摘要
目的 探讨血小板与淋巴细胞比值(PLR)、中性粒细胞与淋巴细胞比值(NLR)与2型糖尿病(T2DM)患者颈动脉粥样硬化(CAS)斑块的相关性,以及PLR、NLR对T2DM患者CAS斑块的预测价值.方法 选择2019年9月至2021年11月新乡医学院第三附属医院内分泌科收治的369例T2DM患者为研究对象.通过查阅电子医疗记录系统收集患者的性别、年龄、T2DM病程、体质量指数(BMI)、收缩压(SBP)、舒张压(DBP)、个人史、既往史等临床资料.应用全自动血常规分析仪检测中性粒细胞计数(NC)、淋巴细胞计数(LC)、血小板(PLT)计数,计算PLR、NLR;应用生物化学分析仪检测空腹血糖(FBG)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平;应用高效液相色谱法测糖化血红蛋白(HbA1c)水平.按照是否合并CAS斑块将T2DM患者分为T2DM未合并CAS斑块组(n=94)和T2DM合并CAS斑块组(n=275),比较2组患者的一般临床资料、血液指标及PLR、NLR.按照合并CAS斑块数量将T2DM患者分为无斑块组(A组,n=94)、1个斑块组(B组,n=79)、2个斑块组(C组,n=89)、3个及以上斑块组(D组,n=107),将T2DM未合并CAS斑块组与T2DM合并CAS斑块组间差异有统计学意义的指标进行4组间比较.根据PLR四分位数将患者分为P1组(PLR≤94.87,n=93)、P2组(94.87＜PLR≤117.30,n=91)、P3 组(117.30＜PLR≤148.53,n=93)、P4 组(PLR＞148.53,n=92),比较 4 组患者的 CAS 斑块检出率;根据NLR四分位数将研究对象分为N1组(NLR≤1.59,n=92)、N2组(1.59＜NLR≤1.93,n=92)、N3组(1.93＜NLR≤2.50,n=93)、N4组(NLR＞2.50,n=92),比较4组患者的CAS斑块检出率.应用多因素logistic回归分析T2DM合并CAS斑块的危险因素,受试者操作特征曲线评估PLR、NLR对T2DM合并CAS斑块的预测效能.结果 T2DM合并CAS斑块组患者的年龄、T2DM病程、合并高血压患者占比、SBP、PLR、NLR均显著高于T2DM未合并CAS斑块组,LC、TG水平显著低于T2DM未合并CAS斑块组(P＜0.05);T2DM未合并CAS斑块组与T2DM合并CAS斑块组患者的性别、合并高脂血症患者占比、有抽烟史占比、有饮酒史占比、DBP、BMI、NC、PLT计数、TC、HDL-C、LDL-C、FBG、HbA1c比较差异均无统计学意义(P＞0.05).B组、C组和D组患者的年龄、合并高血压患者占比、T2DM病程、SBP、PLR、NLR显著高于A组,LC水平显著低于A组(P＜0.05).D组患者的TG水平显著低于A组(P＜0.05);A组、B组、C组患者的TG水平比较差异无统计学意义(P＞0.05).C组和D组患者的年龄、合并高血压患者占比、T2DM病程显著高于B组,D组患者的SBP显著高于B组(P＜0.05);C组与B组患者的SBP比较差异无统计学意义(P＞0.05);D组患者的年龄、合并高血压患者占比、T2DM病程、SBP显著高于C组(P＜0.05);B组、C组、D组患者的LC、TG水平及PLR比较差异无统计学意义(P＞0.05).D组患者的NLR显著高于B组(P＜0.05);C组与B组患者的NLR比较差异无统计学意义(P＞0.05),D组与C组患者的NLR比较差异无统计学意义(P＞0.05).P1组、P2组、P3组、P4组患者的CAS斑块检出率呈显著增加趋势(x2=30.610,P=0.000);N1组、N2组、N3组、N4组患者并发CAS斑块检出率呈显著增加趋势(x2=35.170,P=0.000).多因素logistic回归分析显示,年龄、PLR、NLR是T2DM患者并发CAS斑块的独立危险因素(比值比=1.107、1.017、1.940,P＜0.05).PLR预测T2DM患者并发CAS斑块的最佳截断值为119.95,曲线下面积为0.680,灵敏度为54.7％,特异度为76.3％;NLR预测T2DM患者并发CAS斑块的最佳截断值为1.97,曲线下面积为0.698,灵敏度为56.5％,特异度为79.6％.结论 PLR、NLR与T2DM患者CAS斑块相关,是T2DM并发CAS斑块的独立危险因素,对T2DM患者CAS斑块有一定的预测价值.
