| Objective:Through the study of the relationship between the Blood Routine Indexes,such as white blood cell count,lymphocyte count,neutrophil-to-lymphocyte ratio,red blood cell count,red cell distribution width,platelet distribution width,and the attack of acute coronary syndrome(ACS),to judge some indexes alone or in combination on the diagnostic value for the ACS,in order to guide the clinic.Methods:Collect 500 patients as the research objects,they are selected from the second hospital cardiology of shanxi medical university during June 2013 to June 2015,and they are all examined by selective Coronary angiography(CAG)of,according to the results of the CAG,they can be divided into acute Coronary syndrome group(n = 320),the non-CHD group(n = 180).Completely record the relatively general information of all the research objects,including age,gender,on admission heart rate,height,weight,smoking history,hypertension history,diabetes history,etc.,and conduct routine blood tests for all the objects of the study,analysis and compare the two groups of patients with clinical datas and the difference of blood routine;According to the statistics of general information and blood routine parameters,the risk factors of ACS is obtained by single factor analysis,and then put the risk factors of single factor analysis into multiariable Logistic regression analysis model,then we can get the independent predictors of ACS;Further using ROC curve,through calculating the area under the curve,getting a certain or some indicators of diagnostic sensitivity and specific degrees,we can speculate the value of one or some independent predictors for the diagnosis of ACS,and get the corresponding cut-off values and 95% confidence interval,then they can be used to guide clinical diagnosis.Using SPSS 19.0 statistical package analysis results.Results:1.According to the comparation of the acute coronary syndrome group and non-CHD group,admission heart rate,age,gender,history of diabetes,smoking history,leukocyte count,neutrophil count,monocyte count,Neutrophile-to-Lymphocyte Ratio,basophils,neutrophil percentage,lymphocyte percentage,monocyte percentage,basophils percentage,hemoglobin,mean corpuscular volume,mean corpuscular hemoglobin,mean corpuscular hemoglobin concentration and the platelet distribution width have statistically significant,P < 0.05.2.The multi factor Logistic regression analysis shows that admission heart rate,age,gender,history of diabetes,neutrophil and lymphocyte percentage,monocytes,lymphocyte percentage and basophils percentage are independent predictive factors of ACS,the value of OR respectively are 0.96,1.06,6.47,4.63,1.63,5.41,0.94,0.24,the value of B respectively are 0.04,0.06,1.87,1.53,0.49,1.69,-0.06,-1.43.3.According to the results of ROC curve,we get that the area under the curve of Neutrophile-to-Lymphocyte Ratio is 0.691,95%CI:0.641-0.741,P < 0.001,cut-off value is 2.361,the sensitivity is 0.574,specificity is 0.784.The area under the curve of monocytes is 0.665,95%CI:0.614-0.715,P < 0.001,cut-off value is 0.475×109/L,the sensitivity is 0.619,the specificity is 0.611.The area under the curve of basophil percentage is 0.662,95%CI:0.609-0.715,P < 0.001,the best cut-off value is 0.605%,the sensitivity is 0.732,the specificity is 0.527.Using parallel test combined with two indicators for the diagnosis of ACS,combining Neutrophile-to-Lymphocyte Ratio and basophil percentage had the highest diagnostic value,the sensitivity is 0.891,the specificity is 0.443.Using parallel test combined with three indicators for the diagnosis of ACS,the sensitivity was 0.948,the specificity was 0.281.Conclusion:1.The concentration or level changes of partial abnormal indexes of blood routine examination in ACS patients can be used as an important reference index for the diagnosis of ACS;2.There is a certain correlation between the changes of erythrocyte morphological parameters(including HGB,MCV,MCH and MCHC)and the onset of ACS,and the change of the parameters is helpful to the timely diagnosis of ACS;3.There are some correlations between the changes of PDW,one item of the parameters of platelet,and ACS,wether it could be used as an independent predictive factor of ACS needs further investigations;4.The variation of the white blood cell count and the relevant ratio in the peripheral blood circulation is closely related to ACS,which also have the higher diagnostic ability of ACS than erythrocyte morphology parameters and platelet related indexes;5.In the blood routine indexes,paralleling the changes of NLR and the basophil percentage has the higher diagnostic value for the ACS,and paralleling the changes of other parameters and traditional risk factors is helpful to improve the clinical diagnostic accuracy of ACS. |
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