| Objective:?To discuss the relationship between the neutrophil-to-lymphocyte ratio(NLR)and red cell distribution width(RDW)in peripheral blood and severity of coronary artery lesions in patients with acute coronary syndrome(ACS).To assess the predictive value of NLR and RDW for the severity of coronary artery lesions in patients with ACS.?To discuss the relationship between NLR and RDW and left ventricular systolic function in patients with acute mycardial infarction(AMI)and to assess the predictive effects of NLR and RDW on left ventricular systolic dysfunction in patients with AMI.Methods:?subjects:From January 2018 to December 2019,328 patients with“chest pain or chest distress”as the main complaint were selected to receive coronary angiography in heart internal medical department,the Second Affiliated Hospital of Dalian Medical University.Among them,175 were male and 153 were female,the age range was 29-88 years old,the average age was(62.06 ± 11.04)years old.All the selected patients received coronary angiography for the first time,and according to the results of coronary angiography combined with ECG and myocardial enzyme test results,the selected patients were divided into two groups,one group was ACS group,a total of 228 cases,including:unstable angina group(UA group)70 cases;acute myocardial infarction group(AMI group)158 cases,the other group selected coronary angiography showed normal or coronary artery stenosis < 50% in 100 cases as thecontrol group.According to the results of Gensini score,ACS group was divided into mild to moderate lesions(Gensini score 1-45),a total of 113 cases;severe lesions(Gensini score ?46),a total of 115 cases.According to the level of LVEF measured by echocardiography,AMI group was divided into:left ventricular systolic dysfunction group(LVEF <50%),a total of 50 cases;normal left ventricular systolic function group(LVEF ? 50%),a total of 108 cases.?blood index detection:the elbow vein blood was taken immediately at admission and sent for examination.The blood routine was detected by the automatic blood cell analyzer.The peripheral blood WBC,NEU,LYM,HGB,PLT,RDW and PDW were measured,then NLR(the formula is neutrophil absolute value / lymphocyte absolute value)was calculated.The next morning,on an empty stomach(after fasting for 8 hours),venous blood of the elbow was extracted for examination.The high sensitive C-reactive protein(Hs-CRP),renal function,fasting plasma glucose(FPG),blood fat were detected by the automatic blood biochemical analyzer,the brain natriuretic peptide(BNP)was detected by the automatic immunoluminescence analyzer.?measurement of cardiac function : Left ventricular ejection fraction(LVEF)and left ventricular end-diastolic diameter(LVEDD)were measured by cardiac ultrasound.? SPSS 22.0 was used for statistical analysis.Results:1.Compared with the control group,ACS group significantly increased the male proportion,smoking rate,prevalence of diabetes,Hs-CRP,BNP,Cr,FPG,LDL-C,LVEDD,Gensini scores and significantly prolonged the length of stay,while HDL-C,Apo A I,LVEF was significantly decreased,the otherness was statistically significant between the two groups(P < 0.05).There was no significant otherness in age,prevalence of hypertension,admission systolic blood pressure,admission diastolic blood pressure,UA,TG,TC,Apo B between the two groups(P > 0.05).2.Compared with the control group,ACS group significantly increased WBC,NEU,NLR,HGB,RDW,the otherness was statistically significant between the twogroups(P < 0.05);in LYM,PLT,PDW,the otherness was not statistically significant between the two groups(P > 0.05).Further analysis showed that:(1)compared with the control group,UA group had no statistical significance in WBC,NEU,LYM,NLR,HGB,RDW,PLT and PDW(P > 0.05).(2)compared with the control group,the WBC,NEU,NLR,HGB and RDW of AMI group were significantly higher,the otherness was statistically significant between the two groups(P < 0.05);the otherness between the two groups in LYM,PLT and PDW was not statistically significant(P >0.05).