Non-HDL-C/HDL-C和NHR与冠状动脉病变严重程度的相关性

doi:10.3969/j.issn.1004-583X.2024.02.003

摘要/Abstract

摘要：

目的探讨非高密度脂蛋白胆固醇/高密度脂蛋白胆固醇比值(non-high-density lipoprotein cholesterol to high density lipoprotein cholesterol ratio, non-HDL-C/HDL-C)和中性粒细胞计数/高密度脂蛋白胆固醇比值(neutrophil to high-density lipoprotein cholesterol ratio, NHR)与冠状动脉病变严重程度的相关性。方法选取2022年1月至2023年6月因胸闷、胸痛于华北理工大学附属医院心内科住院初次行冠状动脉造影检查的患者284例,根据冠状动脉造影结果分为冠状动脉病变组(n=223)和对照组(n=61)。收集两组临床资料(一般资料和实验室资料),计算non-HDL-C/HDL-C和NHR,比较两组临床资料。根据Gensini评分将冠状动脉病变组分为低、高分值两个亚组,Gensini评分<30分为低分值亚组、Gensini评分≥30分为高分值亚组,比较两亚组实验室资料。采用Spearman相关性分析探讨冠状动脉病变患者Gensini评分与non-HDL-C/HDL-C、NHR的相关性。应用多因素Logistic回归分析探讨冠状动脉病变患者高Gensini评分的影响因素,并绘制受试者工作特征(receiver operating characteristic, ROC)曲线以评价non-HDL-C/HDL-C和NHR对冠状动脉病变患者高Gensini评分的预测价值。结果冠状动脉病变组non-HDL-C/HDL-C和NHR水平高于对照组(均P<0.05);Gensini评分高分值亚组non-HDL-C/HDL-C、NHR水平高于低分值亚组(均P<0.05)。相关性分析显示,non-HDL-C/HDL-C、NHR与Gensini评分均呈正相关(均P<0.05)。多因素Logistic回归分析显示,NHR升高是冠状动脉病变患者高Gensini评分的独立危险因素(OR=1.650,95%CI:1.262-2.158,P<0.05)。绘制ROC曲线,non-HDL-C/HDL-C和NHR预测冠状动脉病变严重程度的ROC曲线下面积分别为0.657(95%CI: 0.582-0.732,P<0.01)和0.736(95%CI: 0.666-0.807,P<0.01)。结论 non-HDL-C/HDL-C、NHR与冠状动脉病变严重程度呈正相关,且NHR是冠状动脉病变患者高Gensini评分的独立预测因子。

关键词: 冠状动脉疾病, 非高密度脂蛋白胆固醇/高密度脂蛋白胆固醇比值, 中性粒细胞计数/高密度脂蛋白胆固醇比值, Gensini评分

Abstract:

Objective To investigate the correlation of non-high-density lipoprotein cholesterol to high density lipoprotein cholesterol ratio (non-HDL-C/HDL-C), neutrophil to high-density lipoprotein cholesterol ratio (NHR) with the severity of coronary artery disease. Methods A total of 284 patients who underwent coronary angiography for the first time in the Cardiology Department of North China University of Technology Affiliated Hospital from January 2022 to June 2023 due to chest tightness and pain were selected. According to the results of coronary angiography, they were divided into the coronary artery disease group (n=223) and control group (n=61). Clinical data (general data and laboratory data), non-HDL-C/HDL-C and NHR were compared between groups. According to the Gensini score, patients in the coronary artery disease group were divided into low-score subgroup (Gensini score<30) and high-score subgroup (Gensini score≥30). Laboratory data of the two subgroups were compared. Spearman correlation analysis of the two subgroups was performed to explore the correlation of Gensini score with non-HDL-C/HDL-C and NHR count. Multivariate logistic regression analysis was performed to explore the influencing factors of high Gensini scores in patients with coronary artery disease. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive value of non-HDL-C/HDL-C and NHR on high Gensini scores in patients with coronary artery disease. Results The levels of non-HDL-C/HDL-C and NHR in coronary artery disease group were significantly higher than those of control group (P<0.05). Non-HDL-C/HDL-C and NHR levels in patients with high-score subgroup were significantly higher than those of low-score subgroup (P<0.05). Correlation analysis showed that non-HDL-C/HDL-C and NHR were positively correlated with Gensini scores (P<0.05). Multivariate Logistic regression analysis showed that an elevated NHR increased the risk of high Gensini score in patients with coronary artery disease (OR=1.650, 95%CI: 1.262-2.158, P<0.05). ROC curve analysis showed that the area under the curve of non-HDL-C/HDL-C and NHR to predict the severity of coronary lesions was 0.657 (95%CI: 0.582-0.732, P<0.01) and 0.736 (95%CI: 0.666-0.807, P<0.01), respectively. Conclusion Non-HDL-C/HDL-C and NHR are positively correlated with the severity of coronary artery disease, and NHR is an independent predictor of high Gensini score in patients with coronary artery disease.

