Study On The Relationship Between NHR,LMR And The Stability Of Coronary Atherosclerotic Plaque Based On Intravascular Ultrasound

Research objective To investigate the correlation of neutrophil count to high density lipoprotein cholesterol ratio(NHR),lymphocyte count to monocyte count ratio(LMR)to the occurrence of coronary heart disease and the stability of coronary atherosclerotic plaque based on intravascular ultrasound(IVUS),and to evaluate the predictive value of NHR and LMR in the occurrence of coronary heart disease and unstable coronary plaque.To provide a theoretical basis for the prevention and treatment of coronary heart disease,and to provide a convenient detection index for early diagnosis of unstable plaque of coronary artery,so as to reduce the occurrence of acute cardiovascular events.Method Patients with complete examination records who underwent coronary angiography or intravascular ultrasound examination in the second affiliated Hospital of Shenyang Medical College from August 2019 to August 2021 were divided into coronary heart disease group and non-coronary heart disease group according to the results of coronary angiography.In coronary heart disease group,they were divided into stable plaque group and unstable plaque group according to the results of IVUS.A total of 100 cases were randomly selected from each group by random number method.After admission,their clinical references were recorded in detail,including sex,age,history of hypertension,history of diabetes,history of smoking,history of drinking,body mass index(BMI),neutrophil count,lymphocyte count,monocyte count,total cholesterol(TC),triglyceride(TG),apolipoprotein A1(apo A1),apolipoprotein B(apo B),lipoprotein a[Lp(a)],low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol,uric acid(UA),homocysteine(Hcy),fibrinogen(Fg),NHR and LMR were calculated at the same time.NHR,LMR and coronary heart disease were analyzed.To evaluate the diagnostic value of CHD and LMR in the occurrence of coronary heart disease and the stability of coronary atherosclerotic plaque.Results1.The general clinical data of patients with coronary heart disease and non-coronary heart disease were statistically analyzed.The results showed that there was no significant difference in the proportion of alcohol consumption,BMI and monocyte count between the two groups.The average age,smoking,hypertension,diabetes,neutrophil count,total cholesterol,triglyceride,apolipoprotein B,lipoprotein a,low density cholesterol lipoprotein,uric acid,homocysteine,fibrinogen and NHR in the coronary heart disease group were significantly higher than those in the non-coronary heart disease group.The lymphocyte count,apolipoprotein A1,LMR and high density lipoprotein cholesterol in the CHD group were significantly lower than those in the non-CHD group.2.Taking the occurrence of coronary heart disease as dependent variable and the related indexes with statistically significant differences in baseline data as independent variables,univariate Logistic regression analysis was carried out.The results showed that age,NHR,total cholesterol,triglyceride,apolipoprotein B,low density lipoprotein cholesterol,uric acid and homocysteine were positively correlated with coronary heart disease.LMR,apolipoprotein A1 and high density lipoprotein cholesterol were negatively correlated with the occurrence of coronary heart disease.The results of multivariate Logistic regression analysis showed that advanced age,elevated NHR,elevated total cholesterol,elevated uric acid,elevated homocysteine,elevated low density lipoprotein cholesterol,decreased LMR and decreased apolipoprotein A1 were independent risk factors for coronary heart disease.3.The results of ROC showed that the AUC of LMR for predicting coronary heart disease was 0.84 [95%CI(0.79-0.90),P < 0.05].The best cutoff value was 3.64,81% sensitivity and 75% specificity.The AUC of NHR for predicting the occurrence of coronary heart disease was 0.59[95%CI(0.51-0.68),P < 0.05.The best cut-off value was 4.42.its sensitivity and specificity were 62% and 61%,respectively.4.The analysis of general clinical data between stable plaque group and unstable plaque group showed that there were no significant differences in age,hypertension,diabetes,alcohol consumption,smoking,BMI,neutrophil count,triglyceride,apolipoprotein A1,apolipoprotein B,lipoprotein a,low density lipoprotein cholesterol and high density lipoprotein cholesterol between the two groups.The proportion of smoking,lymphocyte count,monocyte count,total cholesterol,lipoprotein a,uric acid,homocysteine,fibrinogen and NHR in unstable plaque group were significantly higher than those in stable plaque group,while the levels of apolipoprotein A1 and LMR in unstable plaque group were significantly lower than those in stable plaque group.5.The results of IVUS in stable plaque group and unstable plaque group showed that the area of extravascular elastic membrane,plaque area and plaque load in unstable plaque group were significantly higher than those in stable plaque group,while the minimum lumen area in unstable plaque group was significantly lower than that in stable plaque group.6.Taking the stability of coronary atherosclerotic plaque as dependent variable and the related indexes with statistically significant differences in baseline data as independent variables,univariate Logistic regression analysis was carried out.The results showed that LMR was negatively correlated with the instability of coronary atherosclerotic plaque,while NHR and smoking were positively correlated with the instability of coronary atherosclerotic plaque.The results of multivariate Logistic regression analysis showed that the decrease of LMR was an independent risk factor for unstable coronary atherosclerotic plaque.7.The ROC results showed that the AUC of LMR for the diagnosis of unstable coronary atherosclerotic plaques was 0.71 [95%CI(0.65-0.78),P< 0.05],and the best cut-off value was 4.71,with a sensitivity of 81% and a specificity of 55%.The AUC of NHR in the diagnosis of unstable coronary atherosclerotic plaque was 0.84 [95%CI(0.79-0.89),P < 0.05.The best cut-off value was 3.69.its sensitivity and specificity were 86% and 70%,respectively.Conclusion NHR and LMR have diagnostic value for coronary heart disease,and the increase of NHR and the decrease of LMR are independent risk factors for coronary heart disease,NHR and LMR have diagnostic value for the stability of coronary atherosclerotic plaque,and the decrease of LMR is an independent risk factor for unstable coronary atherosclerotic plaque.