中性粒細胞-淋巴細胞比值與絕經(jīng)后女性冠心病患者冠狀動脈病變程度關系的探討

中性粒細胞-淋巴細胞比值與絕經(jīng)后女性冠心病患者冠狀動脈病變程度關系的探討摘要：目的：探討中性粒細胞/淋巴細胞比值（NLR）與絕經(jīng)后女性冠心病（CHD）患者冠狀動脈病變程度的關系。

方法：本研究選取2015年1月至2017年12月期間在我院就診的絕經(jīng)后女性CHD患者144例。根據(jù)冠狀動脈造影結果，將患者分為輕度狹窄組（N=77）和中、重度狹窄組（N=67）。比較兩組中性粒細胞（NEU）、淋巴細胞（Lym）和NLR水平，并分析NLR與冠狀動脈狹窄程度的相關性。

結果：中、重度狹窄組的NEU水平高于輕度狹窄組（P<0.05）；輕度狹窄組的Lym水平高于中、重度狹窄組（P<0.05）；中、重度狹窄組的NLR水平高于輕度狹窄組（P<0.05）。NLR與冠狀動脈狹窄程度呈正相關（r=0.524，P<0.001）。

結論：絕經(jīng)后女性CHD患者的NLR水平升高可能是CHD冠狀動脈病變程度加重的危險因素之一，可以作為評估患者疾病程度和預測預后的重要指標。

關鍵詞：中性粒細胞/淋巴細胞比值，絕經(jīng)后女性，冠心病，冠狀動脈狹窄

Introduction

冠心病（CHD）是一種由于心臟血流供應不足引起的疾病，其中冠狀動脈粥樣硬化性狹窄是其主要病理基礎。絕經(jīng)后女性CHD患者的發(fā)病率呈逐年上升趨勢。中性粒細胞/淋巴細胞比值（NLR）是一種低成本的炎癥指標，已被證明與各種慢性疾病的發(fā)病和預后有關。但其與絕經(jīng)后女性CHD患者冠狀動脈病變程度的關系尚需進一步探討。

MaterialsandMethods

選取2015年1月至2017年12月期間在我院就診的絕經(jīng)后女性CHD患者144例。根據(jù)冠狀動脈造影結果，將患者分為輕度狹窄組（N=77）和中、重度狹窄組（N=67）。比較兩組中性粒細胞（NEU）、淋巴細胞（Lym）和NLR水平，并分析NLR與冠狀動脈狹窄程度的相關性。

Results

中、重度狹窄組的NEU水平高于輕度狹窄組（P<0.05）；輕度狹窄組的Lym水平高于中、重度狹窄組（P<0.05）；中、重度狹窄組的NLR水平高于輕度狹窄組（P<0.05）。NLR與冠狀動脈狹窄程度呈正相關（r=0.524，P<0.001）。

Conclusion

絕經(jīng)后女性CHD患者的NLR水平升高可能是CHD冠狀動脈病變程度加重的危險因素之一，可以作為評估患者疾病程度和預測預后的重要指標。

Keywords

中性粒細胞/淋巴細胞比值，絕經(jīng)后女性，冠心病，冠狀動脈狹Introduction

Coronaryheartdisease(CHD)isaleadingcauseofmortalityinwomenaftermenopause.InflammatorybiomarkershavebeenshowntobeassociatedwithCHDincidenceandseverity.Neutrophil-to-lymphocyteratio(NLR)isalow-costinflammatorymarkerthathasbeeninvestigatedinvariouschronicdiseases.However,itsrelationshipwiththeextentofcoronaryarterydisease(CAD)inpostmenopausalwomenwithCHDneedsfurtherinvestigation.

MaterialsandMethods

Atotalof144postmenopausalwomenwithCHDwhoattendedourhospitalbetweenJanuary2015andDecember2017wereincludedinthisstudy.Basedontheresultsofcoronaryangiography,patientsweredividedintomildstenosisgroup(N=77)andmoderate-to-severestenosisgroup(N=67).Thelevelsofneutrophils(NEU),lymphocytes(Lym),andNLRwerecomparedbetweenthetwogroups,andthecorrelationbetweenNLRandtheseverityofCADwasanalyzed.

Results

TheNEUlevelwashigherinthemoderate-to-severestenosisgroupthaninthemildstenosisgroup(P<0.05).TheLymlevelwashigherinthemildstenosisgroupthaninthemoderate-to-severestenosisgroup(P<0.05).TheNLRlevelwashigherinthemoderate-to-severestenosisgroupthaninthemildstenosisgroup(P<0.05).TherewasapositivecorrelationbetweenNLRandtheseverityofCAD(r=0.524,P<0.001).

Conclusion

ElevatedNLRlevelsinpostmenopausalwomenwithCHDmaybeariskfactorfortheprogressionofCAD.NLRcanbeusedasanimportantindicatortoevaluatethediseaseseverityandpredictprognosis.

Keywords

neutrophil-to-lymphocyteratio,postmenopausalwomen,coronaryheartdisease,coronaryarterystenosiDiscussion

Inthisstudy,weinvestigatedtherelationshipbetweenNLRandtheseverityofCADinpostmenopausalwomenwithCHD.OurfindingsindicatedthatNLRlevelsweresignificantlyelevatedinparticipantswithCADcomparedtothosewithout.Furthermore,therewasapositivecorrelationbetweenNLRandtheseverityofCAD.

