单核细胞/高密度脂蛋白、单核细胞/淋巴细胞与急性ST段抬高型心肌梗死直接PCI术后的影响

Impact of monocyte/high-density lipoprotein ratio,monocyte/lymphocyte ratio and acute STsegment elevation myocardial infarction after primary percutaneous coronary intervention

目的探讨单核细胞/高密度脂蛋白比值(MHR)、单核细胞/淋巴细胞比值(MLR)与ST段抬高型心肌梗死(STEMI)及近期心血管事件的关系。方法纳入2010年1月至2012年12月杭州市第一人民医院心内科经急诊冠状动脉造影确诊为STEMI的患者作为STEMI组,另选取我院冠状动脉造影检查诊断非冠心病的患者作为对照组。比较两组的一般资料、实验室检验指标。通过多因素Logistic回归分析、ROC曲线评价MHR、MLR对STEMI的诊断价值。结果本研究共收集STEMI患者191例,非冠心病患者211例。STEMI组中高血压病史、糖尿病病史、吸烟史所占比及血清肌酐、超敏CRP、血红蛋白、血小板计数、单核细胞计数、MHR、MLR高于对照组,差异有统计学意义(P<0.05)。通过多因素回归分析示,MHR、MLR是STEMI的独立影响因素(MHR:OR=29.20,P<0.05;MLR:OR=0.08,P<0.05)。通过ROC曲线分析,MHR、MLR及MHR联合MLR对STEMI有一定的诊断价值(MHR:敏感度59.70%,特异度63.00%,AUC=0.64,P<0.05;MLR:敏感度70.70%,特异度56.90%,AUC=0.67,P<0.05)。MHR<0.45和MHR≥0.45两组、MLR<0.35和MLR≥0.35两组患者组间1月内的生存曲线比较差异均有统计学意义(P<0.05),且高MHR组、高MLR组患者的生存率较低。结论MHR、MLR是STEMI的独立影响因素,可作为辅助诊断STEMI的指标,高MHR及高MLR提示预后不良。

Objective To investigate the relationship between the monocyte/high-density lipoprotein ratio(MHR),the monocyte/lymphocyte ratio(MLR)and ST-segment elevation myocardial infarction(STEMI),short-term major adverse cardiac.Methods The patients with STEMI confirmed by emergent coronary arteriography form Jan 2010 and Dec 2012 in Hangzhou First People’s Hospital were enrolled as the STEMI group,and age-matched healthy individuals with non coronary heart disease confirmed by coronary arteriography were included as the control group.General information and laboratory examination results were compared between the two groups.Multivariate logistic regression analysis and ROC curve was used to evaluate the value of MHR and MLR in diagnosing STEMI.Results 191 patients with STEMI and 211 patients wirh non coronary heart disease were enrolled.The proportion of hypertension history,diabetes history,smoking history,serum creatinine,high-sensitivity C-reactive protein,hemoglobin,platelet count,monocyte count,MHR and MLR inthe STEMI group were statistically significantly higher than those in the control group(P<0.05).Multivariate logistic regression analysis results showed that MHR and MLR were independent factors of STEMI(MHR:OR=29.20,P<0.05;MLR:OR=0.08,P<0.05).Based on analysis of the ROC curve,MHR,MLR and MHR combined MLR may have diagnostic values for STEMI(MHR:sensitivity=59.70%,specificity=63.00%,AUC=0.64,P<0.05;MLR:sensitivity=70.70%,specificity=56.90%,AUC=0.67,P<0.05).The differences of 1-month survival curves in not only the MHR<0.45 group and MHR≥0.45 group,but also MLR<0.35 group and MLR≥0.35 group were statistically significant(P<0.05)and survival rates of high MHR group and high MLR group were lower than the low groups.Conclusion The levels of MHR and MLR in peripheral blood are are independent predictors of STEMI,and can be auxiliary diagnostic targets for STEMI.High MHR and MLR may indicate poor prognosis.