National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Boston, MA, USA.
J Cardiovasc Comput Tomogr. 2021 Jul-Aug;15(4):372-379. doi: 10.1016/j.jcct.2020.12.006. Epub 2020 Dec 28.
Inflammation in the form of elevated high-sensitivity c-reactive protein (hs-CRP) has been shown to be critical in the development of atherothrombosis. Psoriasis, a chronic inflammatory skin disease, is associated with high systemic-inflammation, elevated neutrophil-to-lymphocyte ratio (NLR) and accelerated non-calcified coronary artery burden (NCB) by coronary computed tomography angiography (CCTA). We hypothesized that NLR would associate with early, rupture-prone atherosclerosis assessed as NCB independent of hs-CRP.
316 consecutive psoriasis participants were recruited with 233 having one-year follow-up as part of a prospective, observational cohort study design. CCTA scans were performed to assess NCB in all three major epicardial coronary arteries.
Patients with above average NLR (>mean: 2.29 ± 1.21) were older (mean ± SD; 52.0 ± 12.8 vs. 47.9 ± 12.6, p = 0.002), had higher hs-CRP (med. IQR: 2.3 (0.9-7.3) vs. 1.4 (0.7-3.2), p = 0.001) and had higher NCB (mean ± SD; 1.21 ± 0.58 vs. 1.13 ± 0.49, p = 0.018) when compared to patients with below average NLR. NLR associated with psoriasis area severity index score (β = 0.14, p = 0.017), hs-CRP (β = 0.16, p = 0.005), as well as NCB independent of traditional risk factors, body mass index, statin use and hs-CRP (β = 0.08, p = 0.009). One year of biologic therapy for psoriasis was associated with a reduction in NLR (-14.5%, p < 0.001), and this change in NLR associated with change in NCB in fully adjusted models and beyond hs-CRP (β = 0.17, p = 0.002).
NLR associated with psoriasis severity, hs-CRP and NCB at baseline. Biologic therapy reduced NLR over time and this change in NLR associated with the change in NCB at one-year. Taken together, these findings suggest that NLR may capture psoriasis patients at higher risk of NCB due to residual inflammation not fully captured by hs-CRP.
已证实，以高敏 C 反应蛋白（hs-CRP）升高为表现的炎症在动脉粥样硬化血栓形成的发展中起着关键作用。银屑病是一种慢性炎症性皮肤病，通过冠状动脉计算机断层扫描血管造影（CCTA）检查发现，银屑病患者全身炎症水平较高，中性粒细胞与淋巴细胞比值（NLR）升高，非钙化性冠状动脉负担（NCB）加快。我们假设，NLR 与 hs-CRP 无关，可用于评估早期易破裂的动脉粥样硬化。
316 名连续的银屑病患者参与了前瞻性观察队列研究，其中 233 名患者进行了为期一年的随访。对所有三支主要心外膜冠状动脉进行 CCTA 扫描以评估 NCB。
NLR 高于平均值（>平均值：2.29±1.21）的患者年龄较大（平均±标准差；52.0±12.8 岁比 47.9±12.6 岁，p=0.002），hs-CRP 水平较高（中位数 IQR：2.3（0.9-7.3）比 1.4（0.7-3.2），p=0.001），NCB 较高（平均±标准差；1.21±0.58 比 1.13±0.49，p=0.018）。与 NLR 平均值以下的患者相比，NLR 与银屑病面积严重指数评分（β=0.14，p=0.017）、hs-CRP（β=0.16，p=0.005）以及传统危险因素、体重指数、他汀类药物使用和 hs-CRP 以外的 NCB 相关。银屑病患者一年的生物治疗与 NLR 降低（-14.5%，p<0.001）有关，在充分调整的模型中以及在 hs-CRP 以外，NLR 的这种变化与 NCB 的变化相关（β=0.17，p=0.002）。
NLR 与基线时银屑病的严重程度、hs-CRP 和 NCB 相关。生物治疗随时间推移降低了 NLR，这种 NLR 的变化与一年时 NCB 的变化相关。综上所述，这些发现表明，NLR 可能反映了银屑病患者因 hs-CRP 无法充分捕捉到的残留炎症而导致的 NCB 风险较高。