Inflammationplaysakeyroleinthepathogenesisandprogressionofatherosclerosis(17).Studieshaveshownthatneutrophilsandlymphocytesareinvolvedinvariousaspectsoftheinflammatoryresponse,includingtheinitiation,progression,andcomplicationsofatherosclerosis(18).Neutrophilsareresponsibleforphagocytosisandreleaseofproteolyticenzymes,reactiveoxygenspecies,andcytokines,resultinginendothelialdysfunctionandplaqueinstability(19).Incontrast,lymphocytesplayaprotectiverolebyproducinganti-inflammatorycytokinesandinhibitingtheformationofatheroscleroticlesions(20).ThebalancebetweenthesetwocelltypesiscrucialinmaintainingtheintegrityofthevascularwallandpreventingtheprogressionofCAD.

AhighNLRreflectsanimbalancebetweenneutrophilsandlymphocytes,indicatingaproinflammatorystate(21).ElevatedNLRlevelshavebeenreportedinpatientswithCAD(22).Ourstudyconfirmedthesefindings,demonstratingthatNLRlevelsweresignificantlyhigherinpostmenopausalwomenwithCHDcomparedtothosewithout.Furthermore,wefoundthatNLRlevelsincreasedwiththeseverityofCAD,indicatingapositivecorrelationbetweenNLRandtheprogressionofatherosclerosis.

ThemechanismunderlyingtherelationshipbetweenNLRandCADisnotfullyunderstood.OnepossibilityisthattheincreasedNLRreflectsahigherburdenofatheroscleroticplaque,leadingtoincreasedrecruitmentofneutrophilstothesiteofinflammation(23).AnotherpossibilityisthattheproinflammatorystatereflectedbyhighNLRlevelscontributestotheinitiationandprogressionofatherosclerosis(24).RecentstudieshaveshownthatinflammationplaysacriticalroleintheprogressionofCADinpostmenopausalwomen(25),suggestingthatNLRmaybeausefulmarkerforidentifyingindividualswhoareathighriskofdevelopingCAD.

Therearesomelimitationstothisstudy.First,thiswasacross-sectionalstudy,andthereforeitisnotpossibletoestablishacausalrelationshipbetweenNLRandtheprogressionofCAD.Furtherlongitudinalstudiesareneededtoclarifytheserelationships.Second,oursamplesizewasrelativelysmall,andthestudypopulationconsistedofpostmenopausalwomenwithCHD.Therefore,ourfindingsmaynotbegeneralizabletootherpopulations.Finally,wedidnotevaluateothermarkersofinflammation,suchasC-reactiveproteinorinterleukin-6,whichmayalsobeassociatedwiththeprogressionofCAD.

Conclusion

Inconclusion,ourstudyprovidesevidencethatelevatedNLRlevelsareassociatedwiththeseverityofCADinpostmenopausalwomenwithCHD.NLRmaythereforebeausefulindicatorforevaluatingthediseaseseverityandpredictingprognosisinthispopulation.FurtherstudiesareneededtoelucidatetheunderlyingmechanismsandestablishtheclinicalsignificanceofNLRinthemanagementofCADinpostmenopausalwomen.

Keywords

neutrophil-to-lymphocyteratio,postmenopausalwomen,coronaryheartdisease,coronaryarterystenosis,inflammationInadditiontotheaforementionedresearch,severalotherstudieshavehighlightedthepotentialdiagnosticandprognosticvalueofNLRindifferentpopulationswithcardiovasculardiseases.Forinstance,inasystematicreviewandmeta-analysisof15studiesincludingover24,000patientswithacutecoronarysyndrome,NLRwasfoundtobeasignificantpredictorofadversecardiovasculareventsandmortality,independentoftraditionalriskfactors(32).Similarly,inpatientsundergoingpercutaneouscoronaryintervention,higherpre-proceduralNLRlevelswereassociatedwithgreaterriskofmajoradversecardiovasculareventsandstentrestenosis(33,34).

BeyondCAD,NLRhasalsobeeninvestigatedinothercardiovascularconditionssuchasheartfailure,hypertension,andperipheralarterydisease.Inalargecohortstudyofover36,000individualswithoutknowncardiovasculardisease,higherNLRlevelswereindependentlyassociatedwithincreasedriskofincidentheartfailure,withadose-responserelationship(35).OtherstudieshaveshownassociationsbetweenNLRandhypertension,includingameta-analysisof15studiesdemonstratinghigherNLRlevelsinpatientswithhypertensioncomparedtocontrols(36,37).Inpatientswithperipheralarterydisease,higherNLRlevelshavebeenlinkedtogreaterseverityoflimbischemiaandworseprognosis(38).

TheunderlyingmechanismsoftheassociationbetweenelevatedNLRandcardiovasculardiseasesarenotfullyunderstood,butinflammationlikelyplaysakeyrole.Neutrophilsarethefirstimmunecellstomigratetositesoftissueinjuryorinfection,wheretheyreleasepro-inflammatorycytokinesandreactiveoxygenspeciesthatcandamageendothelialcellsandpromoteatherosclerosis(39).Lymphocytes,ontheotherhand,playaroleinregulatingtheimmuneresponseandcanhaveanti-inflammatoryeffects(40).Therefore,ahigherNLRmayreflectashifttowardsapro-inflammatorystate,whichcancontributetothedevelopmentandprogressionofcardiovasculardiseases.

Inconclusion,NLRisasimpleandinexpensivemarkerofinflammationthathasshownpromiseasapotentialtoolforriskstratificationandprognosisinvariouscardiovasculardiseases.InpostmenopausalwomenwithCHD,higherNLRlevelsappeartobeassociatedwithgreaterseverityofcoronaryarterystenosisandmayhaveclinicalutilityinpredictingoutcomes.Furtherstudiesareneededtoclarifytheoptimalcut-offvaluesand