Study on the correlation of NLR, PLR and MLR with type 2 diabetes mellitus complicated with coronary heart disease

doi:10.3969/j.issn.1004-583X.2023.11.006

Abstract

Abstract:

Objective To investigate the correlation of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and monocyte-lymphocyte ratio (MLR) with the severity of coronary artery disease in patients with type 2 diabetes mellitus (T2DM) complicated with coronary heart disease (CHD). Methods A total of 517 T2DM patients who underwent coronary angiography (CAG) in Weihai Central Hospital from January 2019 to December 2021 were divided into T2DM group ( $n$ =161) and T2DM + CHD group ( $n$ =356) according to the CAG findings of CHD or not. The general data and laboratory examination indexes of the two groups were compared. According to the results of CAG, Gensini scores were calculated. Patients in T2DM+CHD group were further divided into low-risk subgroup (Gensini score<16, $n$ =151), medium-risk subgroup (16≤Gensini score <40, $n$ =97) and high-risk subgroup (Gensini score≥40, $n$ =108). The general data and laboratory examination indexes of patients in each subgroup were compared. Spearman correlation analysis was used to evaluate the correlation of NLR, PLR and MLR with the Gensini scores. Logistic regression analysis was used to explore the risk factors for the severity of coronary artery disease in T2DM patients complicated with CHD. Results There were significant differences in sex constituent ratio, age, low density lipoprotein (LDL), LDL/high density lipoprotein (HDL), glycosylated hemoglobin (HbA₁c), urea nitrogen, creatinine, cystatin, NLR, PLR and MLR between T2DM group and T2DM+CHD group. The levels of age, cystatin, NLR, PLR and MLR in the high-risk subgroup were significantly higher in those of the low-risk and medium-risk subgroups ( $P$ <0.05). Spearman correlation analysis showed that NLR, PLR and MLR were positively correlated with the Gensini scores ( $r s$ =0.393, $P$ <0.01; $r s$ =0.322, $P$ <0.01; $r s$ =0.360, $P$ <0.01). Ordered multivariate logistic regression analysis showed that age, sex, diastolic blood pressure, body mass index, creatinine, NLR and PLR were independent factors for the severity of coronary artery disease in T2DM patients complicated with CHD ( $P$ <0.05). Conclusion NLR, PLR and MLR are positively correlated with the Gensini score of T2DM patients complicated with CHD. NLR and PLR can be used as independent predictors of the severity of coronary artery disease in them. Monitoring NLR and PLR is helpful to early identify the severity of coronary artery disease in T2DM patients complicated with CHD and prevent the occurrence of acute coronary syndrome.

Key words: diabetes mellitus, type 2, coronary heart disease, Gensini score, NLR, PLR, MLR

CLC Number:

R587.1

Shi Peihua, Lin Yanlin, Bi Lifang. Study on the correlation of NLR, PLR and MLR with type 2 diabetes mellitus complicated with coronary heart disease[J]. Clinical Focus, 2023, 38(11): 996-1001.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2023.11.006

https://huicui.hebmu.edu.cn/EN/Y2023/V38/I11/996

Figures/Tables 6

Tab. 1 Comparison of general data, biochemical indexes, NLR, PLR, MLR between the two groups

