单核细胞/高密度脂蛋白胆固醇比值、红细胞分布宽度、尿酸与冠心病患者冠状动脉病变严重程度的相关性

doi:10.3969/j.issn.1004-583X.2023.09.004

摘要/Abstract

摘要：

目的探讨单核细胞/高密度脂蛋白胆固醇比值(monocyte to high density lipoprotein cholesterol,MHR)、红细胞分布宽度(red blood cell distribution width,RDW)、尿酸(Serum uric acid,SUA)与冠心病(Coronary heart disease,CHD)患者冠状动脉病变严重程度的相关性。方法纳入2022年2月至2023年2月于我院收治的358例患者,分为正常对照组(n=70)和冠心病组(n=288), 冠心病组根据Gensini积分结果进一步分为轻度狭窄组、中度狭窄组、重度狭窄组3个亚组,比较各组一般资料和MHR、RDW、SUA水平的差异,并进行Logistic回归评价MHR、RDW、SUA与不同冠状动脉狭窄程度相关性,绘制受试者工作特征(ROC)曲线分析MHR、RDW、SUA对冠状动脉狭窄程度的临床诊断价值。结果 3亚组高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)、MHR、RDW、SUA比较差异均有统计学意义( $P$ <0.05),Spearman相关性分析显示,3亚组MHR、RDW、SUA水平与冠状动脉狭窄程度呈正相关( $P$ <0.05),HDL-C水平与冠状动脉狭窄程度呈负相关( $P$ <0.05);Logistic回归分析显示,MHR、RDW、SUA均是冠心病患者冠状动脉病变严重程度的独立危险因素。( $P$ <0.05)。ROC曲线分析显示,MHR、RDW、SUA预测冠状动脉病变严重程度的曲线下边面积(AUC)分别为0.611、0.778、0.769。结论在冠心病患者中,MHR、RDW、SUA水平均是冠状动脉病变严重程度的独立危险因素。

关键词: 冠心病, 单核细胞/高密度脂蛋白胆固醇比值, 尿酸, 红细胞分布宽度, 冠状动脉狭窄

Abstract:

Objective To explore the correlation of monocyte-to-high density lipoprotein cholesterol ratio (MHR) and red cell distribution width (RDW), and serum uric acid (SUA) with the severity of coronary artery disease in patients with coronary heart disease (CHD). Methods A total of 358 patients admitted to our hospital from February 2022 to February 2023 were included. They were divided into normal control group ( $n$ =70) and CHD group ( $n$ =288). According to the Gensini score, patients in CHD group were subgrouped into mild stenosis group, moderate stenosis group and severe stenosis group. General data, MHR, RDW and SUA among all groups were compared. Logistic regression was performed to evaluate the correlation of MHR, RDW and SUA with the severity of coronary artery stenosis, and receiver operating characteristic (ROC) curve was drawn to analyze the clinical diagnostic value of MHR, RDW and SUA in predicting the degree of coronary artery stenosis. Results There were significant differences in the high-density lipoprotein cholesterol (HDL-C), MHR, RDW and SUA among the three subgroups of CHD ( $P$ <0.05). Spearman correlation analysis showed that MHR, RDW and SUA were positively correlated with the degree of coronary artery stenosis ( $P$ <0.05), and HDL-C was negatively correlated with it ( $P$ <0.05). Logistic regression analysis showed that MHR, RDW and SUA were independent risk factors for the severity of coronary artery disease in CHD patients ( $P$ <0.05). ROC curve analysis showed that the area under the curve (AUC) of MHR, RDW and SUA in predicting the severity of coronary artery disease was 0.611, 0.778 and 0.769, respectively. Conclusion MHR, RDW and SUA are independent risk factors for the severity of coronary artery disease in CHD patients.

Key words: coronary disease, monocyte-to-HDL-C ratio, uric acid, red cell distribution width, coronary stenosis

中图分类号:

R541.4

魏宇涵, 赵亚楠, 张桂彬, 吴雨晴, 董博华, 扈家源, 杨文琦. 单核细胞/高密度脂蛋白胆固醇比值、红细胞分布宽度、尿酸与冠心病患者冠状动脉病变严重程度的相关性[J]. 临床荟萃, 2023, 38(9): 796-801.

