Changes Of Neutrophil/lymphocyte Ratio And Platelet/lymphocyte Ratio In Patients With Acute Coronary Syndrome And Their Relationship With The Degree Of Coronary Artery Disease

[Objective]To investigate the changes of neutrophil-to-lymphocyte Ratio(NLR)and Platelet to-lymphocyte Ratio(PLR)in patients with Acute Coronary Syndrome(ACS)and their relationship with the severity of Coronary artery disease,as well as the diagnostic and predictive value of the two separately and jointly for Acute Coronary Syndrome.[Methods]A total of 405 patients with ACS diagnosed by coronary angiography in the department of cardiovascular medicine of Kunshan first people's hospital from May 2016 to May 2019 were collected and divided into 3 groups according to clinical classification:Patients in the ST segment elevation myocardial STEMI group were 160,patients in the non-ST segment elevation myocardial STEMI group were 120,and patients in the unstable angina UA group were 125.110 patients with negative coronary angiography were selected as the control group.After admission,all patients were recorded:name,gender,age,smoking history,history of hypertension,history of diabetes,history of hyperlipidemia,family history of cardiovascular disease,history of stroke.Before using antiplatelet aggregation and anticoagulant drugs,extraction of venous blood detection routine blood including Neutrophil(Neu),Lymphocyte(Lym)and Platelet(PLA),and calculated the neutrophils/Lymphocyte ratio(NLR)and Platelet/Lymphocyte ratio(PLR);Renal function and coagulation function was measured including Creatinine(Cre),Uric Acid(UA)and Fibrinogen(FIB);The next morning without food,venous blood was collected to measure full set of blood lipids,fasting glucose and other biochemical indexes.Including the levels of Total Cholesterol(TC),low-density Lipoprotein Cholesterol(LDL-C),high-density Lipoprotein Cholesterol(HDL-C),Triglyceride(TG),Lipoprotein a(Lp a),Apolipoprotein Al(Apo Al),Apolipoprotein B(Apo B)and homocysteine(Hcy).After admission,all patients underwent emergency or selective coronary angiography(including stent implantation)according to their conditions,and performed Gensini score for angiography results,and recorded the number of vessels involved.Baseline clinical and laboratory data of patients in the STEMI group,NSTEMI group,UA group and control group were compared,and NLR and PLR of the patients in the STEMI group,NSTEMI group and UA group were compared,then all patients in the ACS group were regrouped according to the Gensini score and the number of diseased vessels,and the NLR and PLR of patients in different Gensini score groups and the number of diseased vessels groups were compared,and the correlation between NLR and PLR and the severity of coronary artery disease in ACS patients was analyzed,and the predictive value of NLR and PLR alone or in combination for ACS was assessed by ROC curve.[Results]1.Fasting blood glucose(6.77± 1.36,6.94±1.45,6.35±1.17),triglyceride(1.68±0.71,1.93±0.75,1.79±0.64),low-density lipoprotein(3.00±0.78,2.95±0.73,2.84±0.76),lipoprotein a(252.94± 125.21,279.51 ± 118.61,271.86± 127.38),creatinine(75.81±15.89,67.89±14.79,72.33± 16.84),homocysteine(15.01 ±4.57,15.06±4.23,15.55±4.04)and fibrinogen(3.03±0.74,2.8±0.80,2.51 ±0.50)in the STEMI group,NSTEMI group and UA group were all higher than those in the control group,with statistically significant differences(P<0.001).The apolipoprotein A1(1.13±0.18,1.08±0.22,1.19±0.19)in the STEMI group,NSTEMI group and UA group was lower than that in the controlgroup(P<0.001).Total cholesterol(4.61±0.92,4.711±0.84)and apolipoprotein B(0.94±0.21,0.91±0,18)in the STEMI group and NSTEMI group were higher than those in the control group(P=0.003,P=0.001).The high-density lipoprotein(1.15±0.20,1.10±0.21)in the STEMI group and NSTEMI group was lower than that in the control group,and the difference was statistically significant(P<0.001).Multiple comparisons between the two groups showed that the fasting blood glucose and fibrinogen of the STEMI group and the NSTEMI group were higher than those of the UA group,with statistically significant differences(P<0.05).The age(55.81 ± 13.5,55.21 ± 12.6)and apolipoprotein A1 of the STEMI group and NSTEMI group were lower than those of the UA group(62.69±10.41)(P<0.05).Triglycerides in the STEMI group were lower than those in the NSTEMI group,with statistically significant difference(P<0.05).The high-density lipoprotein in the NSTEMI group(1.10±0.21)was lower than that in the UA group(1.17±0.22),and the difference was statistically significant(P<0.05).There was no significant difference in uric acid between the STEMI group,NSTEMI group and UA group and