基于血管内超声探讨MHR与斑块稳定性的相关性研究  

Study on the correlation between MHR and plaque stability based on intravascular ultrasound

作　　者：林朋 李旭[1] 陈天平[1] 李辉[1] 陈耀[1] 史晓俊[1] 高大胜[1] 胡司淦[1] LIN Peng;LI Xu;CHEN Tianping;LI Hui;CHEN Yao;SHI Xiaojun;GAO Dasheng;HU Sigan(Department of Cardiovasology,the First Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui 233004 China)

机构地区：[1]蚌埠医学院第一附属医院心血管科,安徽蚌埠233004

出　　处：《重庆医学》2021年第20期3496-3501,共6页Chongqing medicine

基　　金：蚌埠医学院科技发展基金项目(BYKF1889);2018年度蚌埠市级科技创新指导类项目(20180311)。

摘　　要：目的通过血管内超声(IVUS)探讨单核细胞与高密度脂蛋白胆固醇(HDL-C)比值(MHR)与冠状动脉斑块稳定性的相关性,评估MHR对经皮冠状动脉介入(PCI)治疗冠状动脉粥样硬化性心脏病患者12个月的主要不良心血管事件(MACE)预测价值。方法选取2017年6月至2019年6月于该院行冠状动脉造影且行PCI及IVUS的132例冠状动脉粥样硬化性心脏病患者,检测单核细胞计数及HDL-C,以两者比值计算出MHR。根据IVUS判断的患者罪犯血管的斑块稳定性分为稳定性斑块组、不稳定性斑块组,分析MHR与斑块稳定性的相关性,并规律随访患者12个月的MACE。结果不稳定性斑块组的MHR值显著高于稳定性斑块组(P<0.05)。多因素logistic回归分析显示,MHR、糖尿病、C反应蛋白(CRP)是不稳定性斑块的独立危险因素。ROC曲线分析显示,MHR较单核细胞、HDL-C单一指标诊断斑块稳定性有更高的价值,MHR预测冠状动脉粥样硬化性心脏病PCI术后发生MACE的曲线下面积为0.794(95%CI:0.715~0.859,P<0.001),切点值为19.31时预测价值最大,此时其诊断灵敏度为68.42%、特异度为83.19%。结论MHR对冠状动脉粥样硬化性心脏病患者的斑块稳定性有诊断价值,是不稳定性斑块的独立危险因素,且对冠状动脉粥样硬化性心脏病患者行PCI后12个月发生MACE具有预测价值。Objective To investigate the correlation between the monocyte/high-density lipoprotein cholesterol(HDL-C)ratio(MHR)and the stability of coronary atherosclerotic plaques by intravascular ultrasound(IVUS),and to evaluate the predictive value of MHR on 12-month major adverse cardiovascular events(MACE)in patients with coronary atherosclerotic heart disease who were treated with percutaneous coronary intervention(PCI).Methods One hundred and thirty-two patients with coronary atherosclerotic heart disease who underwent coronary angiography and PCI and IVUS were selected in this hospital from June 2017 to June 2019.Monocyte count and HDL-C were tested,and the MHR was calculated.According to the stability of criminal blood vessel plaques judged by IVUS,the patients were divided into the stable plaque group and the unstable plaque group.The correlation between MHR and plaque stability was analyzed,and the patients were followed up for MACE for 12 months on a regular basis.Results The MHR value of the unstable plaque group was significantly higher than that of the stable plaque group(P<0.05).Multivariate logistic regression analysis showed that MHR,diabetes,and C-reactive protein were independent risk factors for unstable plaque.ROC curve analysis showed that MHR was more valuable than monocytes and HDL-C single in diagnosing stability of plaque.The area under the ROC curve of MHR predicting MACE after PCI for coronary atherosclerotic heart disease was 0.794(95%CI:0.715-0.859,P<0.001),and when the cut-off point value was 19.31,the predictive value was the greatest,at this time,the sensitivity was 68.42%and the specificity was 83.19%.Conclusion MHR has diagnostic value for plaque stability in patients with coronary atherosclerotic heart disease,and is an independent risk factor for unstable plaque,and has predictive value for the occurrence of MACE in patients with coronary heart disease 12 months after PCI.

关 键 词：血管内超声 单核细胞/高密度脂蛋白胆固醇比值 冠状动脉粥样硬化性心脏病 斑块稳定性 主要不良心血管事件 

分 类 号：R541.4[医药卫生—心血管疾病]