Key words: coronary artery disease, non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio, neutrophil to high-density lipoprotein cholesterol ratio, Gensini score

中图分类号:

R541.4

黄宇玲, 张欣悦, 荣萍萍, 杨文琦, 曹新营, 邢彩耐, 王志军, 刘宁. Non-HDL-C/HDL-C和NHR与冠状动脉病变严重程度的相关性[J]. 临床荟萃, 2024, 39(2): 115-120.

Huang Yuling, Zhang Xinyue, Rong Pingping, Yang Wenqi, Cao Xinying, Xing Cainai, Wang Zhijun, Liu Ning. Correlation analysis of Non-HDL-C/HDL-C and NHR with the severity of coronary artery disease[J]. Clinical Focus, 2024, 39(2): 115-120.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.02.003

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I2/115

图/表 5

参考文献 28

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组别	例数	年龄 (岁)		男性 [例(%)]		BMI (kg/m²)		吸烟史 [例(%)]		饮酒史 [例(%)]		高血压 [例(%)]		糖尿病 [例(%)]		收缩压 (mmHg)			舒张压 (mmHg)
对照组	61	56.18±10.45		31(50.8)		25.45±2.52		15(24.6)		12(19.7)		29(47.5)		5(8.2)		133.82±15.45			80.33±10.04
冠状动脉病变组	223	61.91±9.08		111(49.8)		25.68±3.52		62(27.8)		46(20.6)		125(56.1)		52(23.3)		137.92±18.35			82.49±12.10
统计值		t=-3.293		χ²=0.021		χ²=-0.588		χ²=0.250		χ²=0.027		χ²=1.398		χ²=6.827		t=-1.760			t=-1.279
P值		0.001		0.885		0.557		0.617		0.870		0.237		0.009		0.081			0.202
组别	肌酐 (μmol/L)		血糖 (mmol/L)		NEU计数 (×10⁹/L)		TG (mmol/L)		TC (mmol/L)		LDL-C (mmol/L)		HDL-C (mmol/L)		non-HDL-C (mmol/L)		non-HDL-C/ HDL-C	NHR
对照组	71.15±15.38		5.45(4.69, 5.73)		3.22(2.83, 4.02)		1.81(0.97, 2.34)		4.60±0.89		2.82±0.88		1.42±0.33		3.18±0.86		2.38±0.89	2.37(1.85, 3.20)
冠状动脉病变组	67.77±13.79		5.86(5.15, 6.99)		3.55(2.77, 4.39)		1.33(1.04, 1.79)		4.82±1.10		2.98±0.86		1.31±0.31		3.52±0.98		2.80±0.88	2.70(2.05, 3.82)
统计值	t=1.655		Z=-6.453		Z=-3.255		Z=-0.099		t=-1.47		t=-1.361		t=2.501		t=-2.437		t=-3.293	Z=-6.328
P值	0.099		<0.01		0.001		0.921		0.143		0.175		0.013		0.015		0.001	<0.01

