作者：李其华，韦耀达

单位：

广西壮族自治区柳州市人民医院全科医学科

单位（英文）：

Department of General Medicine, Liuzhou People's Hospital, Liuzhou 545006, China

关键词：

冠心病; 中年人; 单核细胞与高密度脂蛋白胆固醇比值; Gensini评分; 冠状动脉病变; 预测价值;

关键词（英文）：

　Coronary disease; Middle aged; Monocyte/high-density lipoprotein cholesterol ratio; Gensini score;Coronary artery lesions; Predictive value

中图分类号：

DOI：

10.12114/j.issn.1008-5971.2023.00.078

基金项目：

摘要：

目的 探讨单核细胞与高密度脂蛋白胆固醇比值（MHR）评估中年人群发生冠心病及重度冠状动脉病变的价值。方法 选取2018—2019年柳州市人民医院心血管内科行冠状动脉造影的中年人群254例为研究对象。收集受试者的一般资料、实验室检查指标，计算MHR。采用冠状动脉造影评估受试者是否发生冠心病，采用Gensini评分方法评估冠状动脉病变严重程度。采用单因素及多因素Logistic回归分析探讨中年人群发生冠心病和重度冠状动脉病变的影响因素；采用ROC曲线分析MHR对中年人群发生冠心病和重度冠状动脉病变的评估价值。结果根据MHR四分位数将受试者分为MHR1组（MHR<0.31,60例）、MHR2组（0.31≤MHR<0.44,62例）、MHR3组（0.44≤MHR<0.58,67例）和MHR4组（MHR≥0.58,65例）。四组性别、BMI、有吸烟史占比、有糖尿病病史者占比、有高脂血症病史者占比、空腹血糖（FBG）、糖化血红蛋白（HbA1c）、HDL-C、TG、超敏C反应蛋白（hsCRP）、WBC、淋巴细胞计数（LYM）、中性粒细胞计数（NEU）、单核细胞计数（MON）、冠心病发生率、冠状动脉病变严重程度比较，差异有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，年龄[OR=1.092,95%CI(1.031,1.158)]、吸烟史[OR=2.839,95%CI(1.459,5.526)]、糖尿病病史[OR=2.965,95%CI(1.397,6.292)]、MHR[OR=1.938,95%CI(1.465,2.563)]是中年人群发生冠心病的独立影响因素（P<0.05）；性别[OR=3.481,95%CI(1.182,10.246)]、糖尿病病史[OR=2.613,95%CI(1.085,6.295)]、TC[OR=1.690,95%CI(1.155,2.472)]、MHR[OR=1.841,95%CI(1.181,2.869)]是中年人群发生重度冠状动脉病变的独立影响因素（P<0.05）。ROC曲线分析结果显示，MHR评估中年人群发生冠心病的曲线下面积为0.732[95%CI(0.671,0.793),P<0.001]，最佳截断值为0.39，灵敏度为0.821，特异度为0.563;MHR评估中年人群发生重度冠状动脉病变的曲线下面积为0.739[95%CI(0.649,0.830),P<0.001]，最佳截断值为0.54，灵敏度为0.688，特异度为0.752。结论 MHR升高是中年人群发生冠心病及重度冠状动脉病变的独立危险因素，且MHR对冠心病及重度冠状动脉病变具有中等评估价值。

英文摘要：

Objective To investigate the value of monocyte/high-density lipoprotein cholesterol ratio (MHR) inevaluating coronary heart disease (CHD) and the severe coronary artery lesions in middle-aged people. Methods A total of 254middle-aged people who underwent coronary angiography in the Cardiovascular Department of Liuzhou People's Hospital from2018 to 2019 were selected as the research subjects. The general data and laboratory examination indexes of the subjects werecollected, and MHR was calculated. Selective coronary angiography was used to evaluate whether CHD occurred, and Gensiniscoring method was used to evaluate the severity of coronary artery lesions. Univariate and multivariate Logistic regression analysiswas used to explore the influencing factors of CHD and severe coronary artery lesions in middle-aged people. ROC curve was usedto evaluate the value of MHR in evaluating CHD and severe coronary artery lesions in middle-aged people. Results The researchsubjects were divided into MHR1 group (MHR < 0.31, 60 cases) , MHR2 group (0.31 ≤ MHR < 0.44, 62 cases) , MHR3 group (0.44≤ MHR < 0.58, 67 cases) and MHR4 group (MHR ≥ 0.58, 65 cases) according to MHR quartile. There was statistically significantdifferences in gender, BMI, proportion of smoking history, proportion of diabetes history, proportion of hyperlipidemia history, fasting blood glucose (FBG) , glycosylated hemoglobin (HbA1c) , HDL-C, TG, high-sensitivity C-reactive protein (hs-CRP) ,WBC, lymphocyte count (LYM) , neutrophil count (NEU) , monocyte count (MON) , incidence of CHD and the severity of coronaryartery lesions among the four groups (P < 0.05) . Multivariate Logistic regression analysis showed that age [OR=1.092, 95%CI(1.031, 1.158) ] , smoking history [OR=2.839, 95%CI (1.459, 5.526) ] , diabetes history [OR=2.965, 95%CI (1.397, 6.292) ] ,MHR [OR=1.938, 95%CI (1.465, 2.563) ] were the independent influencing factors of CHD in middle-aged people (P < 0.05) ;gender [OR=3.481, 95%CI (1.182, 10.246) ] , diabetes history [OR=2.613, 95%CI (1.085, 6.295) ] , TC [OR=1.690, 95%CI(1.155, 2.472) ] , MHR [OR=1.841, 95%CI (1.181, 2.869) ] were the independent influencing factors of severe coronary arterylesions in middle-aged people (P < 0.05) . ROC curve analysis showed that the area under the curve of MHR in evaluating CHDin middle-aged people was 0.732 [95%CI (0.671, 0.793) , P < 0.001] , the best cutoff value was 0.39, the sensitivity was 0.821,the specificity was 0.563, and the area under the curve of MHR in evaluating severe coronary artery lesions in middle-aged peoplewas 0.739 [95%CI (0.649, 0.830) , P < 0.001] , the best cutoff value was 0.54, the sensitivity was 0.688, the specificity was 0.752.Conclusion Increased MHR is an independent risk factor for CHD and severe coronary artery lesions in middle-aged people,and MHR has medium evaluation value for CHD and severe coronary artery lesions in middle-aged people.

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