Wei Yuhan, Zhao Yanan, Zhang Guibin, Wu Yuqing, Dong Bohua, Hu Jiayuan, Yang Wenqi. Correlation analysis of monocyte-to-high density lipoprotein cholesterol ratio, red cell distribution width, and uric acid with the severity of coronary artery disease in patients with coronary heart disease[J]. Clinical Focus, 2023, 38(9): 796-801.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.09.004

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I9/796

图/表 5

表1 2组临床资料比较

Tab. 1 Comparison of clinical data between the two groups

项目	正常对照组( $n$ =70)	冠心病组( $n$ =288)	χ²/ $F$ / $Z$ 值	$P$ 值
年龄(岁)	61.00[54.75,69.00]	62.00[55.00,68.75]	-0.398	0.691
BMI(kg/m²)	25.32±3.74	25.67±3.68	0.099	0.474
男性[例(%)]	30(42.9)	152(52.8)	2.218	0.136
女性[例(%)]	40(57.1)	136(47.2)
吸烟史[例(%)]	18(25.7)	120(41.7)	6.050	0.014
糖尿病[例(%)]	16(22.9)	60(20.8)	0.138	0.710
高血压[例(%)]	16(22.9)	63(21.9)	0.032	0.859
脑血管病[例(%)]	6(8.6)	42(14.6)	1.753	0.185
应用降脂药[例(%)]	24(34.3)	113(39.2)	0.584	0.445
中性粒细胞计数(×10⁹/L)	3.45[2.93,4.27]	3.98[3.13,4.98]	-2.857	0.004
淋巴细胞计数(×10⁹/L)	1.65[1.29,2.27]	1.65[1.34,2.03]	-0.100	0.920
单核细胞计数(×10⁹/L)	0.33[0.26,0.41]	0.35[0.28,0.42]	-1.892	0.059
丙氨酸氨基转移酶(U/L)	17.00[13.75,24.00]	20.00[13.00,29.75]	-1.609	0.108
天冬氨酸氨基转移酶(U/L)	19.00[16.00,22.00]	20.00[16.25,26.00]	-1.725	0.084
γ谷氨酰转肽酶(U/L)	22.00[17.00,33.25]	24.50[18.00,37.90]	-1.541	0.123
肌酐(μmol/L)	62.50[54.75,75.25]	67.00[57.00,76.00]	-1.667	0.096
D-二聚体(ng/ml)	261.62[189.24,415.79]	275.89[187.46,384.05]	-0.355	0.723
葡萄糖(mmol/L)	5.78[5.17,7.22]	5.89[5.14,7.53]	-0.513	0.608
TC(mmol/L)	4.54[4.01,5.02]	4.72[3.82,5.52]	-1.436	0.151
TG(mmol/L)	1.44[0.90,2.22]	1.62[1.14,2.18]	-2.019	0.044
LDL-C(mmol/L)	2.93±0.79	2.89±0.89	1.184	0.742
HDL-C(mmol/L)	1.27[1.15,1.40]	1.03[0.95,1.12]	-9.385	0.000
RDW(%)	12.20[11.60,13.13]	12.60[12.10,13.10]	-2.680	0.007
SUA (μmol/L)	258.40±61.98	345.41±45.91	15.083	0.000
MHR	0.25[0.20,0.31]	0.34[0.27,0.42]	-6.035	0.000

表1 2组临床资料比较

Tab. 1 Comparison of clinical data between the two groups

项目	正常对照组( $n$ =70)	冠心病组( $n$ =288)	χ²/ $F$ / $Z$ 值	$P$ 值
年龄(岁)	61.00[54.75,69.00]	62.00[55.00,68.75]	-0.398	0.691
BMI(kg/m²)	25.32±3.74	25.67±3.68	0.099	0.474
男性[例(%)]	30(42.9)	152(52.8)	2.218	0.136
女性[例(%)]	40(57.1)	136(47.2)
吸烟史[例(%)]	18(25.7)	120(41.7)	6.050	0.014
糖尿病[例(%)]	16(22.9)	60(20.8)	0.138	0.710
高血压[例(%)]	16(22.9)	63(21.9)	0.032	0.859
脑血管病[例(%)]	6(8.6)	42(14.6)	1.753	0.185
应用降脂药[例(%)]	24(34.3)	113(39.2)	0.584	0.445
中性粒细胞计数(×10⁹/L)	3.45[2.93,4.27]	3.98[3.13,4.98]	-2.857	0.004
淋巴细胞计数(×10⁹/L)	1.65[1.29,2.27]	1.65[1.34,2.03]	-0.100	0.920
单核细胞计数(×10⁹/L)	0.33[0.26,0.41]	0.35[0.28,0.42]	-1.892	0.059
丙氨酸氨基转移酶(U/L)	17.00[13.75,24.00]	20.00[13.00,29.75]	-1.609	0.108
天冬氨酸氨基转移酶(U/L)	19.00[16.00,22.00]	20.00[16.25,26.00]	-1.725	0.084
γ谷氨酰转肽酶(U/L)	22.00[17.00,33.25]	24.50[18.00,37.90]	-1.541	0.123
肌酐(μmol/L)	62.50[54.75,75.25]	67.00[57.00,76.00]	-1.667	0.096
D-二聚体(ng/ml)	261.62[189.24,415.79]	275.89[187.46,384.05]	-0.355	0.723
葡萄糖(mmol/L)	5.78[5.17,7.22]	5.89[5.14,7.53]	-0.513	0.608
TC(mmol/L)	4.54[4.01,5.02]	4.72[3.82,5.52]	-1.436	0.151
TG(mmol/L)	1.44[0.90,2.22]	1.62[1.14,2.18]	-2.019	0.044
LDL-C(mmol/L)	2.93±0.79	2.89±0.89	1.184	0.742
HDL-C(mmol/L)	1.27[1.15,1.40]	1.03[0.95,1.12]	-9.385	0.000
RDW(%)	12.20[11.60,13.13]	12.60[12.10,13.10]	-2.680	0.007
SUA (μmol/L)	258.40±61.98	345.41±45.91	15.083	0.000
MHR	0.25[0.20,0.31]	0.34[0.27,0.42]	-6.035	0.000

