应用虚拟组织学血管内超声探讨血小板/淋巴细胞比值水平与冠心病合并2型糖尿病患者冠状动脉斑块特点的关系

doi:10.3969/j.issn.1004-583X.2025.02.003

摘要/Abstract

摘要：

目的应用虚拟组织学血管内超声(VH-IVUS)探讨血小板/淋巴细胞比值(PLT/LYM,PLR)与冠心病合(CHD)并2型糖尿病(T2DM)患者冠状动脉斑块特点的关系。方法选取2023年3月-2024年3月于华北理工大学附属医院心血管内科一病区住院患者,同时接受了冠状动脉介入治疗(PCI)以及虚拟组织学血管内超声(VH-IVUS)检查的CHD合并T2DM的患者86例。根据患者的PLR中位数水平分为两组:高PLR水平组(n=43)和低PLR水平组(n=43)。通过VH-IVUS检查,探讨PLR与CHD合并T2DM患者冠状动脉斑块特点的关系。结果全部患者血液指标中PLR水平为37.22~331.76,中位数为119.22,其中低PLR组斑块面积、外弹力膜面积、坏死核心组织容积比例、纤维脂肪组织容积比例、斑块负荷、斑块总容积均低于高PLR组,差异具有统计学意义(P<0.05); Pearson相关分析显示:PLR与斑块面积(r=0.398,P=0.000)、外弹力膜面积(r=0.299, P=0.005)、斑块负荷(r=0.338, P=0.001)、斑块总容积(r=0.263, P=0.014)呈正相关。结论 PLR水平可作为一项判断斑块面积及斑块容积的一项研究指标。

关键词: 冠心病, 糖尿病, 2型, 血小板, 淋巴细胞, 超声检查, 介入性

Abstract:

Objective The relationship between platelet/lymphocyte ratio (PLT/LYM, PLR) and the characteristics of coronary plaque in coronary heart disease (CHD) patients combined with type 2 diabetes mellitus (T2DM) was studied by virtual histology intravascular ultrasound (VH-IVUS). Methods A total of 86 CHD patients combined with T2DM who were hospitalized in the First Ward of the Cardiovascular Department of the Affiliated Hospital of North China University of Science and Technology from March 2023 to March 2024 and underwent coronary intervention therapy (PCI) and intravascular ultrasound (VH-IVUS) examination were recruited. The patients were divided into two groups based on the median PLR levels: high PLR group (n=43) and low PLR group (n=43). The relationship between PLR and coronary plaque characteristics in CHD patients combined with T2DM was explored by VH-IVUS. Results Blood PLR levels in all patients ranged from 37.22 to 331.76, with a median of 119.22. The plaque area, outer elastic membrane area, necrotic tissue volume ratio, adipose tissue volume ratio, plaque burden, and total plaque volume in the low PLR group were all significantly lower than those in the high PLR group (P<0.05). Pearson correlation analysis showed that plaque area (r=0.398, P=0.000), outer elastic membrane area (r=0.299, P=0.005), plaque load (r=0338, P=0.001), and total plaque volume (r=0.263, P=0.014) were positively correlated with PLR. Conclusion PLR level can be used as a study index to determine plaque area and plaque volume.

Key words: coronary disease, diabetes mellitus, type 2, platelets, lymphocyte, ultrasonography, interventional

中图分类号:

胡松林, 邸雅, 刘灿章, 闫杰. 应用虚拟组织学血管内超声探讨血小板/淋巴细胞比值水平与冠心病合并2型糖尿病患者冠状动脉斑块特点的关系[J]. 临床荟萃, 2025, 40(2): 117-121.

Hu Songlin, Di Ya, Liu Canzhang, Yan Jie. Study on the relationship between platelet/lymphocyte ratio and coronary plaque characteristics in coronary heart disease patients combined with type 2 diabetes mellitus by virtual histology intravascular ultrasound[J]. Clinical Focus, 2025, 40(2): 117-121.

