Zang Shu-Wen, Long Jun-Jie, Wang Yong
Department of Emergency Medicine, Shenzhen Luohu Hospital Group Luohu People's Hospital (The Third Affiliated Hospital of Shenzhen University), Shenzhen, People's Republic of China.
Department of Cardiology, Shenzhen Luohu Hospital Group Luohu People's Hospital (The Third Affiliated Hospital of Shenzhen University), Shenzhen, People's Republic of China.
Int J Gen Med. 2024 Aug 14;17:3511-3519. doi: 10.2147/IJGM.S477431. eCollection 2024.
Accumulating evidences suggest that low-grade inflammatory response plays a key role in the pathophysiology of coronary slow flow phenomenon (CSFP). As a new hematological inflammatory indicator, the neutrophil percentage to albumin ratio (NPAR) and its role in the occurrence and development of CSFP remains unclear. In this study, we aimed to investigate the predictive value of NPAR in the presence of CSFP in patients with myocardial ischemia and no obstructive coronary arteries (INOCA).
In total, 1323 individuals with INOCA were included in this study. 85 patients developed CSFP were included in the CSFP group. 1:2 age-and sex-matched patients were selected from the absence of CSFP, with normal blood flow, as the control group. Clinical characteristics, laboratory parameters, and angiographic findings were compared between groups. NPAR was also calculated to explore its relationship with CSFP.
NPAR was significantly higher in the CSFP patients than in the controls (19.3±2.5 vs 16.7±1.8, p<0.001). The NPAR increased with the number of coronary arteries involved in CSFP. Multivariate logistic regression analysis showed that an elevated NPAR level was an independent predictor of CSFP (OR 1.915, 95% CI 1.612-2.275, P < 0.001). The ROC curve showed that when NPAR was > 17.39, the sensitivity and specificity were 90.6% and 78.8%, respectively, and the area under the ROC curve (AUC) was 0.860 (95% CI: 0.811-0.909, P < 0.001). The AUC of neutrophil percentage was 0.845 (95% CI: 0.794-0.897, p < 0.001), and that of albumin was 0.808 (95% CI: 0.753-0.864, p < 0.001).
Elevated NPAR levels are an independent predictor of CSFP in patients with INOCA. NPAR could improve the predictive value of CSFP compared with neutrophil percentage or albumin ratio alone.
越来越多的证据表明，低度炎症反应在冠状动脉慢血流现象（CSFP）的病理生理学中起关键作用。作为一种新的血液学炎症指标，中性粒细胞与白蛋白比值（NPAR）及其在CSFP发生发展中的作用尚不清楚。在本研究中，我们旨在探讨NPAR对无阻塞性冠状动脉的心肌缺血患者（INOCA）出现CSFP的预测价值。
本研究共纳入1323例INOCA患者。85例发生CSFP的患者纳入CSFP组。从无CSFP、血流正常的患者中按年龄和性别1:2匹配选择作为对照组。比较两组间的临床特征、实验室参数和血管造影结果。还计算了NPAR以探讨其与CSFP的关系。
CSFP患者的NPAR显著高于对照组（19.3±2.5 vs 16.7±1.8，p<0.001）。NPAR随着CSFP累及冠状动脉的数量增加而升高。多因素逻辑回归分析显示，NPAR水平升高是CSFP的独立预测因素（OR 1.915，95%CI 1.612 - 2.275，P < 0.001）。ROC曲线显示，当NPAR>17.39时，敏感性和特异性分别为90.6%和78.8%，ROC曲线下面积（AUC）为0.860（95%CI：0.811 - 0.909，P < 0.001）。中性粒细胞百分比的AUC为0.845（95%CI：0.794 - 0.897，p < 0.001），白蛋白的AUC为0.808（95%CI：0.753 - 0.864，p < 0.001）。
NPAR水平升高是INOCA患者CSFP的独立预测因素。与单独的中性粒细胞百分比或白蛋白比值相比，NPAR可提高CSFP的预测价值。