指标	单纯T2DM组( $n$ =161)	T2DM合并CHD组( $n$ =356)	χ²/ $Z$ / $t$ 值	$P$ 值
男性[例(%)]	49(21.2)	182(78.8)	18.760	<0.01
年龄(岁)	60.79±8.17	65.35±8.60	5.658	<0.01
SBP(mmHg)	142.67±18.74	145.52±22.03	1.511	0.132
DBP(mmHg)	82.31±11.67	83.67±12.52	1.165	0.245
BMI[kg/m²]	24.56(23.37, 26.57)	25.30(23.85, 26.67)	1.541	0.123
TC(mmol/L)	4.82±1.09	4.97±1.13	1.423	0.155
TG(mmol/L)	1.52(0.96, 2.31)	1.48(1.00, 2.17)	0.244	0.807
HDL-C(mmol/L)	1.15(0.98, 1.32)	1.13(0.92, 1.30)	1.448	0.148
LDL-C(mmol/L)	2.84(2.24, 3.38)	2.99(2.36, 3.70)	1.997	0.046
LDL-C/HDL-C	2.40(1.99, 3.10)	2.72(2.12, 3.45)	2.929	0.003
FBG(mmol/L)	7.46(5.81, 9.25)	7.00(5.83, 9.38)	0.787	0.431
HbA₁c(%)	6.80(6.30, 7.70)	7.30(6.60, 8.38)	3.618	<0.01
BUN(mmol/L)	5.90(5.00, 6.80)	6.20(5.13, 7.40)	2.185	0.029
Cr(μmol/L)	58.00(49.25, 65.00)	64.00(55.00, 77.00)	4.799	<0.01
UA(μmol/L)	328.00(274.25, 389.00)	331.00(284.00, 399.00)	1.082	0.279
CysC(mg/L)	0.88(0.80, 0.98)	0.94(0.86, 1.05)	4.236	<0.01
NLR	1.57(1.17, 1.93)	2.08(1.52, 2.77)	6.550	<0.01
PLR	101.94(84.15, 130.24)	114.34(92.46, 142.73)	3.571	<0.01
MLR	0.17(0.13, 0.21)	0.22(0.17, 0.28)	6.711	<0.01

Tab. 1 Comparison of general data, biochemical indexes, NLR, PLR, MLR between the two groups

指标	单纯T2DM组( $n$ =161)	T2DM合并CHD组( $n$ =356)	χ²/ $Z$ / $t$ 值	$P$ 值
男性[例(%)]	49(21.2)	182(78.8)	18.760	<0.01
年龄(岁)	60.79±8.17	65.35±8.60	5.658	<0.01
SBP(mmHg)	142.67±18.74	145.52±22.03	1.511	0.132
DBP(mmHg)	82.31±11.67	83.67±12.52	1.165	0.245
BMI[kg/m²]	24.56(23.37, 26.57)	25.30(23.85, 26.67)	1.541	0.123
TC(mmol/L)	4.82±1.09	4.97±1.13	1.423	0.155
TG(mmol/L)	1.52(0.96, 2.31)	1.48(1.00, 2.17)	0.244	0.807
HDL-C(mmol/L)	1.15(0.98, 1.32)	1.13(0.92, 1.30)	1.448	0.148
LDL-C(mmol/L)	2.84(2.24, 3.38)	2.99(2.36, 3.70)	1.997	0.046
LDL-C/HDL-C	2.40(1.99, 3.10)	2.72(2.12, 3.45)	2.929	0.003
FBG(mmol/L)	7.46(5.81, 9.25)	7.00(5.83, 9.38)	0.787	0.431
HbA₁c(%)	6.80(6.30, 7.70)	7.30(6.60, 8.38)	3.618	<0.01
BUN(mmol/L)	5.90(5.00, 6.80)	6.20(5.13, 7.40)	2.185	0.029
Cr(μmol/L)	58.00(49.25, 65.00)	64.00(55.00, 77.00)	4.799	<0.01
UA(μmol/L)	328.00(274.25, 389.00)	331.00(284.00, 399.00)	1.082	0.279
CysC(mg/L)	0.88(0.80, 0.98)	0.94(0.86, 1.05)	4.236	<0.01
NLR	1.57(1.17, 1.93)	2.08(1.52, 2.77)	6.550	<0.01
PLR	101.94(84.15, 130.24)	114.34(92.46, 142.73)	3.571	<0.01
MLR	0.17(0.13, 0.21)	0.22(0.17, 0.28)	6.711	<0.01

Tab. 2 Comparison of general data, biochemical indexes, NLR, PLR, MLR between groups

