单核细胞/高密度脂蛋白胆固醇比值对急性冠状动脉综合征患者近期预后的预测价值

The predictive value of monocyte to high-density lipoprotein cholesterol ratio for the short-term prognosis in patients with acute coronary syndrome

目的探讨单核细胞/高密度脂蛋白胆固醇比值(MHR)与急性冠状动脉综合征(ACS)患者近期发生主要不良心血管事件(MACE)的相关性,评估MHR对ACS患者近期预后的预测价值。方法选择2020年8月至2021年6月在我院心内科住院的252例ACS患者,收集患者的临床资料,根据单核细胞计数及高密度脂蛋白胆固醇(HDL-C)水平,计算出二者的比值,得出MHR。依据MHR值三分位数分组,分为低值组(MHR<11.19)84例、中值组(11.19≤MHR≤15.38)84例、高值组(MHR>15.38)84例。随访时间为6个月,观察终点为MACE发生,通过Cox回归模型分析MHR对近期预后的影响,ROC曲线比较MHR、GRACE评分对ACS患者出院后6个月内发生MACE的预测价值。结果MHR高值组的年龄、Gensini评分、GRACE评分、单核细胞计数、hsCRP高于低值组和中值组,差异均有统计学意义(P<0.001)。多因素Cox回归分析结果显示,MHR增加(HR=1.126,95%CI 1.065~1.190,P<0.001)是ACS患者出院后6个月内发生MACE的独立危险因素。ROC曲线分析结果显示,MHR、GRACE评分预测ACS患者近期发生MACE的曲线下面积(AUC)分别为0.742、0.735,敏感度分别为68.89%、66.67%,特异度分别为71.89%、69.57%,比较二者AUC的差异无统计学意义(P>0.05)。结论MHR对ACS患者近期预后有一定的预测价值,其预测效能与GRACE评分相当。

Objective To investigate the correlation between monocyte to high-density lipoprotein cholesterol ratio(MHR)and recent major adverse cardiovascular events(MACE)in patients with ACS and to evaluate the predictive value of MHR for the short-term prognosis in ACS patients.Methods From August 2020 to June 2021,252 patients diagnosed with ACS were enrolled in our hospital.The data of the patients were collected and the ratio of monocyte count and high density lipoprotein cholesterol(HDL-C)level was calculated to obtain MHR.According to the MHR level,the patients were stratified into three groups by tertiles,including the low MHR group(n=84 with MHR<11.19),middle MHR group(n=84 with 11.19≤MHR≤15.38)and high MHR group(n=84 with MHR>15.38).The follow-up time was 6 months,and the observation end point was the occurrence of MACE.Cox regression model was used to analyze the influence of MHR on the short-term prognosis,and ROC curve was used to compare the predictive value of MHR and GRACE score for MACE occurrence in the ACS patients within 6 months after discharge.Results The age,Gensini score,GRACE score,monocyte count and hsCRP of the high MHR group were significantly higher than those of the low MHR group and the median MHR group(P<0.001).Multivariate Cox regression analysis showed that increased MHR(HR=1.126,95%CI 1.065~1.190,P<0.001)was an independent risk factor of MACE in the ACS patients within 6 months after discharge.ROC curve analysis demonstrated that the area under curve(AUC)of MHR was 0.742,with 68.89%sensitivity and 71.89%specificity,and that of GRACE score was 0.735 with 66.67%sensitivity and 69.57%specificity;there was no significant difference in AUC between the two indexes(P>0.05).Conclusion MHR has a certain predictive value for the short-term prognosis of ACS patients,and its predictive efficacy is similar to that of GRACE score.