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https://lchc.magtechjournal.com/CN/Y2025/V40/I2/117

图/表 9

参考文献 20

[1]	黄金稳, 牟建军. 老年冠心病合并糖尿病患者的临床及冠状动脉病变特点[J]. 中国循证心血管医学杂志, 2017, 9(12): 1525-1527.
[2]	张博强, 井丽, 田园梦, 等. 辽宁省城市40岁及以上居民肥胖患病现状及其影响因素分析[J]. 中国慢性病预防与控制, 2020, 28(12): 903-906.
[3]	王景芳, 邓斌. 血管内超声的临床应用进展[J]. 海南医学, 2021, 32(19): 2555-2560.
[4]	Larmann J, Handke J, Scholz AS, et al. Preoperative neutrophil to lymphocyte ratio and platelet to lymphocyte ratio are associated with major adverse cardiovascular and cerebrovascular events in coronary heart disease patients undergoing non-cardiac surgery[J]. BMC Cardiovasc Disord, 2020, 20(1): 230.
[5]	Bozduman F, Yildirim E, Cicek G. Biomarkers of nondipper hypertension in prehypertensive and hypertensive patients[J]. Biomark Med, 2019, 13(5): 371-378. doi: 10.2217/bmm-2018-0247 pmid: 30919653
[6]	Wang X, Xie Z, Liu X, et al. Association of platelet to lymphocyte ratio with non-culprit atherosclerotic plaque vulnerability in patients with acute coronary syndrome: An optical coherence tomography study[J]. BBMC Cardiovasc Disord, 2017, 17(1): 175.
[7]	刘亚东, 马利军, 杨延星. 冠心病病人冠状动脉斑块性质与Lp-PLA2、Hcy和D-二聚体水平的相关性分析[J]. 中西医结合心脑血管病杂志, 2020, 18(7): 1100-1102.
[8]	孙静, 石丽媛, 康美丽. 冠心病病人血清lncRNA TUG1和miR-140-3p水平与血清炎性因子、斑块稳定性指标的相关性[J]. 中西医结合心脑血管病杂志, 2023, 21(8): 1483-1486.
[9]	Chen T, Xing J, Liu Y. Effects of telmisartan on vascular endothelial function, inflammation and insulin resistance in patients with coronary heart disease and diabetes mellitus[J]. Exp Ther Med, 2018, 15(1):909-913. doi: 10.3892/etm.2017.5451 pmid: 29399098
[10]	Shin HC, Jang JS, Jin HY, et al. Combined use of neutrophil to lymphocyte ratio and c-reactive protein level to predict clinical outcomes in acute myocardial infarction patients undergoing percutaneous coronary intervention[J]. Korean Circ J, 2017, 47(3): 383-391.
[11]	Haasenritter J, Stanze D, Widera G, et al. Does the patient with chest pain have a coronary heart disease? Diagnostic value of single symptoms and signs - a meta-analysis[J]. Croat Med J, 2012, 53(5): 432-441. pmid: 23100205
[12]	师佩华, 林彦琳, 毕丽妨. NLR、PLR及MLR与2型糖尿病合并冠心病患者的相关性研究[J]. 临床荟萃, 2023, 38(11): 996-1001.
[13]	朱志远, 王海燕, 吴波, 等. 冠心病患者血小板和淋巴细胞比值与冠脉斑块稳定性及预后的相关性[J]. 现代检验医学杂志, 2019, 34(4): 112-115,119.
[14]	Karageorgos GM, Apostolakis IZ, Nauleau P, et al. Arterial wall mechanical inhomogeneity detection and atherosclerotic plaque characterization using high frame rate pulse wave imaging in carotid artery disease patients in vivo[J]. Phys Med Biol, 2020, 65(2): 025010.
[15]	Yonetsu T, Hoshino M, Lee T, et al. Plaque morphology assessed by optical coherence tomography in the culprit lesions of the first episode of acute myocardial infarction in patients with low low-density lipoprotein cholesterol level[J]. J Cardiol, 2020, 75(5): 485-493. doi: S0914-5087(20)30012-5 pmid: 32085904
[16]	梁庆辉, 梅立冬, 陈宇, 等. Vh-ivus在冠状动脉粥样硬化性心脏病临界病变介入治疗中的临床研究[J]. 中国分子心脏病学杂志, 2023, 23(1): 5167-5171.
[17]	孙正, 马晓乾. 血管内超声/光声联合成像研究进展[J]. 中国医学影像技术, 2016, 32(6): 979-982.
[18]	郭顺顺, 王建鑫. 冠心病患者ct冠状动脉造影斑块性质与血小板和淋巴细胞比值的相关性分析[J]. 影像研究与医学应用, 2023, 7(21): 69-71.
[19]	吴美美, 王虹, 孙雪, 等. 血小板/淋巴细胞与心血管疾病的研究进展[J]. 临床荟萃, 2020, 35(1): 88-91.
[20]	刘灿章, 闫杰, 刘强, 等. 应用血管内超声虚拟组织学成像技术探讨ldl-c与hdl-c比值与冠心病患者冠状动脉斑块特点关系的研究[J]. 中国循证心血管医学杂志, 2023, 15(2): 234-237.

