MHR与急性ST段抬高型心肌梗死的患者Gensini评分的关系

目的 探讨单核细胞和高密度脂蛋白胆固醇的比值（MHR）与急性ST段抬高型心肌梗死（STEMI）以及Gensini评分的关系，了解MHR对STEMI的预测价值。 方法 纳入南京医科大学第二附属医院行冠脉造影并确诊为STEMI的患者132例，并选取同期行冠脉造影结果为正常的82例患者为对照组，比较两组之间的一般资料及实验室检查；根据Gensini评分三分位法将STEMI组分为低危组、中危组及高危组，比较三组患者的一般资料及实验室检查结果；单因素及多因素Logistic回归分析STEMI的独立影响因素、Gensini评分高危的独立影响因素，并绘制受试者工作特征（ROC）曲线评价MHR对STEMI患者Gensini评分高危的预测价值。 结果 ①STEMI组的患有高血压病（P<0.05）比例高于对照组，男性、吸烟、糖尿病、白细胞计数、中性粒细胞计数、单核细胞计数、肌酐值、MHR等项目比例数值均高于对照组（均P<0.01）。②与低危组比较，中、高危组的年龄高（P<0.05）、MHR升高（P<0.01）、病变支数升高（P<0.01）；高危组的中性粒细胞计数升高（P<0.05）、低密度脂蛋白数值升高（P<0.05）；与中危组比较，高危组的总胆固醇、MHR、病变支数升高，差异具有统计学意义（P<0.05）。③性别、吸烟史、糖尿病是STEMI发生的独立影响因素。④低密度脂蛋白、MHR、病变支数是Gensini评分高危的独立危险因素。⑤ROC曲线结果示，MHR截止值取0.469时，对STEMI患者Gensini评分高危的诊断预测价值最高（灵敏度75.0%，特异度71.9%，曲线下面积0.750，95%CI:0.671～0.827，P<0.01）。结论①MHR不是STEMI发生的独立影响因素，而是STEMI患者Gensini评分高危的独立影响因素，可作为临床预测高危STEMI患者的指标。②MHR>0.469时，对STEMI患者Gensini评分高危最具有预测价值，可作为高危STEMI患者的截断值。

Relationship between ratio of monocyte to high density lipoprotein cholesterol and Gensini score in patients with acute ST-segment elevation myocardial infarction

AIM To explore the relationship between the ratio of monocyte to high density lipoprotein cholesterol (MHR) and acute ST-segment elevation myocardial infarction (STEMI) and Gensini score, and to explore the predictive value of MHR for STEMI. METHODS Retrospective analysis was made in 132 patients who underwent coronary angiography in the second affiliated hospital of Nanjing Medical University from October 2018 to July 2020 and were diagnosed with STEMI, and 82 patients whose coronary angiography results were normal during the same period served as control group. General data and laboratory examination results were compared between the two groups. Then according to the Gensini score and by three-quantile method, the STEMI group was divided into low-risk group, middle-risk group and high-risk group, and general data and laboratory test results of the three groups were compared. Independent influence factors of STEMI and independent influence factors of high Gensini score were analyzed by univariate and multivariate Logistic regression, and draw receiver operating characteristic curve (ROC) was used to evaluate the predictive value of MHR for high-risk Gensini score in STEMI patients. RESULTS ①The proportions of patients with hypertension (P<0.05) in the STEMI group was higher than that in the control group. The proportions of men, smoke, diabetes, white blood cell count, neutrophils count, monocyte count, creatinine value and MHR in the STEMI group were all higher than those in the control group (all, P<0.01). ②Compared with the low-risk group, the middle-risk group and the higher-risk group had a higher age (P<0.05), an increase in MHR (P<0.01), and an increase in the number of diseased branches (P<0.01); the higher-risk group had an increase neutrophil count (P<0.05), the value of low-density lipoprotein increased (P<0.05). Compared with the middle-risk group, the total cholesterol, MHR, and the number of diseased branches in higher-risk group increased, and the difference was statistically significant (P<0.05). ③Gender, smoking history, and diabetes were independent influence factors for STEMI. ④Low-density lipoprotein, MHR, and the number of lesions were independent risk factors for the high risk of Gensini score. ⑤ROC curve showed that when the MHR cut-off value was 0.469, the diagnostic value of the high risk of Gensini score of STEMI patients was the highest (sensitivity 75.0%, specificity 71.9%, area under the curve 0.750, 95%CI: 0.671～0.827, P<0.01). CONCLUSION ①MHR is not an independent influencing factor of the occurrence of STEMI, but an independent influencing factor of the high-risk Gensini score of STEMI patients, which can be used clinically as an index to predict high-risk STEMI patients. ②When MHR>0.469, the Gensini score of STEMI patients has the most predictive value, and it can be used as a cutoff value of high-risk STEMI patients.