组别	例数	年龄 (岁)		男性 [例(%)]		BMI (kg/m²)		吸烟史 [例(%)]		饮酒史 [例(%)]		高血压 [例(%)]		糖尿病 [例(%)]		收缩压 (mmHg)			舒张压 (mmHg)
对照组	61	56.18±10.45		31(50.8)		25.45±2.52		15(24.6)		12(19.7)		29(47.5)		5(8.2)		133.82±15.45			80.33±10.04
冠状动脉病变组	223	61.91±9.08		111(49.8)		25.68±3.52		62(27.8)		46(20.6)		125(56.1)		52(23.3)		137.92±18.35			82.49±12.10
统计值		t=-3.293		χ²=0.021		χ²=-0.588		χ²=0.250		χ²=0.027		χ²=1.398		χ²=6.827		t=-1.760			t=-1.279
P值		0.001		0.885		0.557		0.617		0.870		0.237		0.009		0.081			0.202
组别	肌酐 (μmol/L)		血糖 (mmol/L)		NEU计数 (×10⁹/L)		TG (mmol/L)		TC (mmol/L)		LDL-C (mmol/L)		HDL-C (mmol/L)		non-HDL-C (mmol/L)		non-HDL-C/ HDL-C	NHR
对照组	71.15±15.38		5.45(4.69, 5.73)		3.22(2.83, 4.02)		1.81(0.97, 2.34)		4.60±0.89		2.82±0.88		1.42±0.33		3.18±0.86		2.38±0.89	2.37(1.85, 3.20)
冠状动脉病变组	67.77±13.79		5.86(5.15, 6.99)		3.55(2.77, 4.39)		1.33(1.04, 1.79)		4.82±1.10		2.98±0.86		1.31±0.31		3.52±0.98		2.80±0.88	2.70(2.05, 3.82)
统计值	t=1.655		Z=-6.453		Z=-3.255		Z=-0.099		t=-1.47		t=-1.361		t=2.501		t=-2.437		t=-3.293	Z=-6.328
P值	0.099		<0.01		0.001		0.921		0.143		0.175		0.013		0.015		0.001	<0.01

组别	例数	NEU计数 (×10⁹/L)	血糖 (mmol/L)	肌酐 (μmol/L)	LDL-C (mmol/L)	HDL-C (mmol/L)	non-HDL-C (mmol/L)	non-HDL-C/ HDL-C	NHR
低分值亚组	159	3.19(2.65, 4.15)	5.67(5.10, 6.66)	66.26±13.77	2.96±0.81	1.36±0.31	3.48±0.94	2.67±0.88	2.39(1.91, 3.35)
高分值亚组	64	4.01(3.40, 5.13)	6.62(5.59, 8.69)	71.50±13.19	3.05±0.96	1.17±0.26	3.59±1.10	3.12±0.81	3.45(2.80, 5.35)
统计值		Z=-4.454	Z=-4.035	t=-2.598	t=-0.681	t=4.33	t=-0.749	t=-3.517	Z=-5.514
P值		<0.01	<0.01	0.010	0.496	<0.01	0.454	0.001	<0.01

组别	例数	NEU计数 (×10⁹/L)	血糖 (mmol/L)	肌酐 (μmol/L)	LDL-C (mmol/L)	HDL-C (mmol/L)	non-HDL-C (mmol/L)	non-HDL-C/ HDL-C	NHR
低分值亚组	159	3.19(2.65, 4.15)	5.67(5.10, 6.66)	66.26±13.77	2.96±0.81	1.36±0.31	3.48±0.94	2.67±0.88	2.39(1.91, 3.35)
高分值亚组	64	4.01(3.40, 5.13)	6.62(5.59, 8.69)	71.50±13.19	3.05±0.96	1.17±0.26	3.59±1.10	3.12±0.81	3.45(2.80, 5.35)
统计值		Z=-4.454	Z=-4.035	t=-2.598	t=-0.681	t=4.33	t=-0.749	t=-3.517	Z=-5.514
P值		<0.01	<0.01	0.010	0.496	<0.01	0.454	0.001	<0.01

自变量	r_s值	P值
NHR	0.404	<0.01
non-HDL-C/HDL-C	0.334	<0.01