单核细胞/高密度脂蛋白胆固醇比值和载脂蛋白B/载脂蛋白A1比值与早发冠心病相关性研究  

Association of monocyte/high-density lipoprotein cholesterol ratio and apolipoprotein-B/Apolipoprotein-A1 ratio with premature coronary heart disease

作　　者：刘青华 杨禹娟[1] 刘新宏[1] 赵小利 LIU Qing-hua;YANG Yu-juan;LIU Xin-hong;ZHAO Xiao-li(Department of Cardiology,Shaanxi Provincial People’s Hospital,Xi’an 710068,China;Department of Clinical Medicine,Xi’an Medical of University,Xi’an 710021,China)

机构地区：[1]陕西省人民医院心血管内三科,陕西省西安市710068 [2]西安医学院临床医学系

出　　处：《中国心血管病研究》2023年第6期525-531,共7页Chinese Journal of Cardiovascular Research

基　　金：陕西省人民医院科技人才支持计划项目(2021JY-28);陕西省分子心脏病学重点实验室开放课题(KLMC-2018-04);陕西省人民医院2022年科技发展孵化基金。

摘　　要：目的 讨论单核细胞/高密度脂蛋白胆固醇(Monocyte-to-HDL-C Ratio,MHR)比值、载脂蛋白B载/脂蛋白A1(Apolipoprotein-B-to-Apolipoprotein-A1 Ratio,ApoB/ApoA1)比值与早发冠心病及冠状动脉狭窄程度的相关性。方法 纳入2020年09月至2022年08月因胸痛在陕西省人民医院心内科首次行冠状动脉造影并且满足年龄男性<55岁,女性<65岁的275例患者,其中早发冠心病组166例,非冠心病组109例。比较MHR、ApoB/ApoA1在早发冠心病患者与非早发冠心病患者的特点,并分析MHR、ApoB/ApoA1与Gensini积分的相关性及与临床分型的关系。结果 与非冠心病患者相比,早发冠心病患者的MHR、ApoB/ApoA1水平均升高(P<0.05);多因素logistics回归提示,MHR(OR=1.453,P<0.05)、ApoB/ApoA1(OR=1.002,P<0.05)是早发冠心病的独立危险因素。MHR诊断早发冠心病的临界值是5.51,ROC曲线下面积0.712(95%CI 0.650~0.772,P<0.05),敏感度49.40%,特异度89.00%;ApoB/ApoA1诊断早发冠心病的临界值是0.778,ROC曲线下面积0.664(95%CI 0.601~0.726,P<0.05),敏感度46.40%,特异度84.40%。MHR、ApoB/ApoA1与Gensini行Spearman分析显示存在正相关性(r=0.557,P=0.000;r=0.411,P=0.000)。MHR和ApoB/ApoA1在早发冠心病临床分型亚组中,急性冠状动脉综合征组患者高于稳定性冠心病患者,多因素回归分析提示,与早发冠心病临床分型相关,是急性冠状动脉综合征的独立危险因素。结论 MHR和ApoB/ApoA1水平与早发冠心病患者的冠状动脉严重程度相关,是早发冠心病的独立危险因素,也是早发冠心病患者急性冠状动脉综合征的独立危险因素。Objective To explore the association of the ratio of monocyte to high density lipoprotein(MHR)and apolipoprotein-B to apolipoprotein-A1(ApoB/ApoA1)with premature coronary artery disease and degree of coronary artery stenosis.Methods A total of 275 patients with chest pain who underwent coronary angiography for the first time in the Department of Cardiology of Shaanxi Provincial People’s Hospital from September 2020 to August 2022 were enrolled and met the needs of age of male<55 years old and female<65 years old.There were 166 cases in the premature coronary artery disease group and 109 cases in the no coronary artery disease group.The characteristics of MHR and ApoB/ApoA1 in patients with premature coronary artery disease and those without premature coronary artery disease were compared,and the correlation between MHR,ApoB/ApoA1 and Gensini score was analyzed.Results Compared with the non-coronary patients,the levels of MHR and ApoB/ApoA1 in the patients with premature coronary artery disease were increased(P<0.05)Multifactor logistics regression suggested that both MHR(OR=1.453,P<0.05)and ApoB/ApoA1(OR=1.002,P<0.05)were the independent risk factors for premature coronary artery disease.The critical value of MHR for the diagnosis of premature coronary artery disease was 5.51,and the area under ROC curve was 0.712(95%CI 0.650-0.772,P<0.05);the sensitivity was 49.40%,and the specificity was 89.00%.The critical value of ApoB/ApoA1 for the diagnosis of premature coronary artery disease was 0.778,and the area under ROC curve 0.664(95%CI 0.601-0.726,P<0.05);the sensitivity was 46.40%,and the specificity was 84.40%.Spearman analysis showed that there were the positive correlations between MHR,ApoB/ApoA1 and Gensini(r=0.557,P=0.000;r=0.411,P=0.000).In the clinical classification subgroups of premature coronary artery disease,MHR and ApoB/ApoA1 of the patients in the acute coronary syndrome group were higher than those with stable coronary artery disease.Multivariate regression analysis suggested that both MHR and ApoB

关 键 词：早发冠心病 单核细胞/高密度脂蛋白胆固醇 载脂蛋白B载/脂蛋白A1 

分 类 号：R541.4[医药卫生—心血管疾病]