Correlation Between Neutrophil/lymphocyte Ratio,Red Blood Cell Distribution Width And Prognosis Of ACS Patients With Different TCM Syndromes

Objective: By reviewing the neutrophil-to-lymphocyte ratio(NLR),red blood cell distribution width(RDW)levels and major adverse cardiovascular events(MACE)after percutaneous coronary intervention(PCI)in patients with different TCM evidence of acute coronary syndrome(ACS),we investigated the value of NLR and RDW in assessing the occurrence of MACE within 1 year after PCI in patients with different TCM evidence of ACS,and provided a scientific and reliable basis for the prevention and treatment of TCM in ACS patients after PCI.Methods: A retrospective analysis was used to include a total of 389 inpatients who were clearly diagnosed with acute coronary syndrome in the Department of Cardiovascular Medicine of the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine from January 2019 to January 2022,all of whom underwent coronary angiography and percutaneous coronary intervention,and were judged to have Qi deficiency and blood stasis syndrome,phlegm obstruction of heart and pulse syndrome,Qi and Yin deficiency syndrome after Chinese medicine identification.The Patient’s NLR,RDW and diastolic blood pressure at presentation,systolic blood pressure,red blood cell count(RBC),white blood cell count(WBC),platelets(PLT),creatine kinase isoenzyme(CKMB),serum cholesterol(TC),triglycerides(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),uric acid(UA),creatinine(CR),aspartate aminotransferase(AST),glutamate aminotransferase(ALT),echocardiographic indices of left ventricular ejection fraction(LVEF),left ventricular end-diastolic internal diameter(LVEDD),and other general clinical data were recorded.The occurrence of MACE was collected and recorded within 1 year after consultation,and the patients were divided into MACE and non-MACE groups based on whether MACE occurred within 1 year after surgery.NLR,RDW and MACE were statistically analyzed to explore the value of NLR and RDW in assessing postoperative MACE in patients with different types of ACS.Results:1.The overall differences in the levels of NLR and RDW in patients with each evidence type of ACS were statistically significant(P<0.05),The RDW level of Qi-Yin deficiency syndrome group was statistically different from that of phlegm-obstructing heart-pulse syndrome group and Qideficiency and blood-stasis syndrome group(P<0.05).There was no statistical significance between phlegm-obstructing heart-pulse syndrome group and Qi-deficiency and blood-stasis syndrome group(P>0.05).The NLR level of Qi-Yin deficiency syndrome group was statistically different from that of phlegm-obstructing heart-pulse syndrome group and Qideficiency and blood-stasis syndrome group(P<0.05).There was no statistical significance between the phlegm-obstructing heart-pulse syndrome group and the qi deficiency and blood stasis syndrome group(P>0.05).2.The occurrence of MACE was statistically different among different TCM syndromes of ACS(P<0.05).The occurrence of MACE in the Qi deficiency and blood stasis syndrome group was statistically different from that in the Qi and Yin deficiency syndrome group(P<0.017).3.The differences in comorbid hypertensive disease status,age,WBC,LVEF,NLR,and RDW levels between the MACE and non-MACE groups were statistically significant(P<0.05).The above indicators were included in the binary logistic regression analysis as independent variables,and the occurrence of MACE was used as the dependent variable,and combined hypertensive disease,age,WBC,NLR,and RDW were risk factors for the occurrence of MACE within 1 year after surgery in patients with ACS(P<0.05)4.The receiver operating curve(ROC)was established and the area under the curve(AUC)was calculated.The area under the curve of NLR was0.740.When the Yoden index reached its maximum,the cut-off value of NLR was 3.5508.The AUC value of RDW was 0.716.When the Yoden index reached its maximum,the cut-off value of RDW was 13.35%.The AUC value of the combined index of RDW and RDW was 0.794,larger than that of NLR and RDW.The results were statistically significant(P<0.05).5.Among the TCM syndromes,the AUC values of NLR and RDW were0.709 and 0.734 in the Qi-deficiency and blood-stasis group,respectively;the AUC values of NLR and RDW were 0.801 and 0.688 in the phlegmobstructing heart-pulse syndrome group evidence group,respectively;while the AUC values of NLR and RDW were 0.68 and 0.739 in the QiYin deficiency syndrome group,respectively,which were lower than those in the Qi-deficiency and blood-stasis group and the phlegm-obstructing heart-pulse syndrome group.The results were all statistically significant(P<0.05).Conclusions:1.The levels of NLR and RDW in ACS patients with different TCM syndromes have differences.2.The risk of MACE within 1 year after PCI was higher in the group of ACS patients with Qi deficiency and blood stasis syndrome.3.NLR and RDW are risk factors for the occurrence of MACE within1 year after ACS surgery,and the combination of NLR and RDW has predictive value.4.RDW and NLR have the ability to assess MACE within 1 year in patients with different TCM syndromes of ACS.The ability of RDW to evaluate MACE in Qi-deficiency and blood-stasis group was higher than that in phlegm-blocked heart-pulse group and Qi-yin deficiency group.The ability of NLR to evaluate MACE in phlegm-blocked heart-pulse syndrome group was higher than that in qi deficiency and blood stasis group and qi Yin deficiency group.