the control group,as well as between the STEMI group,NSTEMI group and UA group(P>0.05).2.NLR(6.36±2.42,5.12±2.03,4.56± 1.63)and PLR(176.83±63.21,166.86±63.54,150.21±50.32)in the STEMI group,NSTEMI group and UA group were significantly higher than those in the control group(P<0.001).Multiple comparisons between the two groups showed that the NLR and PLR in the STEMI group were higher than those in the UA group,with statistically significant differences(P<0.001,P<0.05).The NLR in the STEMI group was significantly higher than that of the patients in the NSTEMI group(P<0.001).3.The Gensini score in the STEMI group(74.26±26.13)was higher than that in the NSTEMI group(60.03±22.56)and the UA group(43.47± 17.55),and the Gensini score in the NSTEMI group was higher than that in the UA group,with statistically significant differences(P<0.001).According to Gensini score,ACS patients were divided into severe coronary stenosis group(Gensini score>90),moderate coronary stenosis group(Gensini score:46?90),and mild coronary stenosis group(Gensini score:0?45).Patients in the severe coronary artery stenosis group had higher NLR(6.57±2.38)than those in the moderate coronary artery stenosis group(5.55±2.25)and the mild coronary artery stenosis group(4.76±1.85),and the patients in the moderate coronary artery stenosis group had higher NLR than those in the mild coronary artery stenosis group,with statistically significant differences among the three groups(P<0.05,P<0.001,P<0.05),Patients in severe and moderate coronary artery stenosis had higher PLR(178.58±70.03,173.26±59.41)than those in mild coronary artery stenosis(146.79±53.96)(P<0.05,P<0.001).The number of coronary artery stenosis in the STEMI group[2(2,3)]was higher than that in the NSTEMI[2(1,2)]group and UA group[1(1,2)],The number of coronary artery stenosis in the NSTEMI group was higher than that in the UA group with statistically significant difference(P<0.05,P<0.001,P<0.05).According to the number of stenosis,ACS patients were divided into single-vessel disease group,double-vessel disease group and multi-vessel disease group.The NLR and PLR in the multi-vessel disease group(6.21±2.36,188.26±62.27)were higher than those in the single-vessel disease group(4.85±1.96,148.99±55.69)and double-vessel disease group(5.36±2.17,162.76±58.44),with statistically significant differences(P<0.001,P<0.05,P<0.001,P<0.05)?4.Based on multiple factors logistic regression analysis of risk factors for ACS,found that in addition to smoking,fasting blood glucose,triglyceride,low density lipoprotein cholesterol(LDL-C),lipoprotein,apolipoprotein A1,creatinine,and a homocysteine is an independent risk factor for ACS,NLR(OR=3.259,95%CI:2.110 5.031,P<0.001)and PLR(OR=1.020,95%CI:1.009 1.032,P<0.001)were independent risk factors for ACS.5.The ROC curve was used to evaluate the predictive value of NLR and PLR for ACS alone or in combination.It was found that when NLR alone was used for ACS prediction,the AUC was 0.871(95%CI:0.841-0.902,P<0.0001).When the intercept value of NLR was 4.12,the diagnostic value was the highest,the sensitivity was 70.37%,and the specificity was 91.82%.When the ACS was predicted by PLR alone,the AUC was 0.776(95%CI:0.734-0.817,P<0.0001).When the interception value of PLR was 158.39,the diagnostic value was the highest,the sensitivity was 54.81%,and the specificity was 90.00%.When combined with NLR and PLR,AUC was 0.879(95%CI:0.848-0.909,P<0.0001).Sensitivity:77.28%,specificity:85.45%.Compared with the AUC obtained by NLR or PLR alone,the AUC obtained by the combination of the two is increased,and the sensitivity is significantly improved,which is more conducive to improving the predictive value of ACS.6.Spearman correlation analysis was applied to evaluate the correlation between NLR and PLR and the severity of ACS lesions.In the ACS group,NLR was positively correlated with the coronary Gensini score(r=0.261,P<0.001),and positively correlated with the number of lesions(r=0.234,P<0.001).PLR was positively correlated with coronary Gensini score(r=0.246,P<0.001),and positively correlated with lesion number(r=0.247,P<0.001).[Conclusion]1.NLR and PLR in the STEMI group,NSTEMI group and UA group were significantly higher than those in the control group,and both NLR and PLR were independent risk factors for ACS.2.NLR and PLR have certain predictive value for ACS diagnosis alone,while the combination of NLR and PLR can significantly improve the predictive value for ACS.3.NLR and PLR were positively correlated with the coronary artery Gensini score and the number of coronary artery lesions in ACS patients,which could reflect the severity of coronary artery lesions to some extent.