Significance of the neutrophil-lymphocyte ratio in elderly type 2 diabetic patients with coronary heart disease

Abstract

Objective To evaluate the value of the neutrophil-lymphocyte ratio (NLR) in elderly type 2 diabetic patients (T2DM) with coronary heart disease(CHD). Methods We performed a retrospective observational study on 228 patients undergoing coronary angiography in Guizhou Provincial People's Hospital from April 2014 to July 2015. Patients were divided into three groups: the simple T2DM group (n=77), simple CHD group (n=72), and T2DM complicated with CHD group (n=79). Meanwhile, 70 healthy elderly subjects served as the control group. The white blood cell count, high-sensitivity C-reactive protein (hs-CRP) and other clinical and laboratory parameters were collected, and NLR was calculated. Risk factors for CHD in T2DM patients were determined by logistic regression analysis. Multiple stepwise regression analysis was adopted to identify factors influencing NLR. Results The white blood cell count, neutrophil count, NLR and hs-CRP level in the simple T2DM, CHD, and T2DM+ CHD groups were higher than in the control group 〔(7.48 1.81) 109/L, (7.72±1.89) 109/L, (7.98±2.12) 109/L vs. (6.22±1.61) 109/L; (4.49±1.38) 109/L, (4.88±1.56) 109/L, (5.35±1.40) 109/L vs. (3.52±0.84) 109/L; (2.84±0.77), (3.07±0.79), (3.34±0.83) vs. (1.58±0.42); (2.92±0.65) mg/L, (3.20±0.86) mg/L, (4.98±1.10) mg/L vs. (1.105±0.23) mg/L; respectively, P<0.05 or P<0.01〕. The lymphocyte count in the simple T2DM, CHD, and T2DM+ CHD groups were lower than in the control group 〔(1.57±0.41)×109/L, (1.58±0.40)×109/L, (1.61±0.48)×109/L vs. (2.22±0.51)×109/L, P<0.05〕. NLR and hs-CRP levels in the T2DM+ CHD group were higher than in the former two groups (all P<0.05). Pearson correlation analysis showed that NLR was positively correlated with the Gensini score and hs-CRP level (r=0.7455 and 0.7792, both P<0.01). Logistic regression analysis showed that NLR, hs-CRP levels and glycosylated hemoglobin A1c (HbA1c) were the risk factors for CHD in T2DM patients (OR=4.331, 3.997 and 2.928, all P<0.05). Multiple stepwise regression analysis showed that NLR was positively correlated with fasting plasma glucose, HbA1c levels and systolic blood pressure (β'=0.3133, 0.4720 and 0.3069, all P<0.05). Conclusions NLR may be a valuable predictive factor for CHD in elderly T2DM patients. Key words: Diabetes mellitus, type 2; Coronary disease; Neutrophils; Lymphocytes