外周血MHR与冠状动脉粥样硬化易损斑块的关系

Relationship between peripheral MHR and coronary atherosclerotic vulnerable plaque

目的探讨外周血单核细胞计数/HDL-C(MHR)与冠状动脉粥样硬化易损斑块的关系。方法选择初诊冠心病患者186例,根据冠状动脉粥样硬化斑块的稳定性分为易损斑块组81例、非易损斑块组105例。收集两组一般人口学资料(包括性别、年龄、BMI)、相关临床资料(包括吸烟、高血压、2型糖尿病及冠心病家族史)、实验室检查资料[包括白细胞、中性粒细胞、单核细胞、淋巴细胞计数,血浆LDL-C、HDL-C、TC、TG、尿酸(UA)、肌酐(Cr)水平及MHR]。采用多因素Logistic回归分析获取冠状动脉粥样硬化易损斑块的独立危险因素;采用受试者工作特征(ROC)曲线评估外周血MHR对冠状动脉粥样硬化易损斑块的预测效能。采用Pearson相关分析法分析外周血MHR与冠状动脉粥样硬化易损斑块坏死核心构成比的关系。结果两组合并2型糖尿病者,白细胞、单核细胞计数,血浆LDL-C、HDL-C水平及MHR比较差异均有统计学意义(P均<0.05)。多因素Logistic回归分析显示,2型糖尿病(OR=2.408,95%CI:1.18~4.918)、LDL-C(OR=1.137,95%CI:1.016~1.272)、MHR(OR=2.866,95%CI:1.245~6.597)为冠状动脉粥样硬化易损斑块的独立危险因素(P均<0.05)。ROC曲线分析显示,外周血MHR评估冠状动脉粥样硬化易损斑块的曲线下面积为0.785(95%CI:0.730~0.840),最佳临界值为3.18,此时其诊断敏感性为72.45%、特异性为76.83%。Pearson相关分析显示,外周血MHR与冠状动脉粥样硬化易损斑块坏死核心构成比呈正相关关系(r=0.506,P<0.01)。结论外周血MHR是冠状动脉粥样硬化易损斑块的独立危险因素。外周血MHR可辅助识别冠状动脉粥样硬化易损斑块。

Objective To investigate the relationship between monocyte/high-density lipoprotein cholesterol(MHR)and coronary atherosclerotic vulnerable plaque.Methods One hundred and eighty-six patients with initially diagnosed coronary heart disease were enrolled in this study.Based on the stability of coronary atherosclerotic plaque,the patients were divided into two groups:the vulnerable plaque group(n=81)and non-vulnerable plaque group(n=105).The demographic data(including gender,age,BMI),the related clinical data(including smoking,hypertension,family history of type 2 diabetes and coronary heart disease),and laboratory test data[including white blood cells,neutrophils,monocytes,plasma low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),TC,TG,uric acid(UA),creatinine(Cr)levels and MHR]of the two groups were collected.Multivariate logistic regression analyses were performed to identify independent risk factors for coronary vulnerable plaque in patients with coronary heart disease.Receiver operating characteristic(ROC)curve was used to explore the diagnostic efficacy of MHR in detecting coronary vulnerable plaque.Pearson correlation analysis was used to analyze the correlation between MHR and the necrosis core composition.Results There were statistically significant differences in the distribution of diabetes,leukocyte and monocyte counts,plasma levels of LDL-C,HDL-C and MHR between the two groups(all P<0.05).Type 2 diabetes(OR=2.408,95%CI:1.180-4.918),LDL-C(OR=1.137,95%CI:1.016-1.272),and MHR(OR=2.866,95%CI:1.245-6.597)were independent risk factors for coronary vulnerable plaque.ROC curve revealed that the area under the curve of MHR in detecting coronary vulnerable plaque was 0.785(95%CI:0.730-0.840),with an optimal cut-off value of 3.18,sensitivity of 72.45%,and specificity of 76.83%.MHR was positively correlated with the necrosis core composition(r=0.506,P<0.01).Conclusion Peripheral MHR is an independent risk factor for coronary atherosclerotic vulnerable plaque.Peripheral MHR can assist early recognition of coronary vulnerable plaques in patients with coronary heart diseases.