The value of monocyte to high-density lipoprotein ratio and albumin to globulin ratio in the assessment and prognosis of patients with acute ST-segment elevation myocardial infarction
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摘要: 目的 探讨单核细胞与高密度脂蛋白比值(monocyte to high-density lipoprotein ratio，MHR)、白蛋白及球蛋白比值(albumin to globulin ratio, AGR)在急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction，STEMI)患者病情评估及预后预测方面的价值。方法 选取我院2021年6月—2023年6月STEMI患者146例为研究组，同期选取稳定型心绞痛患者58例为对照组。比较两组MHR、AGR水平及不同病情危重程度STEMI患者MHR、AGR水平，Cox回归分析STEMI患者预后影响因素，受试者工作特征(receiver operating characteristic，ROC)曲线分析MHR、AGR对STEMI患者预后的预测价值。结果 研究组AGR低于对照组，MHR高于对照组，均差异有统计学意义(P < 0.05)；随STEMI患者病情加重，MHR水平逐渐升高，AGR水平逐渐降低(P < 0.05)；Cox回归分析显示，高水平低密度脂蛋白胆固醇、脑利钠肽、MHR与低水平左室射血分数、白蛋白、AGR均为STEMI患者预后不良独立危险因素(P < 0.05)；ROC显示，MHR、AGR联合预测STEMI患者预后的AUC值0.978最大，灵敏度为96.70%，特异度为92.73%。结论 STEMI患者MHR、AGR异常表达，与患者病情程度有关，且对患者预后具有良好预测价值。
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关键词:
- 单核细胞与高密度脂蛋白比值 /
- 白蛋白及球蛋白比值 /
- 急性ST段抬高型心肌梗死 /
- 病情 /
- 预后
Abstract: Objective To investigate the value of monocyte to high-density lipoprotein ratio(MHR) and albumin to globulin ratio(AGR) in the assessment and prognosis of acute ST-segment elevation myocardial infarction(STEMI).Methods One hundred and forty-six STEMI patients in our hospital from June 2021 to June 2023 were selected as the study group, and 58 patients with stable angina pectoris were selected as the control group during the same period. The MHR and AGR levels of the two groups and the MHR and AGR levels of STEMI patients with different severity were compared. Cox regression analysis was conducted to analyze the prognostic factors of STEMI patients. The predictive value of MHR and AGR in STEMI patients was analyzed by receiver operating characteristic(ROC) curve.Results The AGR of study group was lower than that of control group, and the MHR was higher than that of control group(P < 0.05). With the aggravation of STEMI patients, MHR level was gradually increased and AGR level was gradually decreased(P < 0.05). Cox regression analysis showed that high levels of low-density lipoprotein cholesterol, B-type natriuretic peptide, MHR and low levels of left ventricular ejection fraction, albumin, AGR were independent risk factors for poor prognosis in STEMI patients(P < 0.05). ROC showed that the combination of MHR and AGR predicted the prognosis of STEMI patients with the largest AUC value of 0.978, corresponding sensitivity of 96.70%, specificity of 92.73%.Conclusion The abnormal expression of MHR and AGR in STEMI patients is related to the severity of patients' disease, and has good prognostic value for patients. -
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表 1 两组基线特征比较
