术前单核细胞与高密度脂蛋白胆固醇比值对冠心病PCI术后患者预后的预测

Value of MHR predicting prognosis after PCI of patients with coronary artery disease

目的:评估术前单核细胞与高密度脂蛋白胆固醇比值(MHR)对冠状动脉粥样硬化性心脏病(冠心病)患者经皮冠状动脉介入术(PCI)后预后的预测价值。方法:收集2013年1月至2017年12月确诊为冠心病并行PCI治疗的患者3561例的临床资料。PCI术后开始,随访(37.59±22.24)个月。终点事件为主要不良心脑血管事件(MACCE)。MACCE定义为心源性死亡、再发心肌梗死、靶血管重建及脑卒中的复合终点。比较不同预后患者术前MHR。采用Cox回归分析评价术前MHR对冠心病PCI术后患者预后的预测价值。结果:随访期间520例发生MACCE。MACCE和非MACCE组术前MHR分别为(0.62±0.51)和(0.56±0.35),MACCE组高于非MACCE组(P<0.05)。Cox回归分析结果显示,在调整了性别构成、年龄、吸烟史、饮酒史、糖尿病史、高血压病史等混杂因素的影响后,术前MHR升高是冠心病PCI术后患者预后发生MACCE的危险因素(HR=1.323,95%CI=1.116~1.568)。结论:术前MHR升高是冠心病PCI术后患者预后发生MACCE的危险因素,可用于早期高危人群的危险分层。

Aim:To evaluate the value of monocyte-to-high density lipoprotein cholesterol ratio(MHR)for predicting prognosis after percutaneous coronary intervention(PCI)of the patients with coronary artery disease(CAD).Methods:A total of 3561 patients enrolled in this study from January 2013 to December 2017.The follow-up began after the PCI,and the follow-up time was(37.59±22.24)months.The end point was major adverse cardiac and cerebrovascular event(MACCE).MACCE was defined as the composite end point of cardiogenic death,recurrent myocardial infarction,target vessel reconstruction and stroke.The difference in baseline MHR between MACCE group and non-MACCE group was compared.Cox regression analysis was used to evaluate the predictive value of the baseline MHR for the prognosis after PCI.Results:MACCE occurred in a total of 520 cases.The baseline MHR of MACCE group and non-MACCE group was(0.62±0.51)and(0.56±0.35),respectively,and the MHR of MACCE group was higher than that of non-MACCE group(P<0.05).The results of Cox regression analysis showed that,after adjusting the influence of gender,age,smoking,alcohol consumption,diabetes,hypertension and other confounding factors,baseline MHR increasing was a risk factor for the MACCE after PCI of CAD patients(HR=1.323,95%CI=1.116-1.568).Conclusion:Elevated baseline MHR is a risk factor of MACCE after PCI of CAD patients.It can be used for early risk stratification of the high-risk patients.