中性粒细胞-单核细胞/淋巴细胞比值与颈动脉粥样硬化斑块稳定性的相关性分析

Association between the neutrophil-monocyte to lymphocyte ratio and carotid atherosclerotic plaque stability

摘要:

目的 颈动脉粥样硬化斑块的不稳定性是缺血性卒中的重要病理基础，炎症反应在斑块形成及破裂过程中发挥关键作用。中性粒细胞-单核细胞/淋巴细胞比值（NMLR）是一种新型系统性炎症指标，其在颈动脉斑块稳定性评估中的价值尚不明确。本研究旨在探讨NMLR与颈动脉斑块稳定性的相关性，并评估其预测效能。方法 回顾性纳入211例接受颈动脉内膜切除术（CEA）的颈动脉狭窄患者，根据术中获取斑块的病理学评估结果分为斑块不稳定组（n=113）和斑块稳定组（n=98）。收集患者临床特征及术前实验室指标，计算NMLR和中性粒细胞与淋巴细胞计数比值（NLR）。采用多因素Logistic回归分析斑块不稳定的独立相关因素，并通过受试者工作特征（ROC）曲线评估NMLR与NLR对斑块稳定性的预测价值。结果 与稳定组比较，不稳定组患者NMLR和NLR水平均明显升高（均P<0.001）。多因素Logistic回归分析显示，既往卒中史（OR=4.59，95% CI=2.22~9.50）、NMLR（OR=7.07，95% CI=3.71~13.48）和NLR（OR=5.89，95% CI=3.09~11.25）是颈动脉斑块不稳定的独立预测因素。ROC曲线分析显示，NMLR预测斑块不稳定的曲线下面积（AUC）为0.83，最佳截断值为2.71，其敏感度为86.7%，特异度为69.7；NLR的AUC为0.79，两者预测效能相近。结论 NMLR作为一种整合中性粒细胞、单核细胞促炎作用及淋巴细胞免疫保护作用的炎症指标，与颈动脉斑块不稳定性密切相关，对斑块稳定性具有较高的预测价值，可为颈动脉粥样硬化患者的风险分层和卒中预防提供参考。

Abstract:

Background and Aims Plaque instability is a major pathological determinant of ischemic stroke in patients with carotid atherosclerosis, in which inflammation plays a pivotal role. The neutrophil-plus-monocyte to lymphocyte ratio (NMLR) is a novel systemic inflammatory marker, but its association with carotid plaque stability remains unclear. This study aimed to investigate the relationship between NMLR and carotid plaque stability and to evaluate its predictive value.Methods A total of 211 patients with carotid artery stenosis who underwent carotid endarterectomy were retrospectively enrolled. According to postoperative pathological assessment, patients were classified into a vulnerable plaque group (n=113) and a stable plaque group (n=98). Clinical characteristics and preoperative laboratory parameters were collected, and NMLR and neutrophil-to-lymphocyte ratio (NLR) were calculated. Multivariate Logistic regression analysis was performed to identify independent predictors of plaque vulnerability. Receiver operating characteristic (ROC) curves were used to assess the predictive performance of NMLR and NLR.Results Patients with vulnerable plaques had significantly higher NMLR and NLR levels than those with stable plaques (both P<0.001). Multivariate Logistic regression analysis identified previous stroke history (OR=4.59, 95% CI=2.22-9.50), NMLR (OR=7.07, 95% CI=3.71-13.48), and NLR (OR=5.89, 95% CI=3.09-11.25) as independent predictors of plaque vulnerability. ROC curve analysis demonstrated that NMLR yielded an AUC of 0.83 with an optimal cutoff value of 2.71, showing a sensitivity of 86.7% and a specificity of 69.7%. The AUC of NLR was 0.79, with comparable predictive performance.Conclusion NMLR, an inflammatory marker integrating the pro-inflammatory effects of neutrophils and monocytes and the protective role of lymphocytes, is closely associated with carotid plaque instability and exhibits good predictive value. It may serve as a convenient and effective tool for risk stratification and stroke prevention in patients with carotid atherosclerosis.