Abstract
Objective To explore the correlation between platelet to lymphocyte ratio(PLR),neutrophil to lymphocyte ratio(NLR)and carotid atherosclerotic(CAS)plaque in patients with type 2 diabetes(T2DM),and the predictive value of PLR and NLR for T2DM complicated with CAS plaque.Methods A total of 369 T2DM patients admitted to the Department of Endocrinology,the Third Affiliated Hospital of Xinxiang Medical University from September 2019 to November 2021 were se-lected as research subjects.The clinical data such as gender,age,course of disease,body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),personal history,and history of past illness of patients were collected by searching the electronic medical record system.Neutrophil(NC)count,lymphocyte count(LC)and platelet(PLT)count were detected by fully automated blood routine analyzer,and PLR,NLR were calculated;the levels of fasting blood glucose(FBG),total cholesterol(TC),triglycerides(TG),high-density lipoprotein-cholesterol(HDL-C)and low-density lipoprotein-cholesterol(LDL-C)were detected by biochemical analyzer;the level of glycosylated hemoglobin(HbA1c)were detected by high-performance liquid chromatography.The T2DM patients were divided into T2DM uncomplicated with CAS plaque group(n=94)and T2DM complicated with GAS plaque group(n=275)based on whether they complicated with CAS plaque or not;the general clinical data,blood indicators,and PLR,NLR of patients were compared between the two groups.The T2DM patients were divided into non plaque group(group A,n=94),1 plaque group(group B,n=79),2 plaque group(group C,n=89),and 3 or more plaques group(group D,n=107)based on the number of CAS plaques;the indicators with statistical differences between T2DM uncomplicated with CAS plaque group and T2DM complicated with CAS plaque group of patients were compared among the four groups.According to the PLR quartile,the patients were divided into P1 group(PLR≤94.87,n=93),P2 group(94.87＜PLR≤117.30,n=91),P3 group(117.30＜PLR ≤ 148.53,n=93),and P4 group(PLR＞148.53,n=92),and the detection rate of CAS plaques of patients was compared among the four groups;according to the NLR quartile,the patients were divided into N1 group(NLR≤1.59,n=92),N2 group(1.59＜NLR≤1.93,n=92),N3 group(1.93＜NLR≤2.50,n=93),and N4 group(NLR＞2.50,n=92),and the detection rate of CAS plaque of patients was compared among the four groups.The risk factors of T2DM complicated with CAS plaque was analysed by multivariate logistic regression analysis,and the predictive efficacy of PLR and NLR for T2DM complicated with CAS plaque were evaluated by receiver operating characteristic(ROC)curve.Results The age,course of T2DM,proportion of patients combined with hyper-tension,SBP,PLR,and NLR of patients in the T2DM complicated with CAS plaque group were significantly higher than those in the T2DM uncomplicated with CAS plaque group,while LC and TG levels were significantly lower than those in the T2DM uncomplicated with CAS plaque group(P＜0.05);there was no significant difference in gender,proportion of patients com-bined with hyperlipidemia,proportion of smoking history,proportion of drinking history,and the levels of DBP,BMI,NC,PLT,TC,HDL-C,LDL-C,FBG,HbA1c between the T2DM uncomplicated with CAS plaque group and T2DM complicated with CAS plaque group(P＞0.05).The age,proportion of patients combined with hypertension,course of T2DM,SBP,PLR,and NLR of patients in group B,group C,and group D were significantly higher than that in group A,while LC level was significantly lower than that in group A(P＜0.05).The TG level of patients in group D was significantly lower than those in group A(P＜0.05);there was no statistically significant difference in TG level of patients among group A,group B,and group C(P＞0.05).The age,proportion of patients combined with hypertension,and course of T2DM of patients in group C and group D were significantly higher than those in group B,while the SBP of patients in group D was significantly higher than that in group B(P＜0.05);there was no statistically significant difference in SBP of patients between group C and group B(P＞0.05).The age,proportion of patients combined with hypertension,course of T2DM,and SBP of patients in group D were significantly higher than those in group C(P＜0.05).There was no statistically significant difference in the levels of LC,TG,and PLR of patients among group B,group C,and group D(P＞0.05).The NLR of patients in group D was significantly higher than that in group B(P＜0.05);there was no statistically significant difference in NLR of patients between group C and group B(P＞0.05),and there was no statistically significant difference in NLR of patients between group D and group C(P＞0.05).The detection rate of CAS plaques of patients in P1 group,P2 group,P3 group,and P4 group showed a significant increase trend(x2=30.610,P=0.000);and the detection rate of CAS plaques of patients in N1 group,N2 group,N3 group,and N4 group showed a significant increase trend(x2=35.170,P=0.000).Multivariate logistic regression analysis showed that age,PLR,and NLR were independent risk factors for T2DM complicated with CAS plaque(odds ratio=1.107,1.017,1.940;P＜0.05).The opti-mal cutoff value of PLR in predicting T2DM complicated with CAS plaque was 119.95,with an area under the curve of 0.680,a sensitivity of 54.7％,and a specificity of 76.3％;the optimal cutoff value of NLR in predicting T2DM complicated with CAS plaque was 1.97,with an area under the curve of 0.698,a sensitivity of 56.5％,and a specificity of 79.6％.Conclusion PLR and NLR are associated with T2DM complicated with CAS plaque,which are independent risk factors for T2DM compli-cated with CAS plaque,and have certain predictive value for T2DM complicated with CAS plaque.
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