单核细胞与高密度胆固醇比值可预测冠心病患者心血管事件

Monocyte/HDL ratio in predicting cardiovascular events in coronary heart disease patients

目的探讨单核细胞与高密度胆固醇比值(MHR)对冠心病患者心血管事件(CVE)预测的能力是否优于单核细胞计数(MC)。方法本研究是一项前瞻性队列研究。连续入选2011年3月~2014年3月在阜外医院血脂中心住院治疗的中国汉族冠状动脉造影确诊的冠心病患者3798例,电话随访,平均随访时间24.6个月,失访168例,选择完成随访的3630例患者,其中发生CVE 347例(事件组),未发生CVE 3283例(无事件组),采用Cox比例风险模型评估MHR与MC对冠心病患者CVE预测的能力。结果事件组患者的MC和MHR及高敏C反应蛋白水平均高于非事件组(P<0.01)。调整潜在的混杂因素后(年龄、高血压、糖尿病、Gensini评分),Cox比例风险模型分析结果显示,MC和MHR是冠心病患者发生CVE的危险因素(HR=2.734,95%CI:1.547~4.832;HR=2.031,95%CI:1.268~3.254)。MC和MHR预测CVE的ROC曲线下面积分别为0.574(95%CI:0.542~0.606,P<0.01)和0.562(95%CI:0.530~0.594,P<0.01),两者均可预测CVE发生,且无统计学差异(P>0.05)。结论 MHR可预测冠心病患者CVE的发生,但并不优于MC。

Objectives To study whether monocyte/HDL ratio（MHR）is better than monocyte count（MC）in predicting cardiovascular events（CVE）in coronary heart disease（CHD）patients.Methods A total of 3798 coronary angiography-confirmed CHD patients were followed up for an average period of 24.6 months by telephone with 168 patients lost their follow-up.The followed up 3630 patients were divided into CVE group（n=347）and CVE-free group（n=3283）.The ability of MHR and MC to predict CVE in CHD patients was assessed according to the Cox proportional hazards model.Results The MC,MHR and serum hs-CRP level were higher in CVE group than in CVE-free group（P〈0.01）.Cox proportional hazards model showed that MC and MHR were the risk factors for CVE in CHD patients after adjustment for the potential confounders,namely age,hypertension,diabetes mellitus,Gensini score（HR=2.734,95%CI：1.547-4.832;HR=2.031,95%CI：1.268-3.254）.The area under the ROC curve for MC and MHR in predicting CVE was 0.574 and 0.562 respectively（95%CI：0.542-0.606,P〈0.001;95%CI：0.530-0.594,P〈0.01）.Conclusion Although MHR can predict CVE in CHD patients,it is not better than MC in predicting CVE in CHD patients.