单核细胞计数/高密度脂蛋白胆固醇及促甲状腺激素对绝经期女性急性冠脉综合征患者预测价值及与冠状动脉病变相关性研究  

Clinical Study on the Predictive Value of Monocyte Count to High-Density Lipoprotein Cholesterol Ratio and Thyroid-stimulating Hormone for Acute Coronary Syndrome in Postmenopausal Women and Their Correlation with Coronary Artery Lesions

作　　者：戴承晔 邓毅凡 何胜虎[3,4] 张晶 DAI Chengye;DENG Yifan;HE Shenghu;ZHANG Jing(The Yangzhou School of Clinical Medicine of Dalian Medical University,Yangzhou 225001,China;Ningbo NO.2 Hospital,Ningbo 315010,China;Northern Jiangsu People's Hospital,Yangzhou 225001,China;Northern Jiangsu People's Hospital Affiliated to Yangzhou University,Yangzhou 225001,China)

机构地区：[1]大连医科大学扬州临床医学院,江苏省扬州市225001 [2]浙江省宁波市第二医院,315010 [3]苏北人民医院,江苏省扬州市225001 [4]扬州大学附属苏北人民医院,江苏省扬州市225001

出　　处：《中国全科医学》2024年第33期4132-4138,共7页Chinese General Practice

摘　　要：背景既往研究发现单核细胞计数、高密度脂蛋白胆固醇(HDL-C)、促甲状腺激素(TSH)与急性冠脉综合征(ACS)相关,然而单核细胞计数/高密度脂蛋白胆固醇(MHR)与ACS发病的相关性研究较少,绝经期女性MHR、TSH与ACS发病是否存在关联仍不明确。目的探讨MHR、TSH对绝经期女性ACS患者发病的预测价值,并研究上述指标与患者冠状动脉狭窄程度的相关性。方法选择2020—2021年在苏北人民医院心血管内科住院诊治并行冠状动脉造影的325例绝经期女性作为研究对象。通过电子病历系统收集患者一般资料,研究对象入院后采集静脉血检测单核细胞计数、总胆固醇(TC)、三酰甘油(TG)、HDL-C、低密度脂蛋白胆固醇(LDL-C)、TSH等。以双平面Simpson法测量左心室射血分数(LVEF),通过冠状动脉造影术观察冠状动脉病变情况。采用Gensini评分标准统一衡量冠状动脉病变情况。符合ACS诊断标准的患者为ACS组(n=184),非ACS者为对照组(n=141)。同时依据Gensini评分三分位数将ACS组进行分组:≤36.5分为低危亚组(n=59),36.6~66.5分为中危亚组(n=64),>66.5分为高危亚组(n=61)。采用单因素及多因素Logistic回归分析探究ACS的影响因素。绘制受试者工作特征(ROC)曲线评估TSH、MHR及联合检测对ACS的诊断价值并计算ROC曲线下面积(AUC)。采用Spearman秩相关分析探究TSH、MHR及联合检测指标与Gensini积分的相关性。结果ACS组与对照组患者基线资料结果示,ACS组BMI、吸烟比例、高血压、糖尿病、LDL-C、单核细胞计数、TSH、MHR高于对照组,LVEF、HDL-C低于对照组(P<0.05)。多因素Logistic回归分析结果示,吸烟、高血压、BMI≥24.0 kg/m^(2)、LDL-C≥3.30 mmol/L、TSH≥2.1m U/L、MHR≥0.25是绝经期女性发生ACS的危险因素,HDL-C≥1.2 mmol/L为保护因素(P<0.05)。ROC曲线结果显示,MHR、TSH及联合预测指标诊断绝经期女性ACS的AUC分别为0.777(95%CI=0.725~0.830,P<0.001)、0.747(95%CBackground Previous studies have found associations between monocyte count,high-density lipoprotein cholesterol(HDL-C),and thyroid-stimulating hormone(TSH)with acute coronary syndrome(ACS).However,research on the correlation between the monocyte count to high-density lipoprotein cholesterol ratio(MHR)and the onset of ACS is limited.The association between MHR,TSH,and the onset of ACS in postmenopausal women remains unclear.Objective To explore the predictive value of MHR and TSH for the onset of ACS in postmenopausal women and to investigate the correlation between these indicators and the degree of coronary artery stenosis in patients.Methods A total of 325 postmenopausal women hospitalized in the Department of Cardiology at Northern Jiangsu People's Hospital,from 2020 to 2021 and who underwent coronary angiography were selected as the study subjects.Patient general information was collected through the electronic medical record system.Venous blood was collected upon admission to measure monocyte count,total cholesterol(TC),triglycerides(TG),HDL-C,low-density lipoprotein cholesterol(LDL-C),and TSH.Left ventricular ejection fraction(LVEF)was measured using the biplane Simpson method,and coronary artery lesions were observed through coronary angiography.The Gensini scoring system was used to uniformly measure the extent of coronary artery lesions.Patients meeting the diagnostic criteria for ACS were classified as the ACS group(n=184),and non-ACS patients as the control group(n=141).The ACS group was further divided into subgroups based on the tertiles of the Gensini score:≤ 36.5 as the low-risk subgroup(n=59),36.6-66.5as the moderate-risk subgroup(n=64),and >66.5 as the high-risk subgroup(n=61).Univariate and multivariate Logistic regression analyses were used to explore the influencing factors of ACS.The receiver operating characteristic(ROC)curve was plotted to evaluate the diagnostic value of TSH,MHR,and combined detection for ACS and to calculate the area under the curve(AUC).Spearman's rank correlation anal

关 键 词：急性冠脉综合征 绝经期 单核细胞计数/高密度脂蛋白胆固醇比值 促甲状腺激素 风险评估 

分 类 号：R542.22[医药卫生—心血管疾病]