients.The area under the curve of the combination of NHR and Crouse score in predicting CHD reached 0.839(95%CI:0.791-0.887,P<0.001),which was greater than that of the NHR level and Crouse score separately(P<0.05).The ROC analysis displayed that the critical value of NHR was 4.40 for predicting severe coronary artery stenosis among young and middle-aged patients,and the area under the ROC curve was 0.754(95%CI:0.688-0.821,P<0.001).The ROC analysis displayed that the critical value of Crouse score was 5.10 for predicting severe coronary artery stenosis among young and middle-aged patients,and the area under the ROC curve was 0.657(95%CI:0.581-0.733,P<0.001).Multiple Logistic regression model was used to predict severe coronary artery stenosis in young and middle-aged patients.The area under the curve of the combination of NHR and Crouse score in predicting severe coronary artery stenosis reached 0.806(95%CI:0.745-0.867,P<0.001),which was greater than that of the NHR level and Crouse score separately(P<0.05).Conclusion:① The NHR and Crouse score in CHD(+)group were significantly higher than CHD(-)group and the NHR and Crouse score in the severe coronary artery stenosis were significantly higher than mild coronary artery stenosis group.② NHR and Crouse score were positively correlated with Gensini score.③ NHR and Crouse score were independent predictors of CHD and severe coronary artery stenosis in young and middle-aged patients.Diabetes mellitus,triglycerides and platelets were also independent predictors of CHD in young and middle-aged patients.④ Both NHR and Crouse score can be used as predictors of CHD and severe coronary artery stenosis in young and middle-aged patients.The value of NHR combined with Crouse score in predicting CHD and the severity degree of CHD for young and middle-aged patients is significantly greater than that of the NHR and Crouse score separately. |
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