不同糖代谢状态下NPAR对ACS患者发生CRS-1的应用价值

    Application value of NPAR in patients with ACS under different glucose metabolism states for CRS-1

      摘要
    • 摘要:
      目的 探讨在不同糖代谢状态下中性粒细胞百分比与白蛋白比值（NPAR）作为预测急性冠脉综合征（ACS）患者新发Ⅰ型心肾综合征(CRS-1)的应用价值。
      方法 通过回顾性分析2021年01月～2023年10月在武汉市第三医院心血管内科入院诊断急性冠脉综合征1351例患者临床资料，依据患者是否发生CRS-1将其分为非CRS-1组（n=1190例）和CRS-1组（n=161），并基于NPAR数值的高低将进一步分为三分位数组。利用二元Logistic回归分析NPAR对于CRS-1的预测作用，并通过受试者工作特征（ROC）曲线来评估其预测价值。使用二元Logistic回归分析判断不同糖代谢组的风险度，计算ROC的曲线下面积（AUC）和95%CI，以确定NPAR在不同糖代谢状态下检测ACS患者发生CRS-1的准确性。
      结果 与无CRS-1患者相比，CRS-1患者的淋巴细胞百分比、白蛋白均降低，差异具有统计学意义（均P<0.01）。糖化血红蛋白（P<0.05）、C-反应蛋白（P<0.01）、肌酐（P<0.01）、胱抑素-C（P<0.01）、NPAR（P<0.01）均升高，差异具有统计学意义。ACS患者发生CRS-1具有年龄更大（P<0.05），女性更常见（P<0.01），且饮酒史、高血压病史、FPG、中性粒细胞百分比、淋巴细胞百分比指标均更高（均P<0.01）。NPAR对本研究样本的患者CRS-1的发生具有预测价值，其OR值为2.271(1.476~3.496)，通过ROC曲线检验，其AUC值为0.691（95% CI： 0.650~0.731）。通过调整不同糖代谢状态下各组的混杂因素，其中DM组的OR值为6.132(3.081~12.204)是最高，以及其AUC值0.710（95% CI：0.655~0.765）最具有预测价值，且中性粒细胞百分比及白蛋白的ROC曲线下面积（AUC）均比NPAR的要更小。
      结论 NPAR对ACS患者发生CRS-1体现了一定的预测价值，进行不同糖代谢分析后，发现在DM组中NPAR体现了更加良好的预测价值。

       

      Abstract:
      AIM To explore the predictive value of the neutrophil-to-albumin ratio (NPAR) for the onset of type I cardiorenal syndrome (CRS-1) in patients with acute coronary syndrome (ACS) under different glucose metabolic conditions.
      METHODS A retrospective analysis was conducted of the clinical data from patients diagnosed with ACS admitted to the Cardiology Department of Wuhan Third Hospital from January 2018 to October 2023. The patients were divided into non-CRS-1 (1190 cases) and CRS-1 group (161 cases) based on the occurrence of CRS-1 and they were further categorized into three subgroups according to NPAR values. Binary logistic regression analysis was employed to investigate the predictive role of NPAR for CRS-1 and its predictive value was assessed using the receiver operating characteristic (ROC) curve. Binary logistic regression analysis was used to determine the risk levels across different glucose metabolism groups, calculating the area under the curve (AUC) of the ROC and the 95% CI to ascertain the accuracy of NPAR in detecting CRS-1 in ACS patients under varying glucose metabolic states.
      RESULTS Compared with patients without CRS-1, the percentage of lymphocytes and albumin in CRS-1 patients decreased, and the difference was statistically significant (both P<0.01). Glycated hemoglobin (P<0.05), C-reactive protein (P<0.01), creatinine (P<0.01), cystatin C (P<0.01), and NPAR (neutrophil percentage/albumin) all increased, and the differences were statistically significant. ACS patients with CRS-1 are older (P<0.05), more common in females (P<0.01), and have higher alcohol consumption history, hypertension history, FPG, neutrophil percentage, and lymphocyte percentage indicators (all P<0.01). NPAR has predictive value for the occurrence of CRS-1 in the patients in this study sample, with an OR value of 2.271 (1.476~3.496). Through ROC curve testing, its AUC value is 0.691 (95% CI: 0.650~0.731). By adjusting for confounding factors in different glucose metabolism states, the OR value of the DM group was 6.132 (3.081~12.204), which was the highest, and its AUC value of 0.710 (95% CI: 0.655~0.765) was the most predictive. In addition, the percentage of neutrophils and the area under the ROC curve (AUC) of albumin were smaller than those of NPAR.
      CONCLUSION NPAR demonstrates considerable predictive value for the onset of CRS-1 in ACS patients. Upon analyzing different glucose metabolic states, NPAR exhibits enhanced predictive value within the DM group.

       

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