摘要
目的探讨血清单核细胞与高密度脂蛋白比值(MHR)在冠心病诊断中的临床价值。方法收集2019年2月至2021年12月在长沙市第三医院心内科行冠状动脉造影的127例患者为研究对象,将冠状动脉狭窄程度≥50%的患者纳入冠心病组(n=97),<50%的患者纳入非冠心病组(n=30)。再根据临床分型将冠心病组分为稳定性心绞痛组(n=31)、不稳定性心绞痛组(n=35)及急性心肌梗死组(n=31)。采集入选病例的一般临床资料,检测其血清MHR、髓过氧化物酶(MPO)及超敏C反应蛋白(hs-CRP)水平,通过SYNTAX评分系统对冠状动脉病变程度进行评分,统计冠状动脉病变的支数。分析冠心病患者血清MHR、MPO及hs-CRP水平与冠状动脉病变狭窄程度的关系。依据冠心病患者MHR三分位数分为三个亚组:MHR低水平组(≤0.41,n=40),MHR中水平组(0.41<MHR≤0.48,n=30)、MHR高水平组(MHR>0.48,n=27),比较三个亚组中SYNTAX评分及冠状动脉病变支数的差异。用受试者工作特征(ROC)曲线分析血清MHR诊断冠心病的价值。采用多因素logistic回归分析冠心病的危险因素。结果(1)冠心病组血清MHR高于非冠心病组(P<0.001);在冠心病不同临床分型亚组中,血清MHR差异明显,急性心肌梗死组>不稳定性心绞痛组>稳定性心绞痛组,差异有统计学意义(P<0.001)。(2)冠心病组血清MHR、MPO、hs-CRP水平与SYNTAX评分均呈正相关(r=0.878、0.477、0.285,均P<0.001)。(3)MHR高水平组SYNTAX评分高于MHR中、低水平组;MHR中水平组SYNTAX评分高于MHR低水平组(P<0.001);三个MHR水平亚组中冠状动脉病变支数比较差异无统计学意义(P>0.05)。(4)多因素logistic回归分析结果显示,LDL-C(OR=1.107,95%CI:0.974~1.259)、MHR(OR=1.873,95%CI:1.352~2.496)是冠心病的独立危险因素(均P<0.05)。(5)ROC曲线显示,MHR诊断冠心病的曲线下面积为0.987,灵敏度为82.8%。结论冠心病患者血清中MHR较高,MHR与冠状动脉病变严重程度密切相关,是冠心病的独立危险因素。
Objective To investigate the clinical value of serum monocyte/high-density lipoprotein ratio(MHR)level in the diagnosis of coronary heart disease(CHD).Methods A total of 127 patients who underwent coronary angiography in the cardiology department of the Third Hospital of Changsha were enrolled as subjects.Patients with coronary artery stenosis≥50%were included in the CHD group(n=97),and patients with coronary artery stenosis<50%were included in the control group(n=30).According to the clinical classification of CHD,the patients were divided into stable angina group(n=31),unstable angina group(n=35)and acute myocardial infarction group(n=31).The general clinical data of the selected cases were collected,and the serum MHR,myeloperoxidase(MPO)and high sensitivity C-reactive protein(hs-CRP)were detected.The degree of coronary artery lesions was scored by Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery(SYNTAX)score system,and the number of coronary artery lesions was counted.The relationship between MHR level,MPO,hs-CRP and the degree of coronary artery stenosis in CHD group was analyzed.The MHR level of CHD was divided into three subgroups by triquartile:the differences of SYNTAX score and the number of coronary artery lesions were compared in the low MHR group(≤0.41,n=40),the middle MHR group(0.41<MHR≤0.48,n=30)and the high MHR group(MHR>0.48,n=27).The value of serum MHR in diagnosing CHD was analyzed by receiver operating characteristic(ROC)curve.The risk factors of CHD were analyzed by multivariate logistic regression.Results(1)The serum MHR level in CHD group was higher than that in non-CHD group(P<0.001).In different clinical subgroups of CHD:the levels of serum MHR were significantly higher in acute myocardial infarction group than unstable angina group and stable angina group(P<0.001).(2)There was a positive correlation between serum MHR,MPO level with SYNTAX score in CHD group(r=0.878,0.477,0.285,all P<0.001).(3)The SYNTAX score in high MHR group was higher than those in middle MHR and low MHR group;the SYNTAX score in middle MHR group was higher than that of low MHR group(P<0.001);There was no significant difference in the number of coronary artery lesions among the three MHR level subgroups(P>0.05).(4)Multivariate logistic regression analysis showed that LDL-C(OR=1.107,95%CI:0.974-1.259),MHR(OR=1.873,95%CI:1.352-2.496)were independent risk factors for CHD(all P<0.05).(5)ROC curve showed that the area under the curve of MHR in diagnosing CHD was 0.987,and the sensitivity was 82.8%.Conclusions Serum MHR level is higher in patients with CHD,which is closely related to the severity of coronary artery disease and is an independent risk factor of CHD.
作者
肖晓霞
王勇
张育民
刘国兵
石为
Xiao Xiaoxia;Wang Yong;Zhang Yumin;Liu Guobing;Shi Wei(Department of Cardiology,the Third Hospital of Changsha,Changsha 410007,China)
出处
《中国医师杂志》
CAS
2022年第11期1625-1629,1634,共6页
Journal of Chinese Physician
基金
湖南省自然科学基金(2019JJ80067)。