表2 3亚组实验室指标比较

Tab. 2 Comparison of laboratory indexes among the three subgroups

项目	轻度狭窄组( $n$ =120)	中度狭窄组( $n$ =76)	重度狭窄组( $n$ =92)	χ²/ $F$ / $Z$ 值	$P$ 值
TC(mmol/L)	4.73[3.78,5.35]	4.57[3.92,5.41]	4.74[3.80,5.82]	1.07	0.585
TG(mmol/L)	1.58[1.10,2.13]	1.64[1.10,2.28]	1.67[1.29,2.18]	1.16	0.561
LDL-C(mmol/L)	2.89±0.77	2.97±0.95	2.83±0.98	0.98	0.612
HDL-C(mmol/L)	1.09[1.01,1.17]	1.02[0.93,1.11]^*	0.97[0.91,1.04]^*#	51.67	0.000
RDW(%)	12.13±0.62	12.72±0.50^*	13.10±0.74^*#	91.33	0.000
SUA(μmol/L)	321.80±41.84	347.63±43.47^*	374.38±34.82^*#	68.81	0.000
MHR	0.33[0.25,0.41]	0.34[0.27,0.43]	0.36[0.30,0.48]^*	11.26	0.004

表2 3亚组实验室指标比较

Tab. 2 Comparison of laboratory indexes among the three subgroups

项目	轻度狭窄组( $n$ =120)	中度狭窄组( $n$ =76)	重度狭窄组( $n$ =92)	χ²/ $F$ / $Z$ 值	$P$ 值
TC(mmol/L)	4.73[3.78,5.35]	4.57[3.92,5.41]	4.74[3.80,5.82]	1.07	0.585
TG(mmol/L)	1.58[1.10,2.13]	1.64[1.10,2.28]	1.67[1.29,2.18]	1.16	0.561
LDL-C(mmol/L)	2.89±0.77	2.97±0.95	2.83±0.98	0.98	0.612
HDL-C(mmol/L)	1.09[1.01,1.17]	1.02[0.93,1.11]^*	0.97[0.91,1.04]^*#	51.67	0.000
RDW(%)	12.13±0.62	12.72±0.50^*	13.10±0.74^*#	91.33	0.000
SUA(μmol/L)	321.80±41.84	347.63±43.47^*	374.38±34.82^*#	68.81	0.000
MHR	0.33[0.25,0.41]	0.34[0.27,0.43]	0.36[0.30,0.48]^*	11.26	0.004

表3 CHD患者冠状动脉狭窄程度与生化指标的Spearman相关性分析

Tab. 3 Spearman correlation analysis of the degree of coronary artery stenosis and biochemical indexes in CHD patients

变量	MHR	RDW	SUA	HDL-C
冠状动脉狭窄程度
$r$ 值	0.197	0.560	0.489	-0.423
$P$ 值	0.001	0.000	0.000	0.000

表3 CHD患者冠状动脉狭窄程度与生化指标的Spearman相关性分析

Tab. 3 Spearman correlation analysis of the degree of coronary artery stenosis and biochemical indexes in CHD patients

变量	MHR	RDW	SUA	HDL-C
冠状动脉狭窄程度
$r$ 值	0.197	0.560	0.489	-0.423
$P$ 值	0.001	0.000	0.000	0.000

表4 Gensini总分与相关指标的Logistic回归分析

Tab. 4 Logistic regression analysis of Gensini total score and related indicators

变量	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
性别	-0.546	0.323	2.856	0.091	0.579	0.308~1.091
MHR	3.790	1.525	6.175	0.013	44.262	2.227~879.693
RDW	1.316	0.270	23.809	0.000	3.728	2.197~6.324
SUA	0.020	0.004	22.318	0.000	1.020	1.012~1.029

表4 Gensini总分与相关指标的Logistic回归分析

Tab. 4 Logistic regression analysis of Gensini total score and related indicators

变量	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
性别	-0.546	0.323	2.856	0.091	0.579	0.308~1.091
MHR	3.790	1.525	6.175	0.013	44.262	2.227~879.693
RDW	1.316	0.270	23.809	0.000	3.728	2.197~6.324
SUA	0.020	0.004	22.318	0.000	1.020	1.012~1.029

图1 RDW、SUA、MHR的诊断价值的ROC曲线图

Fig. 1 ROC curve of diagnostic value of RDW, SUA, and MHR

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