单核细胞与高密度脂蛋白胆固醇比值评估射血分数降低型心力衰竭患者的预后价值  

Prognostic value of monocyte to high-density lipoprotein cholesterol ratio in assessing patients with heart failure with reduced ejection fraction

作　　者：魏亚君 侯泽 刘雨庭 王孟薇 王欣怡 叶英楠 贾克刚[3] Wei Yajun;Hou Ze;Liu Yuting;Wang Mengwei;Wang Xinyi;Ye Yingnan;Jia Kegang(Clinical Academy of Cardiovascular Diseases,Tianjin Medical University,Tianjin 300457,China;Department of Clinical Laboratory,Eco-city Hospital of Tianjin Fifth Central Hospital,Tianjin 300467;Department of Clinical Laboratory,Teda International Cardiovascular Hospital,Tianjin 300457,China)

机构地区：[1]天津医科大学心血管病临床学院,天津300457 [2]天津市第五中心医院生态城医院检验科,天津300467 [3]泰达国际心血管病医院检验科,天津300457

出　　处：《中华预防医学杂志》2025年第3期309-316,共8页Chinese Journal of Preventive Medicine

基　　金：天津市滨海新区卫生健康委科技项目(2022BWKZ002);天津大学泰达国际心血管病医院高质量发展专项资金资助科研项目(2024-GZL-MS002)。

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)评估射血分数降低型心力衰竭(HFrEF)患者的预后价值。方法选取2019年1月2日至2023年1月15日于泰达国际心血管病医院住院治疗的HFrEF(LVEF<40%)患者,记录HFrEF患者入院时MHR水平,对患者定期随访12个月,将主要心血管不良事件(心源性死亡和心衰再入院)界定为预后不良。采用Cox多因素回归对预后不良的关联因素进行分析;ROC曲线评估MHR对不良预后的诊断价值;采用DeLong检验分析MHR和脑钠肽(BNP)对不良预后的检测效力的差异;通过MHR评估不良预后的临界值分组,用Kaplan-Meier进行生存分析。结果共纳入研究对象286例,其中男206例,女80例,年龄M(Q 1,Q 3)为67(58,74)岁。多因素Cox回归分析显示MHR(HR=1.482,95%CI:1.015~2.164)和BNP(HR=1.001,95%CI:1.000~1.001)是HFrEF患者预后不良的关联因素。MHR、BNP及两者联合对HFrEF患者不良预后的辅助诊断价值的ROC曲线下面积分别为0.709、0.738和0.769;临界值分别为0.486、1090 pg/ml、0.41。DeLong检验分析MHR、BNP和两者联合对不良预后检测效力无差异。12个月的随访Kaplan-Meier生存分析显示,HFrEF患者MHR>0.486组发生预后不良的时间(8.645个月)明显短于MHR≤0.486组(10.296个月,P<0.001),MHR>0.486组预后不良风险是MHR≤0.486组的2.843倍(HR=2.843,95%CI:1.867~4.327)。结论MHR可作为评估HFrEF患者预后不良的指标。Objective To explore the prognostic value of monocyte to high-density lipoprotein cholesterol(HDL-C)ratio(MHR)in assessing patients with heart failure with reduced ejection fraction(HFrEF).Methods Patients with HFrEF(LVEF<40%)admitted to the TEDA International Cardiovascular Disease Hospital between 2 January 2019 and 15 January 2023 were selected.The MHR levels were recorded at admission in patients with HFrEF who were followed up regularly for 12 months.The major adverse cardiovascular events(cardiac death and readmission for heart failure)were defined as poor prognosis.Multivariate Cox regression was used to analyze factors associated with poor prognosis.The receiver operator characteristic(ROC)curves were used to assess the diagnostic value of MHR for poor prognosis.The DeLong test was used to analyze whether there was a difference in the effectiveness of MHR and BNP for detecting poor prognosis.The critical value grouping for poor prognosis was evaluated by MHR,and survival analyses were performed using Kaplan-Meier.Results A total of 286 subjects were enrolled in the study,including 206 males and 80 females,with a median age(Q 1,Q 3)of 67(58,74)years.Multivariate Cox regression showed that MHR(HR=1.482,95%CI:1.015-2.164)and BNP(HR=1.001,95%CI:1.000-1.001)were associated with poor prognosis in patients with HFrEF.The area under the ROC curve for the adjunctive diagnostic value of MHR,BNP and the combination of both for poor prognosis in patients with HFrEF was 0.709,0.738 and 0.769,respectively.The critical values were 0.486,1090 pg/ml and 0.41,respectively.The DeLong test showed no differences in the validity of MHR,BNP and their combination for detecting poor prognosis.Kaplan Meier survival analysis of 12-month follow-up showed that the time for poor prognosis in HFrEF patients with MHR>0.486 group(8.645 months)was significantly shorter than that in MHR≤0.486 group(10.296 months,P<0.001),and the risk of poor prognosis in MHR>0.486 group was 2.843 times higher than that in MHR≤0.486 group(HR=2.843,95%CI

关 键 词：心力衰竭 射血分数降低型心力衰竭 单核细胞与高密度脂蛋白胆固醇比值 预后 队列研究 

分 类 号：R541.6[医药卫生—心血管疾病]