中国患者中脂蛋白（a）与中性粒细胞与淋巴细胞比值联合检测与动脉粥样硬化性心血管疾病的关系
The Association of Lipoprotein(a) and Neutrophil-to-Lymphocyte Ratio Combination with Atherosclerotic Cardiovascular Disease in Chinese Patients.
作者信息
Wang Xiaoyu, Chen Xiaoli, Wang Yanfang, Peng Sheng, Pi Jingjiang, Yue Jinnan, Meng Qingshu, Liu Jie, Zheng Liang, Chan Paul, Tomlinson Brian, Liu Zhongmin, Zhang Yuzhen
机构信息
Key Laboratory of Arrhythmias of the Ministry of Education of China, Shanghai Heart Failure Research Center, Research Center for Translational Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, People's Republic of China.
Department of Trauma, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200120, People's Republic of China.
出版信息
Int J Gen Med. 2023 Jul 3;16:2805-2817. doi: 10.2147/IJGM.S410840. eCollection 2023.
OBJECTIVE
The association of lipoprotein(a) [Lp(a)] with atherosclerotic cardiovascular disease (ASCVD) risk can be modified by chronic systemic inflammation. The neutrophil-to-lymphocyte ratio (NLR) is a reliable and easily available marker of immune response to various infectious and non-infectious stimuli. The purpose of this study was to assess the combined effects of Lp(a) and NLR in predicting the ASCVD risk and coronary artery plaque traits.
METHODS
This study included 1618 patients who had coronary computed tomography angiography (CTA) with risk assessment of ASCVD. CTA was used to evaluate the traits of coronary atherosclerotic plaques, and the association of ASCVD with Lp(a) and NLR was assessed by multivariate logistic regression models.
RESULTS
Plasma Lp(a) and NLR were significantly increased in patients having plaques. High Lp(a) was defined as the plasma Lp(a) level > 75 nmol/L and high NLR as NLR > 1.686. The patients were grouped into four categories according to normal or high NLR and plasma Lp(a) as nLp(a)/NLR-, hLp(a)/NLR-, nLp(a)/NLR+ and hLp(a)/NLR+. The patients in the latter three groups had higher risk of ASCVD compared to the reference group nLp(a)/NLR-, with the highest ASCVD risk in the hLp(a)/NLR+ group (OR = 2.39, 95% CI = 1.49-3.83, = 0.000). The occurrence of unstable plaques was 29.94% in the hLp(a)/NLR+ group, which was significantly higher than groups nLp(a)/NLR+, hLp(a)/NLR- and nLp(a)/NLR- with 20.83%, 26.54% and 22.58%, respectively, and there was a significantly increased risk of unstable plaque in the hLp(a)/NLR+ group compared to the nLp(a)/NLR- group (OR = 1.67, 95% CI = 1.04-2.68, = 0.035). The risk of stable plaque was not significantly increased in the hLp(a)/NLR+ group compared to the nLp(a)/NLR- group (OR = 1.73, 95% CI = 0.96-3.10, = 0.066).
CONCLUSION
The concomitant presence of elevated Lp(a) and higher NLR is associated with increased unstable coronary artery plaques in patients with ASCVD.
目的
脂蛋白(a)[Lp(a)]与动脉粥样硬化性心血管疾病(ASCVD)风险的关联可因慢性全身炎症而改变。中性粒细胞与淋巴细胞比值(NLR)是对各种感染性和非感染性刺激免疫反应的可靠且易于获得的标志物。本研究的目的是评估Lp(a)和NLR联合对预测ASCVD风险及冠状动脉斑块特征的作用。
方法
本研究纳入1618例行冠状动脉计算机断层扫描血管造影(CTA)并进行ASCVD风险评估的患者。采用CTA评估冠状动脉粥样硬化斑块特征，通过多因素逻辑回归模型评估ASCVD与Lp(a)和NLR的关联。
结果
有斑块的患者血浆Lp(a)和NLR显著升高。高Lp(a)定义为血浆Lp(a)水平>75 nmol/L，高NLR定义为NLR>1.686。根据NLR和血浆Lp(a)正常或升高将患者分为四类：nLp(a)/NLR-、hLp(a)/NLR-、nLp(a)/NLR+和hLp(a)/NLR+。与参照组nLp(a)/NLR-相比，后三组患者发生ASCVD的风险更高，其中hLp(a)/NLR+组ASCVD风险最高(OR = 2.39，95%CI = 1.49 - 3.83，P = 0.000)。hLp(a)/NLR+组不稳定斑块发生率为29.94%，显著高于nLp(a)/NLR+组(20.83%)、hLp(a)/NLR-组(26.54%)和nLp(a)/NLR-组(22.58%)，且hLp(a)/NLR+组与nLp(a)/NLR-组相比，不稳定斑块风险显著增加(OR = 1.67，95%CI = 1.04 - 2.68，P = 0.035)。与nLp(a)/NLR-组相比，hLp(a)/NLR+组稳定斑块风险未显著增加(OR = 1.73，95%CI = 0.96 - 3.10，P = 0.066)。
结论
ASCVD患者中Lp(a)升高与较高NLR同时存在，与冠状动脉不稳定斑块增加有关。
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