单核细胞与高密度脂蛋白胆固醇比值对急性心肌梗死患者药物洗脱支架植入术后支架内再狭窄的预测价值

Predictive Value of Monocyte and High-Density Lipoprotein Cholesterol Ratio for In-stent Restenosis After Drug-Eluting Stent Implantation in Acute Myocardial Infarction Patients

目的探讨单核细胞与高密度脂蛋白胆固醇比值(MHR)对急性心肌梗死(AMI)患者药物洗脱支架(DES)植入术后支架内再狭窄(ISR)的预测价值。方法选择2018年1月至2019年12月在郑州大学第一附属医院接受DES植入术的292例AMI患者作为研究对象,根据术后1a内是否发生ISR分为ISR组(101例)和非ISR组(191例)。比较两组的一般资料、实验室检验、冠状动脉病变情况及支架相关数据。采用多因素logistic回归分析MHR与AMI患者DES植入术后ISR的关系。结果两组年龄、高血压史、糖尿病史、高密度脂蛋白胆固醇、MHR、左主干病变、左回旋支病变、支架数目、支架串联、三支病变比较,差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示高血压史、支架数目、MHR是独立影响因素。MHR对AMI患者DES植入术后ISR的曲线下面积(AUC)为0.674(95%CI:0.613~0.735,P<0.001),最佳界值点0.66,其灵敏度为69.3%,特异度为61.3%。结论MHR升高对AMI患者冠状动脉DES植入术后ISR有一定的预测价值,是ISR发生的危险因素。

Objective To investigate the predictive value of monocyte and high-density lipoprotein cholesterol ratio(MHR)for in-stent restenosis(ISR)after drug-eluting stent(DES)implantation in acute myocardial infarction(AMI)patients.Methods A total of 292 patients with AMI who accepted DES in the First Affiliated Hospital of Zhengzhou University from January 2018 to December 2019 were selected as the research object.Patients were divided into ISR group(101 cases)and non-ISR group(191 cases)according to whether ISR occurred within 1 year after procedure.General information,laboratory examination results,coronary artery lesions and DES data were compared between the two groups.Multivariate logistic regression was used to analyze the relationship between MHR and ISR after DES implantation in patients with AMI.Results There were statistical differences between the two groups in age,history of hypertension,history of diabetes,high-density lipoprotein cholesterol,MHR,left main coronary artery disease,left circumflex artery disease,stent number,stent series and three-vessel lesion(P<0.05).Multivariate logistic regression analysis results showed that hypertension history,MHR and stent number were independent factors of AMI.The area under the curve(AUC)of MHR in patients with AMI after DES implantation was 0.674(95%CI:0.613-0.735,P<0.001),the best cut-off point was 0.66,with a sensitivity of 69.3%and a specificity of 61.3%.Conclusion The increase of MHR has a certain predictive value for ISR after coronary DES implantation in patients with AMI,which is a risk factor for ISR.