单核细胞/高密度脂蛋白胆固醇比值与非ST段抬高型心肌梗死患者GRACE评分的关系研究

Relationship between Monocyte to High-density Lipoprotein Cholesterol Ratio and GRACE Score in Patients with Non ST-segment Elevation Myocardial Infarction

背景单核细胞/高密度脂蛋白胆固醇比值(MHR)是近年发现的一种与心血管疾病预后相关的炎性指标,而明确其与非ST段抬高型心肌梗死(NSTEMI)患者GRACE评分的关系有助于临床医生早期识别NSTEMI高危患者。目的分析MHR与NSTEMI患者GRACE评分的关系。方法选取2017年江苏省苏北人民医院收治的NSTEMI患者116例,根据入院时GRACE评分分为低危组(GRACE评分≤108分,n=37)、中危组(GRACE评分为109~140分,n=45)及高危组(GRACE评分>140分,n=34)。比较三组患者一般资料和实验室检查指标,MHR与NSTEMI患者GRACE评分的相关性分析采用Spearman秩相关分析,NSTEMI患者GRACE评分危险分层的影响因素分析采用多因素有序Logistic回归分析,绘制受试者工作特征曲线(ROC曲线)以评价MHR对NSTEMI患者GRACE评分高危的预测价值。结果(1)三组患者男性比例、高血压发生率、吸烟率、收缩压、淋巴细胞计数(LYM)、血小板计数(PLT)、总蛋白、白蛋白、天冬氨酸氨基转移酶(AST)及丙氨酸氨基转移酶(ALT)比较,差异无统计学意义(P>0.05);三组患者年龄、糖尿病发生率、心率、Killip分级≥Ⅱ级者所占比例、白细胞计数(WBC)、血红蛋白(Hb)、单核细胞计数(MON)、中性粒细胞计数(NEU)、MHR、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、肌酐(Cr)、D-二聚体及脑钠肽(BNP)比较,差异有统计学意义(P<0.05)。(2)Spearman秩相关分析结果显示,MHR与NSTEMI患者GRACE评分呈正相关(rs=0.54,P<0.01)。(3)多因素有序Logistic回归分析结果显示,年龄〔OR=1.182,95%CI(1.101,1.268)〕、糖尿病〔OR=3.702,95%CI(1.004,13.639)〕、Killip分级≥Ⅱ级〔OR=74.626,95%CI(8.726,638.230)〕、MHR〔OR=1.226,95%CI(1.091,1.378)〕是NSTEMI患者GRACE评分危险分层的独立影响因素(P<0.05)。(4)ROC曲线显示,MHR预测NSTEMI患者GRACE评分高危的曲线下面积为0.885〔95%CI(0.817,0.953)〕,最佳截断值为20.23,灵敏度为82.4%,特异度为84.1%。结论MHR与NSTEMI患者GRACE评分呈正相关,是NSTEMI患者GRACE评分危险分层的影响因素,且对NSTEMI患者GRACE评分高危具有一定预测价值,可作为NSTEMI患者危险分层及预后的新型预测因子。

Background Monocyte to high-density lipoprotein cholesterol ratio(MHR)has recently been proposed as a new inflammatory index which is associated with prognosis of cardiovascular disease,thus it is helpful for clinicians to clear the relationship between MHR and GRACE score to early diagnose high-risk patients with non ST-segment elevation myocardial infarction(NSTEMI).Objective To analyze the relationship between MHR and GRACE score in patients with NSTEMI.Methods A total 116 patients with NSTEMI were selected in Northern Jiangsu People’s Hospital in 2017,and they were divided into low-risk group(with GRACE score≤108,n=37),medium-risk group(with GRACE score ranged from 109 to 140,n=45)and high-risk group(with GRACE score>140,n=34)according to the GRACE score at admission.General information and laboratory examination results were compared in the three groups,Spearman rank correlation analysis was used to analyze the correlation between MHR and GRACE score in patients with NSTEMI,multivariate ordered Logistic regression analysis was used to analyze the influencing factors of risk stratification of GRACE score in patients with NSTEMI,moreover ROC curve was drawn evaluate the predictive value of MHR on high risk of GRACE score in patients with NSTEMI.Results(1)There was no statistically significant difference in male proportion,incidence of hypertension,smoking rate,SBP,LYM,PLT,total protein,albumin,AST or ALT in the three groups(P>0.05),while there was statistically significant difference in age,incidence of diabetes,heart rate,proportion of patients with Killip grading≥Ⅱ-grade,WBC,Hb,MON,NEU,MHR,HDL-C,LDL-C,Cr,D-dimer and BNP in the three groups,respectively(P<0.05).(2)Spearman rank correlation analysis results showed that,MHR was positively correlated with GRACE score in patients with NSTEMI(rs=0.54,P<0.01).(3)Multivariate ordered Logistic regression analysis results showed that,age[OR=1.182,95%CI(1.101,1.268)],diabetes[OR=3.702,95%CI(1.004,13.639)],Killip grading≥Ⅱ-grade[OR=74.626,95%CI(8.726,638.230)]and MHR[OR=1.226,95%CI(1.091,1.378)]were independent influencing factors of risk stratification of GRACE score in patients with NSTEMI.(4)ROC curve showed that,AUC of MHR in predicting high risk of GRACE score was 0.885[95%CI(0.817,0.953)]in patients with NSTEMI,with optimum critical value of 20.23,sensitivity of 82.4%,specificity of 84.1%.Conclusion MHR is significantly positively correlated with GRACE score in patients with NSTEMI,and as an independent influencing factors of risk stratification of GRACE score,it has relatively high predictive value on high risk of GRACE score in patients with NSTEMI,which may be a new predictor of the risk stratification and prognosis.