血小板/淋巴细胞比值和中性粒细胞/淋巴细胞比值对药物洗脱支架内再狭窄的预测价值

摘要

目的 探讨冠心病患者药物洗脱支架(DES)植入术前和再次冠脉造影(CAG)复查前的血小板/淋巴细胞比值(PLR)和中性粒细胞/淋巴细胞比值(NLR)对于支架内再狭窄(ISR)的预测价值.方法 选择于我院行 DES植入术后再次入院造影复查的冠心病患者(123 例)作为支架植入(SI)组,以同期行造影检查未见明显冠脉狭窄的非冠心病患者(NC,45 例)作为对照组,测定造影检查或支架植入前外周血 PLR、NLR 及其他血液学指标;SI 组按造影复查结果分为再狭窄(ISR)组和非再狭窄(NO-ISR)组两个亚组,并于造影前再次检测血液学指标.分别比较各组间的 PLR和NLR的差异,并绘制PLR和 NLR预测 ISR 的受试者工作特征曲线(ROC).结果 与 NO-ISR 组(89 例)相比, ISR组(34 例)在植入 DES 前和 CAG 复查前的 PLR 和 NLR 水平均显著升高(P＜0.05).植入 DES 前,PLR 预测ISR的最佳截断值为 107.20,灵敏度为 64.7%,特异度为 65.2%;NLR 预测 ISR 的最佳截断值为 2.72,灵敏度为61.8%,特异度为 70.8%.CAG复查前,PLR预测 ISR 的最佳截断值 160.08,灵敏度为 26.5%,特异度为 97.8%;NLR预测 ISR的最佳截断值 2.08,灵敏度为 73.5%,特异度为 56.2%.结论 植入 DES 前和 CAG 复查前外周血PLR和 NLR对 ISR均具有一定的预测价值.%Objective To investigate the predictive values of platelet to lymphocyte ratio (PLR) and neutrophil to lymphocyte ratio (NLR)before percutaneous coronary intervention (PCI)and a reexamination of coronary angiography (CAG)on the development of in-stent restenosis (ISR)in patients implanted with coronary drug eluting stent (DES).Methods For this study we enrolled 123 patients who had undergone successful drug eluting stent implantation (SI)and a further CAG reexamination.Another 45 patients with non-coronary heart disease (NC)served as controls.PLR and NLR were measured before DES implantation or CAG and compared between the groups.Patients in SI group were further divided into two subgroups based on the results of CAG reexamination:ISR group and no-ISR group.Hematologic data were reexamined before further CAG and compared between the subgroups.Receiver operator characteristic curve (ROC)was drawn to evaluate the predictive values of PLR and NLR for ISR.Results PLR and NLR before PCI or a further CAG were significantly higher in ISR group (34 patients)than in non-ISR group (89 patients,P＜0.05).Before PCI,the best cutoff value of PLR in screening restenosis was 107.20;the sensitivity and the specificity were 64.7% and 65.2%.The best cutoff value of NLR in screening restenosis was 2.72; the sensitivity and the specificity were 61.8% and 70.8%. Before CAG reexamination,the best cutoff value of PLR in screening restenosis was 160.08;the sensitivity and the specificity were 26.5% and 97.8%.The best cutoff value of NLR in screening restenosis was 2.08;the sensitivity and the specificity were 73.5% and 56.2%.Conclusion Both PLR and NLR before PCI or CAG reexamination can be predictors of ISR in patients implanted with DES.