单核细胞与高密度脂蛋白胆固醇比值对老年急性心肌梗死患者新发心房颤动的预测价值

Value of monocyte/HDL-C ratio in predicting new-onset AF in elderly acute myocardial infarction patients

目的探讨单核细胞/HDL-C比值(MHR)对老年急性心肌梗死(AMI)患者新发心房颤动(房颤)的预测价值。方法选择2018年1月~2019年12月天津医科大学第二医院心脏科住院的老年AMI患者288例,根据住院期间是否新发房颤分为房颤组58例和非房颤组230例。房颤组又根据MHR截断值分为高MHR组45例,低MHR组13例。收集研究对象一般临床资料,ROC曲线分析MHR对老年AMI患者新发房颤的预测价值。结果与非房颤组比较,房颤组年龄、入院时心率、MHR和左心房内径明显升高,男性、HDL-C水平明显降低,差异有统计学意义(P<0.01)。logistic回归分析显示,MHR对老年AMI患者新发房颤具有最强的预测价值(OR=2.928,95%CI:1.325~10.298,P=0.001)。ROC曲线分析显示,MHR预测老年AMI患者新发房颤的曲线下面积为0.822(95%CI:0.765~0.880,P<0.01),最佳截断值为0.43,敏感性为78%,特异性为77%。高MHR组住院期间新发房颤发生率明显高于低MHR组(46.8%vs 6.8%,P<0.01)。结论MHR可独立预测老年AMI患者新发房颤的发生,对患者危险分层及指导早期预防治疗有一定的应用价值。

Objective To study the value of monocyte/HDL-C ratio(MHR)in predicting the newonset AF in elderly acute myocardial infarction(AMI)patients.Methods Two hundred and eighty-eight elderly AMI patients were divided into AF group(n=58)and AF-free group(n=230).The patients in AF group were further divided into high MHR group(n=45)and low MHR group(n=13).Their clinical data were recorded.The value of MHR in predicting the newonset AF in elderly AMI patients was analyzed by ROC curve analysis.Results The age was significantly older,the heart rate and MHR on admission were significantly higher,the left atrial diameter was significantly longer while the number of elderly male AMI patients was significantly smaller and the serum HDL-C level was significantly lower in AF group than in AF-free group(P<0.01).Logistic regression analysis showed that value of MHR was the highest in predicting the new-onset AF in elderly AMI patients(OR=2.928,95%CI:1.325-10.298,P=0.001).ROC curve analysis displayed that the AUC for MHR in predicting the new-onset AF in elderly AMI patients was 0.822(95%CI:0.765-0.880,P<0.01)with a cut-off value of 0.43,a sensitivity of 78%,and a specificity of 77%.The incidence of new-onset AF was significantly higher in high MHR group than in low MHR group(46.8%vs 6.8%,P<0.01).Conclusion MHR can independently predict the new-onset AF and can thus play a certain role in stratifying the risk of AF and in guiding its early prevention and treatment in elderly AMI patients.