Verdoia M, Schaffer A, Barbieri L, Aimaretti G, Marino P, Sinigaglia F, Suryapranata H, De Luca G
Department of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy.
Division of Diabetology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy.
Diabetes Metab. 2015 Sep;41(4):304-311. doi: 10.1016/j.diabet.2015.01.001. Epub 2015 Feb 2.
Coronary artery disease (CAD) is the leading cause of mortality among diabetic patients, and the neutrophil-to-lymphocyte ratio (NLR) has recently emerged from among inflammatory parameters as a potential indicator of vascular complications and poorer outcome in patients with diabetes. This study aimed to evaluate: 1) the impact of diabetes on NLR; and 2) the role of NLR on the extent of CAD among diabetic patients undergoing coronary angiography.
Consecutive patients undergoing coronary angiography were included. Diabetic status and main chemistry parameters were assessed at the time of admission. Significant CAD was defined as at least one vessel with stenosis>50%, while severe CAD was left main and/or three-vessel disease, as evaluated by quantitative coronary angiography (QCA).
Diabetes was observed in 1377 of 3756 patients (36.7%); they were older, and displayed higher-risk cardiovascular profile and more complex CAD. Diabetic status was also associated with a significant increase in NLR (P=0.004). Among diabetics, higher NLR tertile values were related to ageing (P<0.001), dyslipidaemia (P<0.001), renal failure (P<0.001), body mass index (P<0.001), previous percutaneous coronary revascularization (P=0.004) and cerebrovascular events (P=0.003), acute presentation (P<0.001), treatment at admission with beta-blockers/statins/ASA (all P<0.001), diuretics (P=0.01) or clopidogrel (P=0.04), platelet count (P=0.03), white blood cell count, creatinine, glycaemia and C-reactive protein (P<0.001), and inversely related to haemoglobin, triglyceride levels (P<0.001) and smoking (P=0.03). NLR was associated with multivessel disease (P<0.001), degree of stenosis (P=0.01), type C lesions (P=0.02), coronary calcifications and intracoronary thrombus (P<0.001), but inversely with in-stent restenosis (P=0.003) and TIMI flow grade (P=0.02). Also, NLR was directly related to CAD prevalence (P<0.001; adjusted OR [95% CI]: 1.62 [1.27-2.07], P<0.001) and CAD severity (P<0.001; adjusted OR [95% CI]: 1.19 [1.00-1.43], P=0.05).
NLR is increased among diabetic patients and, in such patients, is independently associated with the prevalence and severity of CAD. Further studies are now needed to confirm present results and to evaluate the underlying pathophysiological mechanisms behind our findings.
冠状动脉疾病（CAD）是糖尿病患者死亡的主要原因，中性粒细胞与淋巴细胞比值（NLR）最近在炎症参数中成为糖尿病患者血管并发症和不良预后的潜在指标。本研究旨在评估：1）糖尿病对NLR的影响；2）NLR在接受冠状动脉造影的糖尿病患者中对CAD程度的作用。
纳入连续接受冠状动脉造影的患者。入院时评估糖尿病状态和主要化学参数。通过定量冠状动脉造影（QCA）评估，显著CAD定义为至少一支血管狭窄>50%，而严重CAD为左主干和/或三支血管病变。
3756例患者中有1377例（36.7%）患有糖尿病；他们年龄更大，具有更高风险的心血管特征和更复杂的CAD。糖尿病状态也与NLR显著升高相关（P=0.004）。在糖尿病患者中，较高的NLR三分位数与年龄增长（P<0.001）、血脂异常（P<0.001）、肾衰竭（P<0.001）、体重指数（P<0.001）、既往经皮冠状动脉血运重建术（P=0.004）和脑血管事件（P=0.003）、急性发作（P<0.001）、入院时使用β受体阻滞剂/他汀类药物/阿司匹林治疗（所有P<0.001）、利尿剂（P=0.01）或氯吡格雷（P=0.04）、血小板计数（P=0.03）、白细胞计数、肌酐、血糖和C反应蛋白（P<0.001）相关，与血红蛋白、甘油三酯水平（P<0.001）和吸烟（P=0.03）呈负相关。NLR与多支血管病变（P<0.001）、狭窄程度（P=0.01）、C型病变（P=0.02）、冠状动脉钙化和冠状动脉内血栓（P<0.001）相关，但与支架内再狭窄（P=0.003）和TIMI血流分级（P=0.02）呈负相关。此外，NLR与CAD患病率直接相关（P<0.001；调整后的OR[95%CI]：1.62[1.27 - 2.07]，P<0.001）和CAD严重程度直接相关（P<0.001；调整后的OR[95%CI]：1.19[1.00 - 1.43]，P=0.05）。
糖尿病患者的NLR升高，并且在这类患者中，NLR与CAD的患病率和严重程度独立相关。现在需要进一步研究来证实目前的结果，并评估我们研究结果背后的潜在病理生理机制。