(3)compared with the UA group,the WBC,NEU,NLR and RDW of AMI group were significantly higher,and there was no significant difference in LYM,HGB,PLT and PDW between the two groups(P > 0.05).3.Compared with the mild and moderate group,the WBC,NEU,NLR and RDW were significantly increased in severe group,the otherness was statistically significant between the two groups(P < 0.05).There was no significant otherness in LYM,HGB,PLT and PDW between the two groups(P > 0.05).4.Compared with the normal left ventricular systolic function group,the WBC,NEU,NLR and RDW were significantly increased in the left ventricular systolic dysfunction group,while LYM was significantly decreased,the otherness was statistically significant between the two groups(P < 0.05).There was no significant otherness in HGB,PLT and PDW between the two groups(P > 0.05).5.Correlation analysis of NLR,RDW,WBC,NEU,Hs-CRP and Gensini scores in ACS group,the results showed that NLR was positively correlated with Gensini score(r = 0.269,P = 0.000),RDW was positively correlated with Gensini score(r =0.292,P = 0.000),WBC was positively correlated with Gensini score(r = 0.453,P =0.000),NEU was positively correlated with Gensini score(r = 0.446,P = 0.000),Hs-CRP was positively correlated with Gensini score(r = 0.328,P = 0.000).Correlation analysis of NLR,RDW,WBC,NEU,BNP,Hs-CRP and LVEF in AMI group,the results showed that NLR was negatively correlated with LVEF(r =-0.260,P = 0.001),RDW was negatively correlated with LVEF(r =-0.210,P = 0.008),WBCwas negatively correlated with LVEF(r =-0.285,P = 0.000),NEU was negatively correlated with LVEF(r =-0.320,P = 0.000),BNP was negatively correlated with LVEF(r =-0.354,P = 0.000),Hs-CRP was negatively correlated with LVEF(r =-0.215,P = 0.007).6.The indexes that may affect the presence of severe lesions in patients with ACS were taken as independent variables,and whether the presence of severe lesions was taken as the dependent variable.The results of single factor Logistic regression analysis showed that WBC,NEU,NLR,RDW,PDW,Hs-CRP,BNP,Apo A?and LVEF were the risk factors of severe lesions in patients with ACS.The results of multivariate logistic regression analysis showed that NLR(OR=1.169,95%CI:1.019-1.341,P=0.025)and RDW(OR=1.970,95%CI:1.096-3.538,P=0.023)were independent risk factors for severe lesions in patients with ACS.WBC(OR=1.174,95%CI :1.047-1.316,P=0.006)was also an independent risk factor for severe lesions in patients with ACS.7.The indexes that may affect the left ventricular systolic dysfunction in patients with AMI were taken as independent variables,and whether the left ventricular systolic dysfunction was taken as the dependent variable.The results of single factor Logistic regression analysis showed that WBC,NEU,NLR,RDW,Hs-CRP,BNP and Gensini scores were the risk factors of left ventricular systolic dysfunction in patients with AMI.The results of multivariate logistic regression analysis showed that NLR(OR=1.494,95%CI:1.090-2.048,P=0.013)and BNP(OR=1.002,95%CI:1.000-1.003,P=0.006)were independent risk factors of left ventricular systolic dysfunction in patients with AMI.WBC(OR=1.600,95%CI : 1.080-2.370,P=0.019)and Gensini scores(OR=1.024,95%CI:1.009-1.040,P=0.002)were independent risk factors of left ventricular systolic dysfunction in patients with AMI.Conclusions:1.NLR and RDW are positively correlated with the degree of coronary artery lesions in patients with ACS.The higher the level of NLR and RDW,the more seriousthe degree of coronary artery lesions in patients with ACS.NLR and RDW can be used as independent predictors of the degree of coronary artery lesions in patients with ACS.2.NLR and RDW are negatively correlated with LVEF in patients with AMI,and NLR is an independent risk factor of left ventricular systolic dysfunction in patients with AMI.RDW is a risk factor of left ventricular systolic dysfunction in patients with AMI,but it is not an independent risk factor. |
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