单核细胞与高密度脂蛋白胆固醇的比值影响非ST段抬高型急性冠脉综合征预后

毛琦; 项朝君; 王玉清; 赵晓辉

doi:10.16016/j.1000-5404.201810137

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单核细胞与高密度脂蛋白胆固醇的比值影响非ST段抬高型急性冠脉综合征预后

临床医学 | 更新时间：2026-01-09

- 单核细胞与高密度脂蛋白胆固醇的比值影响非ST段抬高型急性冠脉综合征预后
- Effect of ratio of monocyte to high-density lipoprotein cholesterol on prognosis of patients with non-ST-segment elevation acute coronary syndrome
- 第三军医大学学报 2019年41卷第5期页码：454-460
- 作者机构：
  
  400037 重庆，陆军军医大学(第三军医大学)第二附属医院心血管内科，全军心血管病研究所
- 作者简介：
  
  [赵晓辉，E-mail：doctorzhaoxiaohui@yahoo.com ZHAO Xiaohui, E-mail:doctorzhaoxiaohui@yahoo.com
- 基金信息：
  
  国家自然科学基金面上项目(81670428)
- DOI：10.16016/j.1000-5404.201810137
  中图分类号： R181.32; R446.11; R541.4
- 收稿：2018-10-23，
  
  修回：2018-12-24，
  
  纸质出版：2019-03-15
- 稿件说明：
移动端阅览
毛琦, 项朝君, 王玉清, 等. 单核细胞与高密度脂蛋白胆固醇的比值影响非ST段抬高型急性冠脉综合征预后[J]. 第三军医大学学报, 2019,41(5):454-460.

Qi MAO, Chaojun XIANG, Yuqing WANG, et al. Effect of ratio of monocyte to high-density lipoprotein cholesterol on prognosis of patients with non-ST-segment elevation acute coronary syndrome[J]. Journal of Third Military Medical University, 2019, 41(5): 454-460.
毛琦, 项朝君, 王玉清, 等. 单核细胞与高密度脂蛋白胆固醇的比值影响非ST段抬高型急性冠脉综合征预后[J]. 第三军医大学学报, 2019,41(5):454-460. DOI： 10.16016/j.1000-5404.201810137.

Qi MAO, Chaojun XIANG, Yuqing WANG, et al. Effect of ratio of monocyte to high-density lipoprotein cholesterol on prognosis of patients with non-ST-segment elevation acute coronary syndrome[J]. Journal of Third Military Medical University, 2019, 41(5): 454-460. DOI： 10.16016/j.1000-5404.201810137.

摘要

目的

探讨单核细胞与高密度脂蛋白胆固醇的比值(monocyte-to-high density lipoprotein cholesterol ratio，MHR)对非ST段抬高型急性冠脉综合征(non-ST-segment elevation acute coronary syndrome，NSTE-ACS)患者预后的影响。

方法

本研究为回顾性队列研究，纳入陆军军医大学第二附属医院心内科2017年1月至2017年9月入院的NSTE-ACS患者435例，男性占67.4%，中位年龄62岁。按MHR三分位数将研究人群分为低水平组(0.152~0.433，145例)、中水平组(0.435~0.633，145例)和高水平组(0.636~2.904，145例)，比较MHR各组间的临床资料，分析MHR与心血管危险因素的相关性，评估MHR与入院后12个月主要不良心脑血管事件(major adverse cardiovascular and cerebrovascular events，MACCE)的关系。

结果

在NSTE-ACS患者中，MHR与C反应蛋白(CRP)(

=0.534，

0.01)、GRACE评分(

=0.433，

0.01)等危险因素显著正相关。入院后12个月，NSTE-ACS患者共有78例发生MACCE(17.9%)；发生MACCE患者的MHR水平高于无MACCE患者(

0.01)；MHR高、中、低水平组各有35例、25例和16例发生MACCE，组间比较差异有统计学意义(

=0.006)。Kaplan-Meier分析表明MHR高水平组有更高的MACCE发生率(log-rank=9.786，

=0.007)。COX回归显示MHR与MACCE相关(

=2.528，95%

: 1.500~4.261，

0.01)，多因素分析进一步表明MHR为MACCE的独立预测因子(

=2.193，95%

: 1.075~4.472，

=0.031)。

结论

MHR与MACCE相关，并且是NSTE-ACS的一个独立预后危险因素。

Abstract

Objective

To investigate the effect of monocyte-to-high density lipoprotein cholesterol ratio (MHR) on the cardiovascular outcomes in the patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).

