MHR改善GRACE评分对NSTEMI患者PCI术后主要心脑血管不良事件的预测价值  

Predictive Value of MHR Improved GRACE Score for Major Adverse Cardiac and Cerebrovascular Events After PCI in NSTEMI Patients

作　　者：李明丽 张文礼 费家玥 王丽娜 冯士涛 于萌文 赵阳[1] LI Mingli;ZHANG Wenli;FEI Jiayue;WANG Lina;FENG Shitao;YU Mengwen;ZHAO Yang(Department of Geriatrics,the Fifth Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第五附属医院老年医学科,河南郑州450000

出　　处：《河南医学研究》2023年第9期1549-1554,共6页Henan Medical Research

基　　金：2019年河南省医学科技攻关计划联合共建项目(LHGJ20190415);2018年河南省医学科技攻关计划联合共建项目(2018020244)。

摘　　要：目的 探讨单核细胞与高密度脂蛋白胆固醇(HDL-C)比值(MHR)与非ST段抬高型心肌梗死(NSTEMI)患者经皮冠状动脉介入术(PCI)后发生主要心脑血管不良事件(MACCE)的关系,以及MHR是否能改善全球急性冠状动脉事件注册(GRACE)评分的预测价值。方法 选择2020年1月至2022年3月就诊于郑州大学第五附属医院并确诊为NSTEMI且行PCI治疗的患者182例,在患者入院24 h内计算MHR值及GRACE评分。按MHR中位数将患者分为高MHR组(MHR>0.48,n=92)和低MHR组(MHR≤0.48,n=90),比较两组患者间的一般资料及MACCE发生率,分析MHR与GRACE评分是否具有相关性。根据是否发生MACCE分为事件组和非事件组,采用单因素及多因素Cox风险回归分析发生MACCE的危险因素,并绘制受试者工作特征(ROC)曲线计算MHR、GRACE评分及两者联合的曲线下面积,并运用Medcalc软件对ROC曲线进行Delong分析MHR是否能改善GRACE评分对MACCE的预测价值。结果 与低MHR组比较,高MHR组男性比率、收缩压、单核细胞计数、超敏C反应蛋白、氨基末端脑钠肽前体较高(P<0.05),总胆固醇、HDL-C较低(P<0.05)。相关性分析表明,MHR与GRACE评分呈正相关(r=0.206,P=0.005)。高MHR组与低MHR组MACCE比较差异有统计学意义(17例比7例,P<0.05)。Kaplan-Meier分析表明,高MHR组MACCE发生率更高(P<0.05)。对事件组及非事件组进行单因素及多因素Cox风险回归分析,结果显示MHR为MACCE发生的独立危险因素(HR=3.657,95%CI:1.008~13.271,P<0.05)。ROC曲线及Delong分析表明MHR可以改善GRACE评分对发生MACCE的预测作用(曲线下面积:MHR+GRACE比GRACE为0.741比0.633,P<0.05)。结论 MHR是NSTEMI患者PCI术后发生MACCE的独立预测因素,并可改善GRACE评分对发生MACCE的预测作用。Objective To investigate the relationship between monocyte to high-density lipoprotein cholesterol(HDL-C)ratio(MHR)and the occurrence of major adverse cardiac and cerebrovascular events(MACCE)after percutaneous coronary intervention(PCI)in patients with non-ST-segment elevation myocardial infarction(NSTEMI)and whether MHR improves the predictive value of the global registry of acute coronary events(GRACE)score.Methods A total of 182 patients who were diagnosed with NSTEMI and underwent PCI in the Fifth Affiliated Hospital of Zhengzhou University between January 2020 and March 2022 were selected,and MHR and GRACE scores were calculated within 24 hours of patient admission.Patients were divided into high MHR(MHR>0.48,n=92)and low MHR(MHR≤0.48,n=90)according to the median MHR score.The general data and MACCE incidence were compared between the two groups,and the correlation between MHR and GRACE score was analyzed.When MACCE was divided into event and non-event groups according to whether it occurred,univariate and multivariate Cox risk regression was used to analyze the relationship between MHR and MACCE,and receiver operating characteristic(ROC)curves were drawn to calculate the area under the curve for MHR,GRACE and the combination of the two,and the ROC curve was Delong analyzed using Medcalc software to determine whether MHR improved the predictive effect of GRACE score.Results Compared with the low MHR group,the high MHR group had higher proportions of men,systolic blood pressure,monocyte count,hypersensitive C reactive protein,amino-terminal pro-brain natriuretic peptide(P<0.05),and lower total cholesterol and HDL-C(P<0.05).Correlation analysis showed that MHR was positively correlated with GRACE score(r=0.206,P=0.005).The comparison of MACCE between the high MHR group and the low MHR group was statistically significant(17 vs.7 patients,P<0.05).Kaplan-Meier analysis indicated that MACCE occurred more frequently in the high MHR group(P<0.05).Univariate and multivariate Cox risk regression analysis of inciden

关 键 词：单核细胞与高密度脂蛋白胆固醇比值 非ST段抬高型心肌梗死 全球急性冠状动脉事件注册评分 预后 

分 类 号：R543.31[医药卫生—心血管疾病]