Shu Hongyun, Han Sisi, Zhao Feng, Xie Zhihai, Qiu Weiping, Zhang Zubing, Li Qiaowen, Zhao Guojun
Department of Cardiovascular Medicine, Guangzhou Geriatric Hospital, Guangzhou Medical University, Guangzhou, China.
Department of Cardiovascular Medicine, Affiliated Qingyuan Hospital, Qingyuan People's Hospital, Guangzhou Medical University, Guangdong, China.
BMC Cardiovasc Disord. 2025 Aug 29;25(1):642. doi: 10.1186/s12872-025-05111-x.
Inflammation plays a crucial role in promoting coronary artery disease (CAD). The Neutrophil-to-Lymphocyte Ratio (NLR) is a novel comprehensive indicator reflecting systemic inflammation, with previous studies indicating its association with cardiovascular events and mortality. However, the correlation between NLR and the severity of new-onset CAD at different glucose metabolism has not been explored. This study aims to determine the relationship between NLR and the new-onset of CAD and severity of coronary artery lesions in patients with varying levels of glucose metabolism.
In this retrospective study, 1689 patients with acute coronary syndromes who underwent coronary angiography were included. Based on patients’ medical history and fasting blood glucose levels, subjects’ glucose metabolism status was categorized as normal glucose regulation (NGR), pre-diabetes mellitus (Pre-DM), and diabetes mellitus (DM). The severity of CAD was assessed using the Gensini score (GS), and subjects were divided into three groups based on GS tertiles. The relationship between NLR and CAD was validated through logistic regression analysis. The Restricted Cubic Spline (RCS) was employed to determine the quantitative relationship between NLR and GS in different populations.
Logistic regression analysis revealed a significant association between elevated NLR levels and increased odds ratio (OR) of CAD in the fully adjusted model, regardless of the glucose metabolic state. Specifically, in individuals with NGR, the OR was 1.13[95%CI: (1.07, 1.20), <0.001]; in Pre-DM, the OR was 1.11[95%CI: (1.01, 1.21), <0.001] and in DM, the OR was 1.08[95%CI: (1.02, 1.15), = 0.009]. It is noteworthy that there was no statistical correlation between NLR and the severity of CAD in the DM population, while an association was observed in non-diabetic patients. The RCS analysis confirmed a nonlinear relationship between NLR and the GS in total population and NGR group (P for nonlinear < 0.05), with distinct inflection points, which was not observed in the Pre-DM and DM groups.
There is a correlation between NLR and the occurrence of new-onset CAD, and more importantly, NLR reflects the severity of CAD to some extent, and this correlation is more common in patients with NGR and Pre-DM; however, in patients with DM, NLR does not accurately reflect the extent of coronary artery disease.
[Image: see text]
炎症在促进冠状动脉疾病（CAD）中起关键作用。中性粒细胞与淋巴细胞比值（NLR）是反映全身炎症的一种新型综合指标，先前的研究表明其与心血管事件和死亡率有关。然而，NLR与不同糖代谢状态下新发CAD严重程度之间的相关性尚未得到探讨。本研究旨在确定不同糖代谢水平患者中NLR与CAD新发及冠状动脉病变严重程度之间的关系。
在这项回顾性研究中，纳入了1689例行冠状动脉造影的急性冠状动脉综合征患者。根据患者的病史和空腹血糖水平，将受试者的糖代谢状态分为正常血糖调节（NGR）、糖尿病前期（Pre-DM）和糖尿病（DM）。使用Gensini评分（GS）评估CAD的严重程度，并根据GS三分位数将受试者分为三组。通过逻辑回归分析验证NLR与CAD之间的关系。采用限制立方样条（RCS）来确定不同人群中NLR与GS之间的定量关系。
逻辑回归分析显示，在完全调整模型中，无论糖代谢状态如何，NLR水平升高与CAD的比值比（OR）增加显著相关。具体而言，在NGR个体中，OR为1.13[95%CI：（1.07，1.20），<0.001]；在Pre-DM个体中，OR为1.11[95%CI：（1.01，1.21），<0.001]，在DM个体中，OR为1.08[95%CI：（1.02，1.15），=0.009]。值得注意的是，在DM人群中，NLR与CAD严重程度之间无统计学相关性，而在非糖尿病患者中观察到相关性。RCS分析证实，在总体人群和NGR组中，NLR与GS之间存在非线性关系（非线性P<0.05），有明显的拐点，而在Pre-DM和DM组中未观察到。
NLR与新发CAD的发生之间存在相关性，更重要的是，NLR在一定程度上反映了CAD的严重程度，这种相关性在NGR和Pre-DM患者中更为常见；然而，在DM患者中，NLR不能准确反映冠状动脉疾病的程度。
[图像：见正文]
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