老年高血压合并不稳定型心绞痛患者γ-谷氨酰基转移酶与血小板比值单核细胞与高密度脂蛋白胆固醇比值与冠状动脉病变程度的相关性

Correlation of gamma-glutamyl transpeptidase to platelet ratioand monocyte count to high-density lipoprotein cholesterol ratio with the severity of coronary artery disease in elderly hypertension patients with unstable angina pectoris

目的探讨老年原发性高血压(EH)合并不稳定型心绞痛(UA)患者γ-谷氨酰基转移酶与血小板比值(GPR)、单核细胞与高密度脂蛋白胆固醇比值(MHR)水平与冠状动脉病变程度的相关性。方法入选2018年9月至2019年9月我院心脏内科门诊以EH收入院且年龄≥60岁并行冠状动脉造影患者218例,根据是否合并UA分为EH+UA组113例、单纯EH组105例,另选择疑诊冠心病入院冠脉造影正常患者为健康组106例。比较各组患者的一般资料,分析EH+UA组GPR.MHR与冠脉Gensini评分的相关性,依据病变支数将EH+UA组分为单支病变组、双支病变组和三支病变组,比较各亚组间冠脉Gensini评分、GPR、MHR差异,采用受试者工作特征(ROC)曲线评估GPR.MHR及两指标联合检测对EH+UA患者的辅助诊断效能。结果与健康组相比,EH+UA组、EH组患者的体质指数(BMI)E(25.8±3.4)kg/m^2、(25.4±3.6)kg/m^2比(24.2±2.3)kg/m^2]、三酰甘油[(1.9±1.2)mmol/L、(2.0±1.2)mmol/L比(1.5±1.1)mmol/L]、MHR[6.6±1.4,5.8±1.7比4.9±1.7]较高,高密度脂蛋白胆固醇(HDL-C)[(1.1±0.2)mmol/L、(1.1±0.3)mmol/L比(1.3±0.3)mmol/L]较低,EH+UA组白细胞E(6.7±1.5)×10^9/L与(6.1±1.8)×10^9/L]、低密度脂蛋白胆固醇(LDL-C)[(2.3±0.6)mmol/L与(2.1±0.6)mmol/L]、GPR(0.3±0.1与0.2±0.1)较高(均P<0.05)。与EH组相比,EH+UA组的GPR(0.3±0.1与0.2±0.1)、MHR(6.6±1.4与5.8±1.7)较高(均P<0.05)。相关性分析表明,EH+UA患者GPR.MHR水平与冠状动脉Gensini评分呈正相关(r=0.537,0.333,均P<0.05),且随病变支数增多而升高(均P<0.05)。受试者工作特征(ROC)曲线分析表明GPR具有较高特异度和阳性预测价值(GPR特异度68.9%,ROC曲线下面积0.842),而MHR具有较高的敏感度(MHR敏感度92.9%),当两指标联合检测时,特异度及阳性预测价值更高(两指标联合检测特异度84.0%,ROC曲线下面积0.871)。结论GPR、MHR比值升高可作为辅助诊断老年EH+UA、评估冠状动脉病变严重程度的标志物。

Objective To investigate the correlation of the gamma-glutamyl transpeptidase to platelet ratio(GPR)and monocyte count to high-density lipoprotein cholesterol(HDL-C)ratio(MHR)with the severity of coronary artery disease in elderly patients with essential hypertension(EH)combined with unstable angina pectoris(UA).Methods A total of 218 EH patients aged 60 years and over undergoing coronary arteriography admitted to cardiology department of our hospital were enrolled from September 2018 to September 2019.They were divided into the EH plus UA group(n=113)and the simple EH group(n=105)according to whether UA was combined.In addition,106 patients with normal coronary angiography who were suspected with coronary heart disease were selected as the healthy group.General data of patients between three groups were compared.Severity of coronary artery disease was evaluated using a Gensini score.The correlation of GPR and MHR with coronary Gensini scores was analyzed in the EH plus UA group.Patients in the EH plus UA group were sub-grouped into the single-,double-and triple-vessel disease groups according to the number of disease branches.Differences in coronary Gensini scores,GPR and MHR were compared among subgroups.A receiver operating characteristic(ROC)curve was used to evaluate the auxiliary diagnostic efficacy of GPR,MHR and the combined GPR and MHR in the EH plus UA group.Results Compared with the healthy group,both EH plus UA group and EH group showed that the BMI(25.8±3.4 kg/m^2,25.4±3.6 kg/m^2 vs.24.2±2.3 kg/m^2),triglyceride(1.9±1.2,2.0 ± 1.2 vs.1.5+1.1 mmol/L),and MHR(6.6±1.4,5.8±1.7 vs.4.9±1.7)were increased,and the HDL-CC1.1±0.2 mmol/L,1.1±0.3 mmol/L vs.1.3±0.3 mmol/L)were reduced(P<0.05),and only EH plus UA group showed that white blood cells(6.7±1.5×10^9/L vs.6.1 zt 1.8×10^9/L),LDL-C(2.3±0.6 mmol/L vs.2.1±0.6 mmol/L)and GPR(0.3±0.1 vs.0.2±0.1)were higher than in the healthy group(P<0.05).Compared with the EH group,the EH plus UA group showed that the GPR(0.3±0.1 vs,0.2±0.1),and MHR(6.6±1.4 us.5.8±1.7)were increased(P <0.05).The correlation analysis showed that the levels of GPR and MHR were positively correlated with Gensini scores in the EH plus UA group(P=0.537,0.333,P<0.05),and the correlation was better along with the increased number of diseased branches(P<0.05).The ROC curve analysis showed that GPR had a high specificity and positive predictive value with the specificity of 68.9%and the area under the ROC curve(AUC)of 0.842,while MHR had a high sensitivity with the sensitivity of 92.9%.The combined detection of GPR and MHR had a higher specificity and positive predictive value with a specificity of 84.0%and the AUC of 0.871.Conclusions The increase of GPR and MHR can be used as a marker to assist the diagnosis of EH combined with UA,and to assess the severity of coronary artery disease in the elderly.