项目	低PLR组(n=43)	高PLR组(n=43)	t/χ²值	P值
男性[例(%)]	30(69.8)	29(67.4)	0.054	0.816
吸烟[例(%)]	26(60.5)	31(72.1)	1.301	0.254
高血压[例(%)]	25(58.1)	20(46.5)	1.165	0.280
饮酒[例(%)]	30(69.8)	33(76.3)	0.534	0.465
年龄(岁)	58.70±12.01	61.05±8.21	2.635	0.013
体质指数(kg/m²)	25.80±2.81	25.04±3.40	1.129	0.262
Gensini评分	39.91±28.92	37.09±27.25	0.464	0.644

项目	低PLR组(n=43)	高PLR组(n=43)	t/χ²值	P值
男性[例(%)]	30(69.8)	29(67.4)	0.054	0.816
吸烟[例(%)]	26(60.5)	31(72.1)	1.301	0.254
高血压[例(%)]	25(58.1)	20(46.5)	1.165	0.280
饮酒[例(%)]	30(69.8)	33(76.3)	0.534	0.465
年龄(岁)	58.70±12.01	61.05±8.21	2.635	0.013
体质指数(kg/m²)	25.80±2.81	25.04±3.40	1.129	0.262
Gensini评分	39.91±28.92	37.09±27.25	0.464	0.644

项目	低PLR组(n=43)	高PLR组(n=43)	t值	P值
白细胞计数(×10⁹/L)	7.43±1.99	6.41±2.02	2.372	0.020
中性粒细胞计数(×10⁹/L)	4.56±1.62	4.58±1.96	0.069	0.945
血小板计数(×10⁹/L)	215.12±50.52	282.19±76.22	4.809	<0.001
淋巴细胞计数(×10⁹/L)	2.43±0.79	1.61±0.38	6.083	<0.001
尿酸(mmol/L)	290.67±79.10	328.65±105.48	1.889	0.063
血肌酐(mmol/L)	64.91±13.73	69.79±16.24	1.506	0.682
三酰甘油(mmol/L)	1.81±0.94	1.43±0.78	2.021	0.046
低密度脂蛋白(mmol/L)	2.97±0.85	2.95±0.95	0.064	0.949
高密度脂蛋白(mmol/L)	1.28±0.29	1.25±0.29	0.533	0.595
总胆固醇(mmol/L)	4.78±1.16	4.60±0.99	0.746	0.458

项目	低PLR组(n=43)	高PLR组(n=43)	t值	P值
白细胞计数(×10⁹/L)	7.43±1.99	6.41±2.02	2.372	0.020
中性粒细胞计数(×10⁹/L)	4.56±1.62	4.58±1.96	0.069	0.945
血小板计数(×10⁹/L)	215.12±50.52	282.19±76.22	4.809	<0.001
淋巴细胞计数(×10⁹/L)	2.43±0.79	1.61±0.38	6.083	<0.001
尿酸(mmol/L)	290.67±79.10	328.65±105.48	1.889	0.063
血肌酐(mmol/L)	64.91±13.73	69.79±16.24	1.506	0.682
三酰甘油(mmol/L)	1.81±0.94	1.43±0.78	2.021	0.046
低密度脂蛋白(mmol/L)	2.97±0.85	2.95±0.95	0.064	0.949
高密度脂蛋白(mmol/L)	1.28±0.29	1.25±0.29	0.533	0.595
总胆固醇(mmol/L)	4.78±1.16	4.60±0.99	0.746	0.458

项目	低PLR组(n=43)	高PLR组(n=43)	t值	P值
斑块最大厚度(mm)	1.59±0.50	1.55±0.48	0.397	0.693
斑块最小厚度(mm)	0.47±0.36	0.50±0.38	0.290	0.773
斑块面积(mm²)	8.06±3.25	11.88±4..26	4.667	<0.001
最小管腔面积(mm² )	3.00±0.97	2.80±0.79	1.050	0.297
外弹力膜面积(mm² )	12.20±4.03	15.33±5.27	3.095	0.003
斑块负荷(%)	73.70±9.34	75.59±8.58	2.973	0.004