To Investigate The Predictive Value Of Platelet-lymphocyte Ratio And Other Indicators For Non-obstructive Coronary Microvascular Disease Based On CFR

Objective:Coronary microvascular disease?CMVD?is a kind of disease in which coronary microcirculation structure and/or function are impaired under the influence of various pathogenic factors.It is mainly divided into three types.The first type is non-obstructive coronary microvascular disease?NOCMVD?.NOCMVD patients are clinically common and have a wide range of cardiovascular disease risk factors.The study found that after controlling for traditional risk factors such as hypertension and hyperlipidemia,the incidence of major cardiovascular adverse events in NOCMVD patients was still higher than that in the healthy control group.The pathogenesis of NOCMVD is controversial.Based on a large number of studies,it is believed that chronic inflammatory response,oxidative stress,platelet aggregation and microvascular endothelial dysfunction may be related to the occurrence of NOCMVD.With the development of many studies,there are different opinions on the risk factors of NOCMVD.Some studies have found that inflammatory markers such as c-reactive protein,neutrophil-lymphocyte ratio,and lymphocyte-monocyte ratio are related to the occurrence of NOCMVD.Some studies also found that hyperuricemia and hyperhomocysteine were associated with NOCMVD.In recent years,studies have confirmed that the platelet-lymphocyte ratio is related to c-reactive protein,which can reflect the state of inflammation and coagulation function in the body,and can be used as a predictor of the occurrence of slow coronary blood flow.Total bilirubin is widely used in clinic as an indicator of hepatobiliary diseases.Few studies have reported the relationship between platelet-lymphocyte ratio,total bilirubin and NOCMVD.At present,the methods to detect NOCMVD mostly use the invasive microvascular resistance index and Myocardial contrast echocardiography.Studies on the reflection of microcirculation function by coronary flow reserve?CFR?are relatively rare.Currently,positron emission tomography?PET?is recognized as the gold standard for measurement of CFR in non-invasive techniques.In clinical practice,it is difficult to popularize NOCMVD because of its invasive,expensive and poor repeatability.It is imperative to try to find simple,non-invasive and reliable clinical indicators to predict NOCMVD.In view of this,the purpose of this study was to investigate the correlation between platelet-lymphocyte ratio,total bilirubin and NOCMVD by detecting the diagnosis of NOCMVD with CFR by ¹³N-ammonia PET myocardial perfusion imaging.Furthermore,the predictive value of NOCMVD occurrence is further analyzed.Methods:A total of sixty-eight patients with angina pectoris with normal coronary artery or no obvious stenosis were selected from the first hospital of shanxi medical university from April 2017 to August 2019 who underwent CAG examination or coronary artery CT angiography,including 36 male patients with an average age of 53.4±8.7 years.From April 2017 to August 2019,sixty-eight patients with angina with normal coronary artery or no obvious narrowing on CAG or coronary CT angiography were selected from the first hospital of shanxi medical university,including 36 male patients.The average age of all patients was 53.4±8.7 years.All enrolled patients were given one-day rest and ¹³N-ammonia PETMPI,and the images were analyzed to obtain cardiac blood flow and CFR,and were grouped according to CFR<2.5.There were thirty patients in the NOCMVD group and thirty-eight patients in the control group.In the elbow vein venous blood was collected and determination of white blood cell count?WBC?,neutrophil counts?NEUT?,red blood cell count?RBC?,hemoglobin?HB?,red blood cell volume distribution width?RDW?and lymphocyte count?Lym?,neutrophil percentage?NEUT%?,platelet count?PLT?,fasting blood glucose?FBG?,total cholesterol?TC?,triglyceride?TG?,low density lipoprotein cholesterol?LDL-C?,high density lipoprotein cholesterol?HDL-C?,total bilirubin?TBIL?,uric acid?UA?and homocysteine?HCY?.The platelet-lymphocyte ratio?PLR?was calculated by blood routine examination.Body mass index?BMI?is calculated from height and weight.SPSS 22.0 software was used to analyze the data.The measurement data conforming to the normal distribution were expressed as mean±standard deviation?±s?,the t-test wasused for inter-group comparison.the counting data were expressed as rate?%?,and the x² test was used for inter-group comparison.Pearson row correlation analysis was used for continuous variables,While spearman row correlation analysis was used for dichotomous variables.Multivariate logistic regression analysis was used to analyze the risk factors of NOCMVD.P<0.05 was considered statistically significant.Results:1.There was no significant difference in gender,diabetes,smoking,hypertension,resting heart rate,BMI,WBC,NEUT,RBC,HB,RDW,FBG,TC,TG,LAD-C and HDL-C between the two groups?P>0.05?.2.In the NOCMVD groups,age,NEUT%,PLT,PLR,UA and HCY were all higher than those in the control group?56.00+/-9.21 vs.50.84+/-8.40,P<0.05;60.513+/-8.823 vs.54.661+/-11.587,P<0.05;213.933+/-49.369 vs.184.289+/-35.985,P<0.05;133.276+/-42.191 vs.90.897+/-32.123,P<0.05;340.700+/-90.128 vs.279.921+/-77.392,P<0.05;17.790+/-9.811 vs.11.776+/-7.662,P<0.05?.In the NOCMVD groups,Lym and TBIL were all lower than those in the control group in patients than controls?1.711+/-0.556 vs.2.161+/-0.521,P<0.05;10.560+/-2.982vs.15.947+/-3.251,P<0.05?.3.CFR value was negatively correlated with age,PLR,UA and HCY?r=-0.396,P<0.05;r=-0.313,P<0.05;r=-0.324,P<0.05;?,which was positively correlated with Lym and TBIL?r=0.305,P<0.05;r=0.677,P<0.05?.4.The multivariate logistic regression analysis showed that the PLR,UA,HCY were independent risk factors of CFR?OR=1.015,95%CI 1.003¹.027,P=0.013?,HCY?OR=1.195,95%CI 1.046¹.364,P=0.009?,and TBIL were independent protection factors of CFR?OR=0.571,95%CI 0.407⁰.801,P=0.000?.Conclusion:PLR,UA and HCY are independent risk factors,while TBIL is independent protective factors of NOCMVD.Clinically significant:1.PLR,UA,HCY and TBIL may be involved in the pathological process of NOCMVD,leading to the decrease of CFR.2.In clinical practice,the measurement of PLR,UA,HCY and TBIL may have certain clinical application value for the diagnosis or intervention of the occurrence of NOCMVD.