指标	低危亚组( $n$ =151)	中危亚组( $n$ =97)	高危亚组( $n$ =108)
男性[例(%)]	63(41.7)	51(52.6)	68(63.0)^*
年龄(岁)	65(61.00, 69.00)	65(60.00, 69.50)	68(61.00, 75.00)^*#
SBP(mmHg)	146.93±18.94	147.94±24.97	141.42±22.83
DBP(mmHg)	85.17±12.38	84.91±13.53	80.49±11.23^*#
BMI(kg/m²)	25.03±2.74	25.27±1.72	25.76±1.96^*
TC(mmol/L)	4.69(3.88,, 5.60)	4.86(4.32, 5.64)	5.03(4.47, 5.82)^*
TG(mmol/L)	1.61(1.02, 2.22)	1.48(1.07, 2.25)	1.43(1.00, 2.02)
HDL-C(mmol/L)	1.11(0.91, 1.29)	1.14(0.98, 1.29)	1.14(0.90, 1.34)
LDL-C(mmol/L)	2.77(2.08, 3.58)	2.96(2.44, 3.71)	3.19(2.63, 3.80)^*
LDL-C/HDL-C	2.56(2.01, 3.38)	2.64(2.06, 3.45)	2.88(2.32, 3.76)^*
FBG(mmol/L)	7.08(5.97, 9.23)	6.46(5.54, 8.14)	7.50(5.70, 10.16)^#
HbA₁c(%)	7.30(6.70, 8.00)	7.30(6.45, 8.50)	7.40(6.53, 8.50)
BUN(mmol/L)	5.90(5.05, 7.10)	6.30(5.00, 7.35)	6.60(5.30, 8.10)
Cr(μmol/L)	59.00(51.00, 68.00)	67.00(58.00, 79.00)^*	69.00(57.00, 86.00)^*
UA(μmol/L)	316.50(275.00, 376.00)	335.00(300.50, 398.50)	349.00(297.50, 414.00)^*
CysC(mg/L)	0.89(0.81, 1.01)	0.94(0.86, 1.04)	0.99(0.93, 1.14)^*#
NLR	1.73(1.34, 2.38)	1.81(1.48, 2.72)	2.70(2.12, 3.72)^*#
PLR	103.21(83.14, 124.78)	111.22(88.52, 144.68)	136.14(109.18, 168.27)^*#
MLR	0.19(0.14, 0.24)	0.20(0.16, 0.29)	0.27(0.22, 0.34)^*#

Tab. 2 Comparison of general data, biochemical indexes, NLR, PLR, MLR between groups

指标	低危亚组( $n$ =151)	中危亚组( $n$ =97)	高危亚组( $n$ =108)
男性[例(%)]	63(41.7)	51(52.6)	68(63.0)^*
年龄(岁)	65(61.00, 69.00)	65(60.00, 69.50)	68(61.00, 75.00)^*#
SBP(mmHg)	146.93±18.94	147.94±24.97	141.42±22.83
DBP(mmHg)	85.17±12.38	84.91±13.53	80.49±11.23^*#
BMI(kg/m²)	25.03±2.74	25.27±1.72	25.76±1.96^*
TC(mmol/L)	4.69(3.88,, 5.60)	4.86(4.32, 5.64)	5.03(4.47, 5.82)^*
TG(mmol/L)	1.61(1.02, 2.22)	1.48(1.07, 2.25)	1.43(1.00, 2.02)
HDL-C(mmol/L)	1.11(0.91, 1.29)	1.14(0.98, 1.29)	1.14(0.90, 1.34)
LDL-C(mmol/L)	2.77(2.08, 3.58)	2.96(2.44, 3.71)	3.19(2.63, 3.80)^*
LDL-C/HDL-C	2.56(2.01, 3.38)	2.64(2.06, 3.45)	2.88(2.32, 3.76)^*
FBG(mmol/L)	7.08(5.97, 9.23)	6.46(5.54, 8.14)	7.50(5.70, 10.16)^#
HbA₁c(%)	7.30(6.70, 8.00)	7.30(6.45, 8.50)	7.40(6.53, 8.50)
BUN(mmol/L)	5.90(5.05, 7.10)	6.30(5.00, 7.35)	6.60(5.30, 8.10)
Cr(μmol/L)	59.00(51.00, 68.00)	67.00(58.00, 79.00)^*	69.00(57.00, 86.00)^*
UA(μmol/L)	316.50(275.00, 376.00)	335.00(300.50, 398.50)	349.00(297.50, 414.00)^*
CysC(mg/L)	0.89(0.81, 1.01)	0.94(0.86, 1.04)	0.99(0.93, 1.14)^*#
NLR	1.73(1.34, 2.38)	1.81(1.48, 2.72)	2.70(2.12, 3.72)^*#
PLR	103.21(83.14, 124.78)	111.22(88.52, 144.68)	136.14(109.18, 168.27)^*#
MLR	0.19(0.14, 0.24)	0.20(0.16, 0.29)	0.27(0.22, 0.34)^*#

