单核细胞/高密度脂蛋白胆固醇比值和游离甲状腺素/游离三碘甲状腺原氨酸比值与原发性高血压合并心房颤动的相关性

Correlation between monocyte to high density lipoprotein cholesterol ratio, free thyroxine to free triiodothyronine ratio and essential hypertension combined with atrial fibrillation

目的探讨原发性高血压(EH)合并心房颤动(AF)与单核细胞/HDL-C比值(MHR)、FT4/FT3比值的相关性。方法收集2020年1月—2021年12月在河北医科大学第一医院心脏中心住院治疗的360例EH患者的临床资料,根据是否合并AF分为EH+AF组(110例)和EH组(250例);采用倾向性评分匹配对两组患者进行匹配,匹配后两组均为102例。比较两组患者的一般资料、实验室指标,采用偏相关分析MHR、FT4/FT3比值与各指标的相关性,采用ROC曲线评估MHR、FT4/FT3比值及两指标联合对EH合并AF患者的诊断效能。结果EH+AF组患者的载脂蛋白A1、血钾、血尿酸、血肌酐水平,以及MHR、FT4/FT3比值均显著高于EH组(P值均<0.05);血钠、TG和LDL-C水平均显著低于EH组(P值均<0.05)。偏相关分析结果显示,在控制年龄、收缩压、舒张压、降压药和他汀类降脂药后,MHR与LDL-C水平呈正相关(r=0.303,P<0.01),与载脂蛋白A1、血钠水平呈负相关(r值分别为-0.403、-0.157,P值分别<0.01、0.05),与血钾、血尿酸、血肌酐、TG水平和FT4/FT3比值均无相关性(r值分别为0.035、0.119、0.079、0.099、-0.040,P值均>0.05);FT4/FT3比值与血尿酸水平呈正相关(r=0.183,P<0.05),与载脂蛋白A1水平呈负相关(r=-0.218,P<0.05),与血钠、血钾、血肌酐、TG、LDL-C水平和MHR均无相关性(r值分别为-0.023、-0.104、0.067、-0.091、-0.050、-0.040,P值均>0.05)。与未服用降压药患者相比,EH+AF组服用钙离子拮抗剂和单片复方制剂降压药患者的MHR均显著降低(P值均<0.05);EH组服用ARB/ACEI降压药患者的MHR有降低趋势,但差异无统计学意义(P>0.05)。与未服用他汀类降脂药患者相比,EH+AF组服用中效降脂药和强效降脂药患者的MHR均显著降低(P值均<0.05),EH组服用强效降脂药患者的MHR显著降低(P<0.05);EH+AF组服用强效降脂药患者的MHR较服用中效降脂药患者显著降低(P<0.05)。MHR、FT4/FT3比值、MHR+FT4/FT3比值诊断EH+AF的ROC的AUC分别为0.619、0.862、0.874。选取约登指数最大值为阈值,MHR、FT4/FT3比值、MHR+FT4/FT3比值诊断EH合并AF的最佳截断值分别为0.455、2.115、0.508,所对应的诊断灵敏度分别为0.569、0.951、0.765,诊断特异度分别为0.647、0.686、0.824。结论MHR、FT4/FT3比值与EH合并AF存在相关性,且两指标联合检测对EH合并AF具有一定的辅助诊断价值。

Objective To investigate the level and significance of monocyte to high density lipoprotein cholesterol ratio(MHR)and free triiodothyronine/free thyroxine(FT4/FT3)in patients with essential hypertension(EH)combined with atrial fibrillation(AF).Methods A total of 360 EH patients admitted to the First Hospital of Hebei Medical University from January 2020 to December 2021 were enrolled in this study.They were divided into an EH+AF group(n=110)and an EH group(n=250),and 102 pairs were successfully matched with the propensity score matching(PSM).The general data and laboratory indicators were compared between two groups.The correlation between MHR,FT4/FT3 and each indicator was investigated by partial correlation analysis.The receiver operator characteristic(ROC)curve was used to evaluate the diagnostic efficacy of MHR,FT4/FT3 and the combination of the two indicators for EH+AF.Results The levels of apolipoprotein A1(Apo A1),serum potassium,blood uric acid(UA),serum creatinine(sCr),MHR and FT4/FT3 in EH+AF group were significantly higher than those in EH group(all P<0.05).The levels of serum sodium,triglyceride(TG)and low-density lipoprotein cholesterol(LDL-C)in EH+AF group were significantly lower than those in EH group(all P<0.05).Partial correlation analysis showed that after controlling the age,systolic pressure,diastolic pressure,antihypertensive drugs and statins,MHR was positively correlated with LDL-C(r=0.303,P<0.05),negatively correlated with Apo A1(r=-0.403,P<0.01)and serum sodium(r=-0.157,P<0.05),and not correlated with serum potassium,UA,sCr,TG and FT4/FT3(r=0.035,0.119,0.079,0.099,-0.040,all P>0.05).FT4/FT3 was positively correlated with UA(r=0.183,P<0.05),negatively correlated with Apo A1(r=-0.218,P<0.05),and not correlated with serum sodium,potassium,sCr,TG,LDL-C or MHR(r=-0.023,-0.104,0.067,-0.091,-0.050,-0.040,all P>0.05).Compared with those without antihypertensive drugs,patients in the EH+AF group who took CCB and monolithic compound antihypertensive drugs had significantly lower MHR(P<0.05),patients in the EH group who took ARB/ACEI had slightly low MHR(P>0.05).Compared with those who did not take statins,patients in the EH+AF group who took moderate and strong lipid-lowering drugs and patients in the EH group who took strong lipid-lowering drugs had significantly lower MHR(P<0.05).In the EH+AF group,patients who took strong lipid-lowering drugs had lower MHR than those taking moderate lipid-lowering drugs(P<0.05).The AUC of EH+AF diagnosed by MHR,FT4/FT3 and MHR+FT4/FT3 were 0.619,0.862 and 0.874,respectively.When the maximum Youden index was selected as the threshold value,the best cutoff values of MHR,FT4/FT3 and MHR+FT4/FT3 for EH+AF diagnosis were 0.455,2.115 and 0.508,respectively,with the sensitivity being 0.569,0.951 and 0.765,and the specificity of 0.647,0.686 and 0.824,respectively.Conclusion Both MHR and FT4/FT3 are correlated with EH+AF,and the combined detection being the two indicators has auxiliary diagnostic value for EH+AF.