NLR和THR及二者联合在预测冠状动脉 严重钙化患者旋磨术后植入药物洗脱支架 临床疗效中的应用价值

Application Value of Neutrophil to Lymphocyte Ratio, Total/HDL Cholesterol Ratio, and Their Combination in Predicting the Clinical Efficacy of Rotational Atherectomy and Drug-Eluting Stent Implantation in Patients with Severe Coronary Artery Calcification

摘要: 目的：探讨中性粒细胞比淋巴细胞比值(NLR)和总胆固醇比高密度脂蛋白胆固醇比值(THR)及二者联合对冠状动脉严重钙化患者旋磨术后植入药物洗脱支架临床预后的预测价值。方法：纳入2020年6月至2024年6月成功行冠状动脉旋磨术并植入药物洗脱支架的270例冠状动脉严重钙化患者，对其术后进行为期1年的随访，排除失访及资料缺失患者，最终纳入241例患者。观察终点是1年随访期间发生包括心源性死亡、再发心肌梗死、靶血管血运重建(TVR)和急性心力衰竭在内的主要不良心血管事件(MACE)。运用Logistic回归模型分析预后相关因素，并结合受试者工作特征(ROC)曲线下面积(AUC)评价NLR、THR及二者联合对冠状动脉严重钙化患者旋磨术后植入药物洗脱支架临床疗效的预测价值。结果：左心射血分数、植入支架数量、NLR和THR与冠状动脉严重钙化患者旋磨术后植入药物洗脱支架临床疗效相关(均p < 0.05)。ROC曲线下面积表明，NLR，THR及二者联合对预测MACE发生有较好的区分度，AUC分别为0.691 (95% CI: 0.628~0.748)，0.703 (95% CI: 0.641~0.760)和0.764 (95% CI: 0.705~0.816)，灵敏度分别为71.5%、65.38%、80.77%，特异度分别为59.26%、71.43%、67.72%，且二者联合预测的曲线下面积大于NLR和THR，具有统计学意义(均p < 0.05)。结论：NLR和THR是预测冠状动脉严重钙化患者旋磨术后植入药物洗脱支架临床疗效的有效指标，且二者联合的预测价值更高。

Abstract: Objective: To investigate the predictive value of neutrophil to lymphocyte ratio (NLR), total/HDL cholesterol ratio (THR) and their combination in predicting the clinical prognosis of rotational atherectomy and drug-eluting stent implantation in patients with severe coronary artery calcification. Methods: 270 patients with severe coronary artery calcification who successfully underwent rotational atherectomy and drug-eluting stent implantation from June 2020 to June 2024 were followed up for one year. Finally, to exclude the patients with loss of follow-up and missing data, 241 patients were included. The end point of observation was major adverse cardiovascular events (MACE) including cardiogenic death, acute myocardial infarction, target vessel revascularization (TVR) and acute heart failure during 1-year follow-up. Logistic regression model was used to analyze the prognostic factors, and combined with the receiver operating characteristic (ROC) curve to evaluate the predictive value of NLR, THR and their combination in the clinical efficacy of drug-eluting stent implantation in patients with severe coronary artery calcification after rotational atherectomy. Results: Left ventricular ejection fraction, number of stents, NLR and THR were related to the clinical efficacy of drug-eluting stent implantation in patients with severe coronary artery calcification after rotational atherectomy (p < 0.05). The area under the ROC curve shows that NLR, THR and the combination of the two have a good discrimination degree for predicting the occurrence of MACE. The area under the curve is 0.691 (95% CI: 0.628~0.748), 0.703 (95% CI: 0.641~0.760) and 0.764 (95% CI: 0.705~0.816), the sensitivity is 71.5%, 65.38% and 80.77%, and the specificity is 59.26%, 71.43% and 67.72%, respectively. The combined indicators had a larger area under the curve than NLR or THR (p < 0.05). Conclusion: NLR and THR are effective indexes to predict the clinical efficacy of drug-eluting stent implantation in patients with severe coronary artery calcification after rotational atherectomy, and their combination has a higher predictive value.