三种数据对冠心病患者冠状动脉病变严重程度的诊断价值

张文婧; 刘超; 史菲; 秦巍; 丁振江; 侯瑞田; 单伟超

doi:10.12125/j.chj.202105114

三种数据对冠心病患者冠状动脉病变严重程度的诊断价值

Diagnostic value of serum NPAR, MHR, CK-MB for severity of coronary artery lesions in patients with coronary heart disease

摘要

摘要:
目的探讨血清中性粒细胞百分比与白蛋白比值（NPAR）、中性粒细胞数与高密度脂蛋白胆固醇比值（MHR）、肌酸激酶同工酶MB（CK-MB）对冠心病患者冠状动脉病变严重程度的诊断价值。
方法连续纳入2016 年1 月～2018 年12月承德医学院附属医院心内科收治的3937例冠心病患者作为研究对象，对冠脉造影结果进行Gensini评分，将 Gensini 评分<14分的患者作为轻症组(n=1339)，Gensini评分≥14分患者作为重症组(n=2598)。收集所有患者的临床资料,记录CK-MB、NPAR、MHR。建立二元Logistic回归模型和受试者工作特征(ROC)曲线，分析单项指标以及联合检测对冠状动脉病变严重程度的预测价值。
结果冠脉病变重症组患者血清NPAR、MHR和CK-MB水平显著高于轻症组(P<0.01)。二元Logistic回归结果示，血清NPAR、MHR和CK-MB是影响冠状动脉病变程度与评估冠脉严重程度的危险因素 (P<0.05)。上述得出，预测模型为 P =1 /［1 + e^{－(−0.522+0.11×NPAR +0.54×MHR + 0.06×CK-MB)}］。ROC曲线显示血清NPAR、MHR及CK-MB的曲线下面积分别为0.775、0.618和0.615，而三者联合检测的预测概率为0.80，显著高于单个指标。
结论冠心病患者血清NPAR、MHR、CK-MB与患者冠状动脉病变严重程度密切相关，上述指标联合应用，可以非常显著的提高对冠心病患者病情严重程度的预测价值。

Abstract:
AIM To explore the diagnostic value of serum neutrophil percentage to albumin ratio (NPAR), neutrophil number to high-density lipoprotein cholesterol ratio (MHR) and creatine kinase-MB (CK-MB) for the severity of coronary artery lesions in patients with coronary heart disease.
METHODS The study subjects were 3937 patients with coronary heart disease who were continuously enrolled in the Department of Cardiology, Affiliated Hospital of Chengde Medical College from January 2016 to December 2018. The Gensini scores were calculated according to coronary angiography results and the patients with Gensini scores <14 were assigned to mild group (1339 cases) and those with Gensini score ≥14 were assigned to severe group (2598 cases). The patients’ clinical data were collected and CK-MB, NPAR and MHR were obtained. A binary logistic regression model was established and the predictive value of single index and combined indexes for the severity of coronary artery lesions was analyzed.
RESULTS The levels of serum NPAR, MHR and CK-MB in the severe coronary artery disease group were significantly higher than those in the mild group. The results of binary logistic regression showed that serum NPAR, MHR and CK-MB were the risk factors that affected the degree of coronary artery disease and could be used to assess the severity of coronary artery. P<0.05 was set as statistic significance and the prediction model was P=1/1+e⁻^{(−0.522+0.11×NPAR+0.54×MHR+0.06×CK-MB)}. The ROC curve showed that the area under the curve of serum NPAR, MHR and CK-MB were respectively 0.775, 0.618 and 0.615, and the predicted probability of combined detection of the three indexes was 0.80, which was significantly higher than that of one single index.
CONCLUSION Serum NPAR, MHR and CK-MB in patients with coronary heart disease are closely related to the severity of coronary artery lesions. The combined detection of the three indexes significantly enhances the predictive value for the severity of coronary artery lesions in patients with coronary heart disease.

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