单核细胞与高密度脂蛋白胆固醇的比值影响非ST段抬高型急性冠脉综合征预后

Effect of ratio of monocyte to high-density lipoprotein cholesterol on prognosis of patients with non-ST-segment elevation acute coronary syndrome

目的探讨单核细胞与高密度脂蛋白胆固醇的比值(monocyte-to-high density lipoprotein cholesterol ratio,MHR)对非ST段抬高型急性冠脉综合征(non-ST-segment elevation acute coronary syndrome,NSTE-ACS)患者预后的影响。方法本研究为回顾性队列研究,纳入陆军军医大学第二附属医院心内科2017年1月至2017年9月入院的NSTE-ACS患者435例,男性占67.4%,中位年龄62岁。按MHR三分位数将研究人群分为低水平组(0.152～0.433,145例)、中水平组(0.435～0.633,145例)和高水平组(0.636～2.904,145例),比较MHR各组间的临床资料,分析MHR与心血管危险因素的相关性,评估MHR与入院后12个月主要不良心脑血管事件(major adverse cardiovascular and cerebrovascular events,MACCE)的关系。结果在NSTE-ACS患者中,MHR与C反应蛋白(CRP)(r=0.534,P<0.01)、GRACE评分(r=0.433,P<0.01)等危险因素显著正相关。入院后12个月,NSTE-ACS患者共有78例发生MACCE(17.9%);发生MACCE患者的MHR水平高于无MACCE患者(P<0.01);MHR高、中、低水平组各有35例、25例和16例发生MACCE,组间比较差异有统计学意义(P=0.006)。Kaplan-Meier分析表明MHR高水平组有更高的MACCE发生率(log-rank=9.786,P=0.007)。COX回归显示MHR与MACCE相关(HR=2.528,95%CI:1.500～4.261,P<0.01),多因素分析进一步表明MHR为MACCE的独立预测因子(HR=2.193,95%CI:1.075～4.472,P=0.031)。结论 MHR与MACCE相关,并且是NSTE-ACS的一个独立预后危险因素。

Objective To investigate the effect of monocyte-to-high density lipoprotein cholesterol ratio(MHR) on the cardiovascular outcomes in the patients with non-ST-segment elevation acute coronary syndrome(NSTE-ACS). Methods This was a retrospective cohort study involving 435 patients diagnosed with NSTE-ACS(males accounted for 67.4% and median age 62 years) who were admitted between January 2017 and September 2017 in our hospital. According to the tertile of MHR, the subjects were divided into the low MHR group(0.152~0.433, n=145), the medium MHR group(0.435~0.633, n=145), and the high MHR group(0.636~2.904, n=145). Clinical data were compared among the 3 groups, the correlation between MHR and cardiovascular risk factors was evaluated, and the association of MHR with major adverse cardiovascular and cerebrovascular events(MACCE) was assessed during 12-month follow-up after admission. Results MHR was positively correlated with C-reactive protein(CRP, r=0.534, P<0.01) and Global Registry of Acute Coronary Event scores(GRACE, r=0.433, P<0.01) in the NSTE-ACS population. During the 12-month follow-up period, totally 78 patients with NSTE-ACS developed MACCE(17.9%), and their MHR levels were higher than those without MACCE(P<0.01). There were 35, 25 and 16 cases respectively developing MACCE in the high, medium and low MHR groups, and significant difference was seen among the 3 groups(P=0.006). Kaplan-Meier analysis revealed that the high MHR group had the higher incidence rate of MACCE than the other groups(log-rank=9.786, P=0.007). COX regression analysis showed that MHR was associated with MACCE(HR=2.528, 95%CI: 1.500~4.261, P<0.01). Multivariate analysis further indicated that MHR was an independent predictor of MACCE after adjustment(adjusted HR=2.193, 95%CI: 1.075~4.472, P=0.031). Conclusion MHR is associated with MACCE and is an independent predictor of cardiovascular outcomes in NSTE-ACS patients.