Fig. 1 Scatter plot of correlation between NLR and Gensini scores in patients with T2DM complicated with CHD

Fig. 2 Scatter plot of correlation between PLR and Gensini scores in patients with T2DM complicated with CHD

Fig. 3 Scatter plot of correlation between MLR and Gensini scores in patients with T2DM complicated with CHD

Tab. 3 Ordered Logistic regression analysis of factors affecting the severity of coronary artery disease in patients with T2DM complicated with CHD

变量	B值	SE	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
变量	B值	SE	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
性别	0.780	0.260	9.019	0.003	2.181	1.311	3.629
年龄	0.033	0.014	5.963	0.015	1.034	1.007	1.062
DBP	-0.023	0.009	6.768	0.009	0.977	0.961	0.994
BMI	0.133	0.049	7.402	0.007	1.142	1.038	1.257
TC	0.223	0.331	0.454	0.501	1.250	0.653	2.392
LDL-C	0.194	0.426	0.207	0.650	1.214	0.526	2.798
LDL-C/HDL-C	-0.096	0.163	0.345	0.557	0.909	0.660	1.251
UA	-0.001	0.001	0.170	0.680	0.999	0.997	1.002
Cr	0.017	0.006	7.037	0.008	1.017	1.004	1.029
NLR	0.286	0.136	4.402	0.036	1.331	1.019	1.739
PLR	0.013	0.004	12.057	0.001	1.013	1.006	1.020
MLR	-0.809	1.527	0.265	0.001	0.445	0.020	9.705

Tab. 3 Ordered Logistic regression analysis of factors affecting the severity of coronary artery disease in patients with T2DM complicated with CHD

变量	B值	SE	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
变量	B值	SE	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
性别	0.780	0.260	9.019	0.003	2.181	1.311	3.629
年龄	0.033	0.014	5.963	0.015	1.034	1.007	1.062
DBP	-0.023	0.009	6.768	0.009	0.977	0.961	0.994
BMI	0.133	0.049	7.402	0.007	1.142	1.038	1.257
TC	0.223	0.331	0.454	0.501	1.250	0.653	2.392
LDL-C	0.194	0.426	0.207	0.650	1.214	0.526	2.798
LDL-C/HDL-C	-0.096	0.163	0.345	0.557	0.909	0.660	1.251
UA	-0.001	0.001	0.170	0.680	0.999	0.997	1.002
Cr	0.017	0.006	7.037	0.008	1.017	1.004	1.029
NLR	0.286	0.136	4.402	0.036	1.331	1.019	1.739
PLR	0.013	0.004	12.057	0.001	1.013	1.006	1.020
MLR	-0.809	1.527	0.265	0.001	0.445	0.020	9.705

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