WMR、MLR及两者联合对冠心病及冠状动脉病变严重程度的诊断价值

目的 探讨白细胞计数与平均血小板体积比值（WMR）、单核细胞计数与淋巴细胞计数比值（MLR）及两者联合与冠状动脉性心脏病（CAD）及冠状动脉病变严重程度的相关性,评价其对CAD的诊断价值。方法 2 728例疑诊CAD患者根据冠状动脉造影术（CAG）结果分为CAD组（1 884例）与非CAD组（844例）。收集患者临床及辅助检查结果。用受试者工作特征（ROC）曲线确定各指标最佳诊断界值。建立多因素二元Logistic回归模型分析CAD的危险因素。分析WMR、MLR与冠脉病变严重程度的相关性。结果 CAD组中的男性、年龄≥65岁、有吸烟史、高血压病、2型糖尿病、血脂异常、缺血性脑卒中的比例以及WMR≥0.77比例、MLR≥0.27比例均较非CAD组高（均P<0.05）。WMR、MLR和两者联合的受试者工作特征曲线下面积（AUC）分别为0.639（95%CI：0.618~0.661）、0.621（95%CI：0.598~0.644）和0.677（95%CI：0.656~0.698）。WMR及MLR均升高为CAD独立危险因素（均P<0.05）。WMR、MLR与Gensini评分均呈正相关（均P<0.05）。结论 WMR及MLR联合升高为CAD的独立危险因素,有望成为辅助诊断CAD患病的新型炎症标志物。

The diagnostic values of WMR,MLR and their combination in the severity of coronary artery disease

Objective To explore the association of the number of white blood cell to mean platelet volume ratio (WMR), monocyte to lymphocyte ratio (MLR) and their combination on the diagnostic value for coronary artery disease (CAD) and the severity of coronary artery stenosis. Methods A total of 2 728 inpatients were divided into the CAD group (n=1 884) and the non-CAD group (n=844) according to coronary angiography (CAG)．The clinical and laboratory data of all the subjects were collected. The cutoff values of these inflammatory markers to diagnose CAD were calculated using receiver operating characteristic (ROC) curves. Multivariate Logistic regression model for the risk factors of CAD was established. The correlation between WMR, MLR and the severity of CAD was analyzed. Results The proportion of male, age≥65 years, smoking, hypertension, diabetes, dyslipidemia, ischemic stroke, WMR≥0.77 and MLR≥0.27 levels were significantly higher in the CAD group than those in the non-CAD group (P<0.05). The areas under the ROC curves of the WMR, MLR and WMR+MLR were 0.639 (95%CI: 0.618-0.661), 0.621 (95%CI: 0.598-0.644) and 0.677 (95%CI: 0.656-0.698), respectively (P<0.05). The elevated WMR and MLR were independent risk factors for CAD (P<0.05). WMR and MLR were positively correlated with Gensini score (P<0.05). Conclusion The combined elevation of WMR and MLR is an independent risk factor for CAD, which is expected to be a novel inflammatory marker to help diagnose CAD.