Predictive Value Of Platelet/Lymphocyte Ratio And Mean Platelet Volume In The Formation Of Carotid Atherosclerosis In Patients With Essential Hypertension

Objective: The changes of platelet/lymphocyte ratio(PLR)and average platelet volume(MPV)to be observed in patients with essential hypertension(EH),so as to analyze their relationship with carotid atherosclerosis formation,explore their predictive value in carotid atherosclerosis formation,and look for new risk factors for carotid atherosclerosis formation in hypertensive patients.It may provide theoretical basis and guidance for the prevention,treatment and intervention of carotid atherosclerosis formation in hypertensive patients.Methods: From April 2017 to July 2018,260 cases of EH hospitalized in the 5th department of cardiology of the second hospital affiliated to Dalian University were enrolled,including 134 cases of females and 126 cases of males.Exclude secondary hypertension,diabetes,anemia,peripheral vascular diseases,severe liver and kidney diseases,malignant tumors,thyroid dysfunction,rheumatic immune diseases,the use of bone marrow proliferative drugs,infectious diseases within two weeks and research data are incomplete.Record the patient's sex,age,height,weight,calculate body mass index(BMI),systolic pressure(SBP),diastolic pressure(DBP),whether to take aspirin in the past,smoking,drinking history.Collecting early morning fasting vein blood and test blood routine,uric acid(UA),triglycerides(TG),total cholesterol(TC),low densitylipoprotein cholesterol(LDL-C),HDL cholesterol(HDL-C),Fibrinogen(FBG),hypersensitive C-reactive protein(Hs-CRP),D-dimer and other laboratory indicators.The patients ' platelets(PLT),lymphocytes(LYM),MPV were recorded and PLR were calculated according to the blood routine results.All the selected patients were routinely examined by the neck vascular ultrasound to determine the thickness of the medial membrane of the carotid artery(cIMT),and non-invasive peripheral vascular detection was tested for recording the conduction velocity of brachial-ankle pulse wave(BaPWV).Study Group:(1)Diagnostic criteria for carotid atherosclerosis by reference to the2009 guidelines for Vascular Ultrasound examination issued by the Chinese Medical Association: cIMT ? 1.5mm is defined as plaque,1.0mm ? cIMT < 1.5mm as intima-media thickening,and cIMT < 1.0mm as normal.They were divided into plaque group,thickening group and normal group.The differences of PLR,MPV and general data among the three groups were compared.(2)According to the quartile of PLR and MPV,PLR was divided into four groups: A1 group(PLR ? 111.52),A2 group(111.52 < PLR ? 132.60),A3 group(132.60 < PLR ? 167.63)and A4 group(PLR > 167.63).MPV was divided into four groups: B1 group(MPV ? 9.65fL),B2group(9.65 fL < MPV ? 10.20fL),B3 group(10.20 fL < MPV ? 11.00fL)and B4group(MPV > 11.00fL).The difference of cIMT in each group was compared.(3)According to the gender grouping,the difference of PLR and MPV between male and female patients was compared,and whether there were gender differences in PLR and MPV was observed.(4)According to whether aspirin was taken,they were divided into aspirin group and non-aspirin group,the difference of MPV and PLR between two groups was compared,and whether aspirin had effect on PLR and MPV was observed.(5)According to cIMT?1.5mm as plaque positive,cIMT<1.5mm is plaque negative,the patients were divided into plaque positive group and plaque negative group.The influencing factors of EH complicated with carotid atherosclerosis were analyzed by spearman correlation coefficient.Through the binary multivariate Logistic stepwise regression analysis,whether PLR and MPV were independent risk factors for theformation of carotid atherosclerosis was discussed.Mapping ROC curve to evaluate the predictive value of blood PLR and MPV levels on carotid atherosclerosis formation in EH.Results:1.There were significant differences in PLR,MPV,SBP,age,smoking history,lymphocyte count,baPWV,HDL-C,LDL-C and D-dimer among plaque group,thickening group and normal group.SBP and baPWV in plaque group were higher than those in thickening group,PLR,MPV,SBP,age,D-dimer,LDL-C,baPWV in plaque group were higher than those in normal group,PLR and age in thickening group were higher than those in normal group,and the difference was statistically significant(P <0.05).There was no significant difference in DBP,BMI,Fbg,Hs-CRP,TG,TC and UA among the three groups(P > 0.05).2.The difference of cIMT between four PLR groups was statistically significant(P < 0 05),and A4 group(1.569±1.062)>A3 group(1.257±1.141)>A2 group(1.251±0.928)>A1 group(1.045±1.297).It can be seen that with the increase of PLR level,the cIMT value also increases.The cIMT values of different MPV groups were compared,but there was no significant difference(P >0.05).The results showed that there was no significant difference in cIMT values among different MPV levels.3.There was no significant difference in PLR and MPV between male and female(P > 0.05).The results showed that there was no gender difference in PLR and MPV values.4.There was no significant difference in MPV and PLR between aspirin group and non-aspirin group((P > 0.05).The results showed that the values of PLR and MPV were not affected by aspirin.5.CIMT ? 1.5mm was regarded as plaque positive and cIMT < 1.5mm as plaque negative,which were divided into plaque positive group and plaque negative group:(1)Spearman correlation analysis was performed on the variables between the two groups.It was found that carotid atherosclerosis was positively correlated with PLR,MPV,SBP,smoking history,age,D-dimer,LDL-C and baPWV,but negatively correlated with sex(female),LYM and HDL-C(P < 0.05).(2)Multivariate Logistic regression analysis showed that PLR,MPV,SBP,sex,age and LDL-C were independent risk factors for carotid plaques.(3)The predictive value of PLR and MPV for carotid atherosclerosis in EH patients was evaluated by drawing ROC curve.The critical value of PLR was 107.26(area under the curve 0.587,sensitivity 87%,specificity 27%);The critical value of MPV was 9.45fL(area under the curve 0.571,sensitivity 87%,specificity 27%)(P <0.05).It is suggested that PLR and MPV have strong sensitivity and poor specificity in predicting carotid atherosclerosis in patients with EH,and have certain clinical application value.Conclusion: PLR and MPV in peripheral blood of EH patients are positively correlated with carotid plaque formation.The increase of PLR and MPV may be an independent risk factor for carotid atherosclerosis formation in EH patients.PLR and MPV have strong sensitivity and poor specificity in predicting the formation of carotid atherosclerosis in patients with EH,and have certain clinical application value.