白细胞及其亚型与冠心病分型的相关性及其临床意义

丁琦; 王淑红; 黄新新; 张欢欢; 冯晔子

doi:10.13191/j.chj.2018.0165

白细胞及其亚型与冠心病分型的相关性及其临床意义

Correlation of white blood cells and its subtypes with different types of coronary heart disease and the clinical significance

摘要

摘要: 目的研究不同冠心病类型与白细胞总数、中性粒细胞及中性粒细胞与淋巴细胞比例（NLR）的相关性及其临床意义。方法入选行冠脉造影确诊冠心病的患者1 058例，分为急性冠脉综合征（ACS）组（n=774）和稳定型心绞痛组（SAP）组（n=284）。ACS组内又分为急性ST段抬高型心肌梗死（STEMI）亚组（n=362）、急性非ST段抬高型心肌梗死（NSTEMI）亚组（n=136）和不稳定型心绞痛（UAP）亚组（n=276）。比较ACS组和SAP组及ACS组内3个亚组的白细胞及其亚型（中性粒细胞、NLR）的差异，并分析其与肌钙蛋白（cTn） I峰值、冠状动脉病变范围的相关性，采用ROC曲线确定各白细胞指标诊断冠心病各临床类型的截断点（cut of value）并计算灵敏度和特异度。结果 ACS组的白细胞总数、中性粒细胞百分比、中性粒细胞绝对值、NLR均显著高于SAP组（P<0.05）。STEMI亚组白细胞相关4项指标均显著高于NSTEMI组及UAP组（P<0.05或P<0.01），NSTEMI组也均显著高于UAP组（P<0.05或P<0.01）；白细胞总数、中性粒细胞绝对值、NLR与cTnI峰值呈正相关（P<0.05），与冠状动脉的病变范围均无相关性；NLR诊断ACS与SAP的截断点为3.00（灵敏度55.9%，特异度85.0%），诊断STEMI与NSTEMI的截断点为4.90（灵敏度50.8%，特异度82.4%），诊断心肌梗死与UAP的截断点为4.81（灵敏度44.0%，特异度91.7%）。结论不同临床类型的冠心病患者白细胞及其亚型存在差异，其与肌钙蛋白峰值呈正相关性，与冠状动脉病变范围无关，能较准确地区分冠心病类型，尤其是NLR具有较高的特异性。

Abstract: AIM To explore the correlation of different types of coronary heart disease (CHD) with white blood cells, neutrophils, and neutrophil lymphocyte ratio (NLR), and to evaluate its clinical significance. METHODS A total of 1 058 CHD patients confirmed by coronary angiography were enrolled in the investigation. Patients were divided into an acute coronary syndrome (ACS) group (n=774) and a stable angina pectoris (SAP) group (n=284). The ACS patients were divided into 3 subgroups:an acute st-segment elevation myocardial infarction (STEMI) group (n=362), an acute non-st-segment elevation myocardial infarction (NSTEMI) group (n=136) and an unstable angina pectoris (UAP) group (n=276). The number of white blood cells and its subtypes (neutrophils and NLR) were compared between the ACS group and SAP group, and compared within 3 subgroups of the ACS (STEMI group, NSTEMI group and UAP group). The present investigaiton analyzed the correlation between peak of troponin, scope of narrow coronary artery and the related parameters of white blood cells, finally, calculated the cut of value to distinguish the subtypes of CHD using area under the ROC curve. RESULTS The total number of white blood cells, proportion of neutrophils, number of neutrophils and NLR in the ACS group were higher compared with the SAP group (P<0.05). These related parameters of white blood cells were higher in the STEMI group compared with the NSTEMI group and the UAP group (P<0.05 or P<0.01). The parameters in the NSTEMI group were higher than that of the UAP group (P<0.05 or P<0.01). The total number of white blood cells, number of neutrophils and NLR were positively correlated with peak of troponin (P<0.05); however, there was no correlation between these parameters and the scope of narrow coronary artery. The cut of value of NLR to distinguish ACS and SAP, STEMI and NSTEMI, MI and UAP were 3.00 (sensitivity 55.9%, specifity 85.0%), 4.90 (sensitivity 50.8%, specifity 82.4%), and 4.81(sensitivity 44.0%, specifity 91.7%), respectively. CONCLUSION The number of white blood cells and subtypes varied in different types of CHD. There was a positive correlation with peak of troponin. This correlation was not related to scope of narrow coronary artery and could be used to distinguish the subtypes of CHD accurately, especially the NLR.

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