摘要
目的探究术前单核细胞/高密度脂蛋白比值(MHR)对低密度脂蛋白胆固醇(LDL-C)正常的老年急性心肌梗死(AMI)患者冠状动脉介入治疗(PCI)近期预后预测价值。方法选择广州市番禺区中心医院2019年1月—2021年7月收治的164例拟行PCI治疗的LDL-C正常的老年AMI患者作为研究对象。收集PCI术前生化学指标(单核细胞计数、HDL水平)及其他临床资料[年龄、性别、体质量指数、发病至入院时间、饮酒史、吸烟史、基础疾病史(高血压、糖尿病等)、心肌梗死病史、病变部位、血肌酐水平及白细胞水平等],术后1周观察TIMI血流分级情况并根据血流状况将其分为血流正常组及血流障碍组。以Logistic多因素回归分析探讨LDL-C正常的老年AMI患者PCI术后血流障碍的相关因素,以受试者工作特征曲线(ROC)判定MHR水平对LDL-C正常的老年AMI患者PCI术后血流障碍的预测价值。结果本研究164例LDL-C正常的老年AMI患者中,PCI术后血流正常患者131例(血流正常组),占比79.88%;剩余33例治疗无效(血流障碍组),占比20.12%。血流正常组单核细胞计数及MHR水平均低于血流障碍组,差异均具有统计学意义(P<0.05);Logistic多因素回归分析结果显示,单核细胞计数及MHR水平均为影响LDL-C正常的老年AMI患者PCI术后血流障碍的相关因素(P<0.05);ROC分析显示,MHR水平预测LDL-C正常的老年AMI患者PCI术后血流障碍的最佳截断点为14.63,灵敏度为72.73%,特异度为74.81%,ROC曲线下面积(AUC)为0.797。结论术前单核细胞计数及MHR水平升高的LDL-C正常的老年AMI患者,术后更易出现血流障碍的情况;MHR水平对LDL-C正常的老年AMI患者PCI术后血流障碍具有一定的预测价值。
Objective To explore the value of preoperative monocyte/high-density lipoprotein ratio(MHR)in predicting the short-term prognosis of elderly patients suffering from acute myocardial infarction(AMI)scheduled to undergopercutaneous coronary intervention(PCI)with normal low-density lipoprotein cholesterol(LDL-C).Methods 164 elderly AMI patients with normal LDL-C,aged≥60,were hospitalized and scheduled to undergo drug eluting stent installation.Peripheral fasting venous blood samples were collected before the PCI to test the high-density cholesterol protein(HDL)and the monocyte level so as to calculate the monocyte to HDL ratio(MHR).The blood flow status was observed one week after PCI based on the standard of thrombolysis in myocardialinfarction(TIMI).Logistic multivariate regression analysis was used to explore the related factors of blood flow disturbance in elderly patients with normal LDL-C after PCI,and receiver operating characteristic curve(ROC)was used to determine the effect of MHR level on elderly patients with normal LDL-C after PCI.Collect pre-PCI biochemical indicators(monocyte count,HDL level)and other clinical data[Age,gender,time from onset of body mass index to hospital admission,history of drinking,smoking history,history of underlying diseases(hypertension,diabetes,etc.),history of myocardial infarction,lesion location,blood creatinine level and white blood cell level,etc.],History of myocardial infarction,diseased location,etc.,the TIMI blood flow grading was observed one week after the operation and divided into normal blood flow group and blood flow disorder group according to the blood flow status.Logistic multivariate regression analysis was used to explore the related factors of blood flow disturbance in elderly patients with normal LDL-C after PCI,and receiver operating characteristic curve(receiver operating characteristic curve,ROC)was used to determine the effect of MHR level on elderly patients with normal LDL-C after PCI.The predictive value of blood flow disorders.Results Among the 164 elderly AMI patients with normal LDL-C in this study,131 patients with normal blood flow after PCI(normal blood flow group),accounting for 79.88%;the remaining 33 cases were ineffective(blood flow disorder group),accounting for 20.12%.The monocyte count and MHR level of the normal blood flow group were lower than those of the blood flow disorder group,and the difference was statistically significant(P<0.05).Logistic multivariate regression analysis showed that the monocyte count and MHR level were both highly related factors affecting blood flow disturbance in elderly AMI patients with normal LDL-C after PCI(P<0.05).ROC analysis showed that the best cut off point,sensitivity,and specificity of MHR to predict the blood flow disturbance in elderly AMI patients with normal LDL-C after PCI was 14.63,72.73%,and 74.81%respectively,and the area under curve(AUC)was 0.797.Conclusion Elderly AMI patients with normal LDL-C with high preoperative monocyte count and MHR levels are more likely to have blood flow disorders after surgery.MHR level hascertain value to predict blood flow disorders in elderly AMI patients with normal LDL-C after PCI.
作者
叶菁
陈燕
曾泽宇
吴结红
YE Jing;CHEN Yan;ZENG Zeyu;WU Jiehong(Department of General Medicine,Guangzhou Panyu District Central Hospital,Guangzhou Guangdong 511400,China)
出处
《中国急救复苏与灾害医学杂志》
2022年第8期993-996,1012,共5页
China Journal of Emergency Resuscitation and Disaster Medicine
基金
2020年广东省自然科学基金(编号:2020A151501277)。
关键词
MHR
LDL-C
老年急性心肌梗死
PCI
预后预测
Monocyte/high-density lipoprotein ratio(MHR)
Acute myocardial infarction(AMI)
Percutaneous coronary intervention(PCI)
Low-density cholesterol protein(LDL)
Elderly patients
