升高的单核细胞/淋巴细胞比值与老年急性心肌梗死患者住院期间死亡风险相关

Elevated monocyte to lymphocyte ratio is associated with the in-hospital mortality risk in elderly patients with acute myocardial infarction

[目的]探讨升高的单核细胞/淋巴细胞比值(MLR)与老年急性心肌梗死(AMI)患者住院期间死亡风险之间是否相关。[方法]回顾性收集2015年12月─2021年12月在大连医科大学附属第二医院心血管内科住院治疗的老年AMI患者的病史资料,共1550例,其中发生住院期间死亡的患者共132例。主要包括性别、年龄、身高、体质量、血常规、血脂相关指标、空腹血糖、心肌酶、心肌梗死类型、估算的肾小球滤过率(eGFR)、住院期间结局、心力衰竭、糖尿病和高血压患病情况以及住院期间他汀类药物、抗血小板药物的使用情况。根据ROC曲线分析结果,将MLR>0.342的患者定义为高MLR组(n=699),MLR≤0.342的患者则定义为低MLR组(n=851)。[结果]高MLR组患者的年龄、白细胞计数、单核细胞计数、MLR、心肌肌钙蛋白I(cTnI)、空腹血糖(FBG)、eGFR<60 mL/(min·1.73 m^(2))、男性患者、心力衰竭、住院期间发生全因死亡人数的比例均高于低MLR组(P<0.05),体质指数(BMI)、淋巴细胞计数、低密度脂蛋白胆固醇(LDLC)、eGFR>60 mL/(min·1.73 m^(2))、高血压、使用抗血小板类药物的人数均低于低MLR组(P<0.05)。多因素逻辑回归结果显示,高MLR与老年AMI患者住院期间死亡风险独立相关(OR=1.812,95%CI:1.106~2.969,P=0.018)。ROC曲线分析结果显示,MLR联合cTnI或FBG后其预测能力显著提升,ROC曲线下面积分别为0.789和0.739。限制性立方样条(RCS)分析结果显示,MLR与老年AMI患者住院结局之间存在线性的剂量-反应关系。[结论]升高的MLR与老年AMI患者住院期间死亡风险独立相关,临床医生可在日常诊疗中考虑使用MLR指标对这类患者进行风险分层和相关处置以改善其短期预后。

Aim To investigate whether elevated monocyte to lymphocyte ratio(MLR)is associated with the in-hospital mortality risk in elderly patients with acute myocardial infarction(AMI).Methods The medical history of 1550 elderly patients with AMI hospitalized in the Department of Cardiology of the Second Affiliated Hospital of Dalian Medical University from December 2015 to December 2021 was retrospectively collected,including 132 patients who died during hospitalization.It mainly includes gender,age,height,body weight,blood routine,lipid related indicators,fasting blood glucose(FBG),myocardial enzyme,type of myocardial infarction,estimated glomerular filtration rate(eGFR),in-hospital outcomes,prevalence of heart failure,diabetes,hypertension,and use of statins and antiplatelets during hospitalization.According to ROC curve analysis,patients with MLR>0.342 were defined as high MLR group(n=699),whereas patients with MLR≤0.342 were defined as low MLR group(n=851).Results The age,white blood cell count,monocyte count,MLR,cardiac troponin I(cTnI),FBG,eGFR<60 mL/(min·1.73 m^(2)),male patients,heart failure,and proportion of all-cause deaths occurred during hospitalisation were higher in the high MLR group than those in the low MLR group(P<0.05),body mass index(BMI),lymphocyte count,low density lipoprotein cholesterol(LDLC),eGFR>60 mL/(min·1.73 m^(2)),hypertension,and use of antiplatelet agents were lower in the high MLR group compared to the low MLR group(P<0.05).Multivariate Logistic regression results showed that high MLR was independently associated with the in-hospital mortality risk in elderly AMI patients(OR=1.812,95%CI:1.106~2.969,P=0.018).The results of ROC curve analysis showed that the predictive ability of MLR combined with cTnI or FBG would be significantly improved,and the area under ROC curve was 0.789 and 0.739,respectively.Restrictive cubic spline(RCS)analysis results indicated a linear dose-response relationship between MLR and in-hospital outcomes in elderly AMI patients.Conclusion Elevated MLR is independently associated with the in-hospital mortality risk in elderly AMI patients,and clinicians can consider using MLR indicators in daily diagnosis for risk stratification and related treatment of such patients to improve their short-term prognosis.