Methods

This was a retrospective cohort study involving 435 patients diagnosed with NSTE-ACS (males accounted for 67.4% and median age 62 years) who were admitted between January 2017 and September 2017 in our hospital. According to the tertile of MHR

the subjects were divided into the low MHR group (0.152~0.433

=145)

the medium MHR group (0.435~0.633

=145)

and the high MHR group (0.636~2.904

=145). Clinical data were compared among the 3 groups

the correlation between MHR and cardiovascular risk factors was evaluated

and the association of MHR with major adverse cardiovascular and cerebrovascular events (MACCE) was assessed during 12-month follow-up after admission.

Results

MHR was positively correlated with C-reactive protein (CRP

=0.534

0.01) and Global Registry of Acute Coronary Event scores (GRACE

=0.433

0.01) in the NSTE-ACS population. During the 12-month follow-up period

totally 78 patients with NSTE-ACS developed MACCE (17.9%)

and their MHR levels were higher than those without MACCE (

0.01). There were 35

25 and 16 cases respectively developing MACCE in the high

medium and low MHR groups

and significant difference was seen among the 3 groups (

=0.006). Kaplan-Meier analysis revealed that the high MHR group had the higher incidence rate of MACCE than the other groups (log-rank=9.786

=0.007). COX regression analysis showed that MHR was associated with MACCE (

=2.528

95%

: 1.500~4.261

0.01). Multivariate analysis further indicated that MHR was an independent predictor of

MACCE after adjustment (adjusted

=2.193

95%

: 1.075~4.472

=0.031).

Conclusion

MHR is associated with MACCE and is an independent predictor of cardiovascular outcomes in NSTE-ACS patients.

关键词

Keywords

references

ROFFI M, PATRONO C, COLLET J, et al . 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation[J ] . Eur Heart J, 2016, 37(3):267-315. DOI:10.1093/eurheartj/ehv320.

HANSSON G K.Inflammation and atherosclerosis: the end of a controversy[J]. Circulation, 2017, 136(20): 1875-1877. DOI:10.1161/CIRCULATIONAHA.117.030484.

RIDKER P M, EVERETT B M, THUREN T, et al . Anti inflammatory therapy with canakinumab for atherosclerotic disease[J ] . New Engl J Med, 2017, 377(12): 1119-1131. DOI:10.1056/NEJMoa1707914.

PATEL V K, WILLIAMS H, LI S C H, et al . Monocyte inflammatory profile is specific for individuals and associated with altered blood lipid levels[J ] . Atherosclerosis, 2017, 263: 15-23. DOI:10.1016/j.atherosclerosis.2017.05.026.

CHOI H Y, HAFIANE A, SCHWERTANI A, et al . High-density lipoproteins: biology, epidemiology, and clinical management[J ] . Can J Cardiol, 2017, 33(3): 325-333. DOI:10.1016/j.cjca.2016.09.012.

SATOH K, SHIMOKAWA H. Recent advances in the development of cardiovascular biomarkers[J]. Arterioscler Thromb Vasc Biol, 2018, 38(5): e61-e70. DOI:10.1161/ATVBAHA.118.310226.

中华医学会心血管病学分会, 中华心血管病杂志编辑委员会.非ST段抬高型急性冠状动脉综合征诊断和治疗指南(2016)[J].中华心血管病杂志, 2017, 45(5): 359-376. DOI:10.3760/cma.j.issn.0253-3758.2017.05.003.

Chinese Society of Cardiology of Chinese Medical Association, Editorial Board of Chinese Journal of Cardiology. Guideline and consensus for the management of patients with non-ST- elevation acute coronary syndrome (2016)[J]. Chin J Cardiol, 2017, 45(5): 359-376. DOI: 10.3760/cma.j.issn.0253-3758.2017.05.003.

FOX K A, DABBOUS O H, GOLDBERG R J, et al . Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE)[J ] . BMJ-Brit Med J, 2006, 333(7578): 1091. DOI:10.1136/bmj.38985.646481.55.

GISTERA A, HANSSON G K.The immunology of atherosclerosis[J]. Nat Rev Nephrol, 2017, 13(6): 368-380. DOI:10.1038/nrneph.2017.51.

