LDL-C水平正常的绝经后女性单核细胞/HDL-C比值与冠状动脉病变和短期预后的关系  

Relationship between monocyte to HDL-C ratio and coronary lesion severity/short-term prognosis in postmenopausal women with normal LDL-C level

作　　者：王莹[1] 吴少敏 许少莹 黄健强[1] 马贵洲[1] 蔡志雄[1] WANG Ying;WU Shao-Min;XU Shao-ying;HUANG Jian-qiang;MA Gui-zhou;CAI Zhi-xiong(Department of Cardiovasology,Shantou Central Hospital,Shantou 515031,China;Department of Rehabilitation Medicine,Shantou Central Hospital,Shantou 515031,China)

机构地区：[1]汕头市中心医院心血管内科,广东汕头515031 [2]汕头市中心医院康复医学科,广东汕头515031

出　　处：《中国病理生理杂志》2020年第7期1255-1260,共6页Chinese Journal of Pathophysiology

基　　金：2018年度汕头市第六批医疗卫生科技计划(自筹经费类)项目基金资助(汕府科[2019]11号-8);2019年度汕头市第五批医疗卫生科技计划项目(财政资金支持类)(汕府科[2019]106号-20)。

摘　　要：目的:探讨单核细胞/高密度脂蛋白胆固醇(HDL-C)比值(MHR)与低密度脂蛋白胆固醇(LDL-C水平正常的绝经后女性冠状动脉粥样硬化性心脏病(冠心病)患者冠状动脉病变和短期预后的关系。方法:选择确诊冠心病且LDL-C≤130 mg/dL的绝经后女性180例,据MHR水平分成3组:低MHR组(MHR<0.28)、MHR组(0.28≤MHR≤0.43)和高MHR组(MHR>0.43)。采集患者住院病历和影像系统的冠状动脉造影检查结果,应用SYNTAX积分系统对冠状动脉进行积分计算,根据冠状动脉的优势型、病变数、每个病变累及的节段、完全闭塞、三叉病变、分叉病变、动脉开口病变、严重扭曲、病变长度>20 mm、严重钙化、血栓及弥漫性病变/小血管病变节段数进行评分。多重线性回归分析MHR与冠状动脉病变程度的关系,logistic回归分析MHR与短期预后的关系。结果:高MHR组急性心肌梗死42例,发生率(59.2%)高于低MHR组(12例,22.2%)和中MHR组(18例,32.7%),差异有统计学意义(P=0.001)。高MHR组SYNTAX积分Ⅰ显著高于低MHR组和中MHR组(P=0.003)。高MHR组住院7d内急性心源性肺水肿发生率(22.5%)高于低MHR组(3.7%)和中MHR组(3.6%),差异有统计学意义(P<0.001)。MHR与SYNTAX积分Ⅰ呈正相关关系(r=0.196,P=0.008)。多重线性回归分析提示SYNTAX积分Ⅰ受MHR水平影响(F=7.631,P=0.001)。logistic回归分析显示急性心源性肺水肿发生的独立危险因素包括MHR(OR:7.910,95%CI:2.268~27.589,P=0.001)和血清肌酐(OR:1.017,95%CI:1.005~1.029,P=0.006)。结论:LDL-C水平正常的绝经后女性冠心病患者MHR与SYNTAX积分Ⅰ呈正相关,是冠状动脉严重程度的独立预测因子;MHR是发生急性心源性肺水肿的独立预测因子。AIM:To investigate the relationship between monocyte to high-density lipoprotein cholesterol(HDL-C)ratio(MHR)and coronary lesion severity/short-term prognosis in postmenopausal women with coronary atherosclerotic heart diseases(CAD)and normal low-density lipoprotein cholesterol(LDL-C)level.METHODS:A cohort of180 postmenopausal women diagnosed as CAD with LDL-C≤130 mg/dL were enrolled.The patients were divided into 3 groups according to the admission MHR:low MHR group(MHR<0.28,n=54),moderate MHR group(0.28≤MHR≤0.44,n=55),and high MHR group(MHR>0.48,n=71).Hospital medical records and coronary angiography of the postmenopausal women were collected.Dominance coronary system,number of lesions,segments for lesions,total occlusion,trifurcation,bifurcation,aorto-ostial lesion,severe tortuosity,length>20 mm,heavy calcification,thrombus,and diffusely diseased and narrowed segment of coronary arteries were scored by SYNTAX scoreⅠsystem.The relationship between MHR and SYNTAX scoreⅠwas assessed by multiple linear regression analysis,while the relationship between MHR and acute cardiogenic pulmonary edema was assessed by logistic regression analysis.RESULTS:The incidence of acute myocardial infarction in high MHR group(59.2%,42 cases)was higher than that in low MHR group(22.2%,12 cases)and moderate MHR group(32.7%,18 cases),with statistical significance(P=0.001).The SYNTAX scoreⅠin high MHR group was significantly higher than that in low MHR group and moderate MHR group(P=0.003).The incidence of acute cardiogenic pulmonary edema within 7 d during admission in high MHR group(22.5%)was higher than that in low MHR group(3.7%)and moderate MHR group(3.6%),with statistical significance(P<0.001).The positive correlation between MHR and SYNTAX scoreⅠwas observed(r=0.196,P=0.008).The result of multiple linear regression indicated that SYNTAX scoreⅠwas affected by MHR(F=7.631,P=0.001).The result of logistic regression analysis indicated that MHR(OR:7.910,95%CI:2.268~27.589,P=0.001)and serum creatinine(OR:1.017,95%CI:1.0

关 键 词：单核细胞 高密度脂蛋白胆固醇 绝经后女性 冠状动脉粥样硬化性心脏病 SYNTAX积分 急性心源性肺水肿 

分 类 号：R541.4[医药卫生—心血管疾病] R363.2[医药卫生—内科学]