Clinical Value Of C-reactive Protein-to-High Density Lipoprotein Cholesterol Ratio And Neutrophil-to-Lymphocyte Ratio In Patients With Coronary Artery Disease

BackgroundCoronary artery disease(CAD)is one of the major diseases harmful to human health.In recent years,the prevalence rate of cardiovascular disease in China is still on the rise,and cardiovascular death is the leading cause of death among urban and rural residents.Atherosclerosis(AS)is the pathological basis of CAD,and inflammation and lipid metabolism play an important role in the occurrence and development of AS.The inflammatory process involving inflammatory cells and inflammatory factors not only accelerates the occurrence and development of AS,but also participates in thrombosis and plaque rupture.White blood cells are the main inflammatory cells,of which neutrophils account for the highest proportion.The increase in the number of leukocytes is often related to the occurrence,development and severity of inflammatory reaction.As an immune regulatory barrier,the decrease of the number of lymphocytes is related to the stress response of the body.When a single inflammatory cell or inflammatory factor is used to evaluate a patient's condition,it may be easily affected by confounding factors such as infection,drugs,trauma and so on.In order to express the level of inflammation and stress state exactly,scholars are looking for a variety of comprehensive indicators,such as neutrophil-to-lymphocyte ratio(NLR),monocyte-to-lymphocyte ratio(MLR),platelet-to-lymphocyte ratio(PLR),et al.And they explore the application value of these indexes in risk stratification and prognosis assessment of coronary artery disease,hypertension,diabetes and other related diseases.These index mainly reflects the inflammatory state of the body at the cellular level.The AS process also involves inflammatory factors and lipid metabolism,so our team propose a combination of C-reactive protein-to-high density lipoprotein cholesterol ratio(CHR)and NLR as a comprehensive evaluation index of inflammation and blood lipids to explore its correlation with inflammatory reaction and stress state of coronary artery disease and its clinical application value.ObjectivesThe purpose of this study was to observe the changes of CHR and NLR in patients with coronary artery disease,to analyze the relationship between these two indexes and the degree of coronary artery stenosis and clinical stability,and to explore their clinical value in patients with coronary artery disease.Methods651 patients who underwent coronary angiography in Nanfang Hospital of Southern Medical University from January 2014 to August 2018 were collected and divided into CAD group(n=480)and non-CAD group(n=171).Serum lipid,inflammation index,CHR and NLR between the two groups were compared.According to clinical classification,CAD group was divided into acute coronary syndrome(ACS)group and stable angina pectoris(SAP)group.The differences of serum lipid,inflammation index,CHR and NLR among the three group were compared and analyzed.The value of CHR and NLR in the diagnosis and prediction of CAD and the evaluation of lesion severity were analyzed.SPSS20.0 statistical software was used to analyze the data and draw the receiver operating characteristic(ROC)curve.DeLong nonparametric test was used to analyze the predictive value of different indexes for coronary artery disease.Correlation analysis between CHR,NLR and Gensini score is based on Spearman analysis.Results1.Compared with non-CAD group,male proportion,age,smoking history,diabetes history,glycosylated hemoglobin(HbAlc),creatinine(Cr),TG,TC,LDL-C,CRP,white blood cell count(WBC),neutrophil count(NEUT),CHR,NLR,in CAD group were higher while HDL-C was lower(P<0.05);2.There were significant differences in male proportion,age,smoking history,diabetes history,glycosylated hemoglobin,blood lipid and inflammatory indexes among non-CAD group,SAP group and ACS group.Further pairwise comparison showed that there were significant differences in CHR,NLR and CRP between ACS group and SAP group or non-coronary artery disease group(P<0.001),but there was no significant difference between SAP group and non-coronary artery disease group(P>0.05);3.CHR and NLR are the independent risk factor for coronary artery disease;4.By drawing the ROC curve,it is found that the area under the curve(AUC)of CAD predicted by CHR was 0.640(95%CI0.568,0.712),by NLR was 0.681(95%CI0.617,0.745),and by CHR combined with NLR was 0.691(95%CI0.625,0.757).The area under the curve of ACS predicted by CHR was 0.676(95%CI 0.615,0.738).The optimum cutoff level of CHR prediction of ACS was 4.60,with a sensitivity of 56%and specificity of 75%.The area under the curve of ACS predicted by NLR was 0.746(95%CI 0.734,0.829).NLR,with an optimal cutoff value of 2.86,predicted ACS with a sensitivity of 69%and specificity of 73%.The area under the curve of ACS predicted by CHR combined with NLR was 0.752(95%CI 0.697,0.807),and its sensitivity and specificity were 77%and 66%,respectively;5.The proportion of multi-vessel disease and Gensini score in high CHR and high NLR groups were higher than those in low CHR and low NLR groups;6.Both CHR and NLR were positively correlated with Gensini score of patients with coronary artery disease(r=0.163,r=0.172,respectivly,P<0.05);7.High CHR is a risk factor for clinical instability of coronary artery disease.The incidence of ACS is higher in the high CHR group.There is a significant difference between the two groups(?2=14.510,P<0.05);8.High NLR is a risk factor for clinical instability of coronary artery disease.The incidence of ACS is higher in the high NLR group.There is a significant difference between the two groups(?2=63.317,P<0.05).Conclusion1.Compared with the non-CHD group,the CHR and NLR of the CAD group were significantly higher.2.CHR and NLR are the independent risk factor for coronary artery disease.They are related to the severity and the clinical stability of coronary artery disease.The higher the value is,the more severe the lesion is,and the more likely the occurrence of coronary instability event is.3.CHR combined with NLR is helpful to evaluate the condition of coronary artery disease.Thess index are easy to obtain and have important value in the clinical application for general practitioners.