AWAN Z, GENEST J. Inflammation modulation and cardiovascular disease prevention[J]. Eur J Prev Cardiol, 2014, 22(6): 719-733. DOI:10.1177/2047487314529350.

MARSCHE G, SAEMANN M D, HEINEMANN A, et al . Inflammation alters HDL composition and function: Implications for HDL-raising therapies[J ] . Pharmacol Ther, 2013, 137(3): 341-351. DOI: 10.1016/j.pharmthera.2012.12.001.

GORDON S M, REMALEY A T. High density lipoproteins are modulators of protease activity: Implications in inflammation, complement activation, and atherothrombosis[J]. Atherosclerosis, 2017, 259: 104-113. DOI:10.1016/j.atherosclerosis.2016.11.015.

LIBBY P, TABAS I, FREDMAN G, et al . Inflammation and its resolution as determinants of acute coronary syndrome[J ] . Circ Res, 2014, 114(12): 1867-1879. DOI:10.1161/ CI RCRESAHA.114.302699..

GOMARASCHI M, BASILICO N, SISTO F, et al . High-density lipoproteins attenuate interleukin-6 production in endothelial cells exposed to pro-inflammatory stimuli[J ] . Biochim Biophys Acta, 2005, 1736(2): 136-143. DOI:10.1016/j.bbalip.2005.08.003.

ACIKGOZ S K, ACIKGOZ E, SENSOY B, et al . Monocyte to high-density lipoprotein cholesterol ratio is predictive of in-hospital and five-year mortality in ST-segment elevation myocardial infarction[J ] . Cardiol J, 2016, 23(5): 505-512. DOI:10.5603/CJ.a2016.0026.

AYDIN E, ATES I, FETTAH ARIKAN M, et al . The ratio of monocyte frequency to HDL cholesterol level as a predictor of asymptomatic organ damage in patients with primary hypertension[J ] . Hypertens Re s, 2017, 40(8): 758-764. DOI:10.1038/hr.2017.36.

AKBOGA M K, BAL CI K G, MADEN O, et al . Usefulness of monocyte to HDL-cholesterol ratio to predict high SYNTAX score in patients with stable coronary artery disease[J ] . Biomark Med, 2016, 10(4): 375-383. DOI:10.2217/bmm-2015-0050..

BETTINGER N, PALMERINI T, CAIXETA A, et al . Risk stratification of patients undergoing medical therapy after coronary angiography[J ] . Eur Heart J, 2016, 37(40): 3103-3110. DOI:10.1093/eurheartj/ehv674.

CICEK G, KUNDI H, BOZBAY M, et al . The relationship between admission monocyte HDL-C ratio with short-term and long-term mortality among STEMI patients treated with successful primary PCI[J ] . Coronary Artery Dis, 2016, 27(3): 176-184. DOI:10.1097/MCA.0000000000000343.

CETIN E H O, CETIN M S, CANPOLAT U, et al . Monocyte/HDL-cholesterol ratio predicts the definite stent thrombosis after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction[J ] . Biomark Med, 2015, 9(10): 967-977. DOI:10.2217/bmm.15.74.

KEDHI E, KENNEDY M W, MAEH ARA A, et al . Impact of TCFA on unanticipated ischemic events in medically treated diabetes mellitus: insights from the PROSPECT Study[J ] . JACC-Cardiovasc Imag, 2017, 10(4): 451. DOI:10.1016/j.jcmg.2015.12.023.

SAMAD F, RUF W. Inflammation, obesity, and thrombosis[J]. Blood, 2013, 122(20): 3415-3422. DOI:10.1182/blood-2013-05-427708.

MCDONALD R A, HALLIDAY C A, MILLER A M, et al . Reducing in-stent restenosis: therapeutic manipulation of miRNA in vascular remodeling and inflammation[J ] . J Am Coll Cardiol, 2015, 65(21): 2314-2327. DOI:10.1016/j.jacc.2015.03.549.

YAHAGI K, KOLODGIE F D, LUTTER C, et al . Pathology of human coronary and carotid artery atherosclerosis and vascular calcification in diabetes mellitus highlights[J ] . Arterioscler Thromb Vasc Biol, 2017, 37(2): 191-204. DOI:10.1161/ATVBAHA.116.306256.

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