指标 研究组(146例) 对照组(58例) t/χ2 P 性别/例(%) 0.333 0.564 男 87(59.59) 32(55.17) 女 59(40.41) 26(44.83) 年龄/岁 60.41±5.19 59.55±6.31 1.002 0.318 高血压史/例(%) 88(60.27) 31(53.45) 0.796 0.372 糖尿病史/例(%) 43(29.45) 16(27.59) 0.070 0.791 吸烟史/例(%) 58(39.73) 22(37.93) 0.056 0.813 饮酒史/例(%) 75(51.37) 28(48.28) 0.159 0.690 家族史/例(%) 31(21.23) 12(20.69) 0.007 0.932 TC/(mmol/L) 4.74±0.65 4.66±0.73 0.765 0.445 TG/(mmol/L) 1.81±0.57 1.75±0.61 0.665 0.507 HDL-C/(mmol/L) 1.15±0.14 1.27±0.16 5.298 < 0.001 LDL-C/(mmol/L) 2.58±0.25 2.41±0.19 4.668 < 0.001 LVEF/% 46.17±5.58 56.51±6.39 11.447 < 0.001 BNP/(pg/mL) 135.84±17.25 53.56±6.59 35.274 < 0.001 白蛋白/(g/L) 36.87±1.05 38.71±1.18 11.896 < 0.001 MHR 0.81±0.16 0.61±0.13 8.470 < 0.001 AGR 1.18±0.06 1.35±0.08 16.530 < 0.001 
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表 2 不同病情危重程度STEMI患者MHR、AGR水平
X ± S 组别 例数 MHR AGR 低危组 61 0.65±0.14 1.26±0.08 中危组 56 0.83±0.17 1.14±0.07 高危组 29 1.11±0.19 1.08±0.06 F 79.408 72.944 P < 0.001 < 0.001
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表 3 STEMI患者预后单因素分析
指标 预后不良组(55例) 预后良好组(91例) t/u/χ2 P 性别/例(%) 0.182 0.670 男 34(61.82) 53(58.24) 女 21(38.18) 38(41.76) 年龄/岁 60.82±6.28 60.16±6.51 0.602 0.549 高血压史/例(%) 38(69.09) 50(54.95) 2.865 0.091 糖尿病史/例(%) 19(34.55) 24(26.37) 1.102 0.294 吸烟史/例(%) 25(45.45) 35(38.46) 0.693 0.405 饮酒史/例(%) 29(52.73) 36(39.56) 2.406 0.121 家族史/例(%) 12(21.82) 19(20.88) 0.018 0.893 梗死部位/例(%) 0.241 0.971 前后壁合并右心室 19(34.55) 33(36.26) 广泛前壁 18(32.73) 29(31.87) 前间壁 10(18.18) 18(19.78) 下壁 8(14.55) 11(12.09) GRACE分级/例(%) 1.753 0.040 低危 20(36.36) 41(45.05) 中危 18(32.73) 38(41.76) 高危 17(30.91) 12(13.19) TC/(mmol/L) 4.77±0.66 4.72±0.63 0.456 0.649 TG/(mmol/L) 1.83±0.55 1.80±0.59 0.305 0.761 HDL-C/(mmol/L) 1.05±0.15 1.21±0.18 5.531 < 0.001 LDL-C/(mmol/L) 2.71±0.22 2.50±0.24 5.284 < 0.001 LVEF/% 43.92±5.87 47.53±5.52 3.739 < 0.001 BNP/(pg/mL) 158.19±22.51 122.33±19.47 10.161 < 0.001 白蛋白/(g/L) 35.94±1.14 37.43±1.22 7.327 < 0.001 MHR 0.92±0.15 0.74±0.17 6.474 < 0.001 AGR 1.09±0.11 1.23±0.09 8.366 < 0.001
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表 4 STEMI患者预后多因素分析
资料 赋值 β SE Wald χ2 HR P 95%CI GRACE分级 低危=1，中危=2，高危=3 0.436 0.493 0.782 1.547 0.311 0.935~2.558 HDL-C 实际值 -0.332 0.415 0.641 0.717 0.326 0.418~1.2311 LDL-C 实际值 1.012 0.395 6.564 2.751 < 0.001 1.761~4.298 LVEF 实际值 -0.935 0.329 8.077 0.393 < 0.001 0.251~0.614 BNP 实际值 1.097 0.426 6.631 2.995 < 0.001 2.059~4.357 白蛋白 实际值 -0.917 0.335 7.493 0.400 < 0.001 0.275~0.581 MHR 实际值 1.677 0.447 14.082 5.352 < 0.001 3.758~7.621 AGR 实际值 -1.272 0.426 8.918 0.280 < 0.001 0.142~0.553
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表 5 MHR、AGR对STEMI患者预后的预测价值
指标 AUC 95%CI P 截断值 灵敏度/% 特异度/% MHR 0.875 0.817~0.933 < 0.001 0.806 79.12 85.45 AGR 0.912 0.901~0.983 < 0.001 1.247 93.41 89.09 联合 0.978 0.930~0.998 < 0.001 - 96.70 92.73
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