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

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

Abstract

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

CLC Number:

R541.4

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.

Add to citation manager EndNote|Ris|BibTeX

URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2023.09.004

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

Figures/Tables 5

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

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

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

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

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

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

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

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

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

References 25

[1]	中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告2020概要[J]. 中国循环杂志, 2021, 36(6): 521-545.
[2]	Fernandes das Neves M, Batuca JR, Delgado Alves J. The role of high-density lipoprotein in the regulation of the immune response: implications for atherosclerosis and autoimmunity[J]. Immunology, 2021, 164(2): 231-241. doi: 10.1111/imm.13348 pmid: 33934336
[3]	Yousefi B, Sanaie S, Ghamari AA, et al. Red cell distribution width as a novel prognostic marker in multiple clinical studies[J]. Indian J Crit Care Med, 2020, 24(1): 49-54. doi: 10.5005/jp-journals-10071-23328 URL
[4]	段丽钦. 冠心病患者临床特征、外周微循环状态与冠状动脉病变程度的关系[J]. 临床荟萃, 2022, 37(2): 119-123.
[5]	Katsiki N, Dimitriadis GD, Mikhailidis DP. Serum uric acid and diabetes:From pathophysiology to cardiovascular disease[J]. Curr Pharm Des, 2021, 27(16): 1941-1951. doi: 10.2174/1381612827666210104124320 URL
[6]	张怡, 崔晓冉, 杨晓红. 单核细胞/高密度脂蛋白胆固醇比值在心血管疾病中研究进展[J]. 临床荟萃, 2022, 37(6): 551-555.
[7]	Godo S, Takahashi J, Yasuda S, et al. Role of inflammation in coronary epicardial and microvascular dysfunction[J]. Eur Cardiol, 2021, 16: e13.
[8]	He Q, Zhang P, Li Y, et al. The application of Gensini score and IL-1ra in assessing the condition and prognosis of patients with coronary artery disease[J]. Am J Transl Res, 2021, 13(9): 10421-10427. pmid: 34650711
[9]	Gabaldon-Perez A, Marcos-Garces V, Gavara J, et al. Coronary revascularization and long-term survivorship in chronic coronary syndrome[J]. J Clin Med, 2021, 10(4): 610. doi: 10.3390/jcm10040610 URL
[10]	Li Y, Liu X, Luo Y. Monocyte to high-density lipoprotein cholesterol ratio and serum uric acid in Chinese adults: A cross-sectional study[J]. BMC Endocr Disord, 2022, 22(1): 48. doi: 10.1186/s12902-022-00966-z pmid: 35216583
[11]	Liu H, Zhan F, Wang Y. Evaluation of monocyte-to-high-density lipoprotein cholesterol ratio and monocyte-to-lymphocyte ratio in ischemic stroke[J]. J Int Med Res, 2020, 48(7): 300060520933806.
[12]	Emmens JE, Jia C, Ng LL, et al. Impaired high-density lipoprotein function in patients with heart failure[J]. J Am Heart Assoc, 2021, 10(9): e019123.
[13]	Jia C, Anderson JLC, Gruppen EG, et al. High-density lipoprotein anti-inflammatory capacity and incident cardiovascular events[J]. Circulation, 2021, 143(20): 1935-1945. doi: 10.1161/CIRCULATIONAHA.120.050808 pmid: 33840204
[14]	Kalyoncuoglu M, Biter Hİ, Ozturk S, et al. Predictive accuracy of lymphocyte-to-monocyte ratio and monocyte-to-high-density-lipoprotein-cholesterol ratio in determining the slow flow/no-reflow phenomenon in patients with non-ST-elevated myocardial infarction[J]. Coron Artery Dis, 2020, 31(6): 518-526.
[15]	Villanueva DLE, Tiongson MD, Ramos JD, et al. Monocyte to high-density lipoprotein ratio (MHR) as a predictor of mortality and major adverse cardiovascular events (MACE) among ST elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention: A meta-analysis[J]. Lipids Health Dis, 2020, 19(1): 55. doi: 10.1186/s12944-020-01242-6 pmid: 32216795
[16]	Chen BW, Liu JJ, Xing JH, et al. Analysis of the correlation between the ratio of monocytes to high-density lipoprotein cholesterol and in-stent restenosis in patients with premature coronary heart disease[J]. Clin Appl Thromb Hemost, 2022, 28: 10760296221079334.
[17]	Turgay Yıldırım Ö, Aydın F, Hüseyinoˇglu Aydın A, et al. Red cell distribution width and its prediction value of mortality[J]. Heart Lung, 2020, 49(2): 205. doi: S0147-9563(19)30522-9 pmid: 31679803
[18]	Ferreira JP, Lamiral Z, Bakris G, et al. Red cell distribution width in patients with diabetes and myocardial infarction: An analysis from the EXAMINE trial[J]. Diabetes Obes Metab, 2021, 23(7): 1580-1587. doi: 10.1111/dom.14371 pmid: 33687751
[19]	Zhang M, Wu S, Xu S, et al. Impact of monocyte to high-density lipoprotein ratio on the identification of prevalent coronary heart disease: insights from a general population[J]. Postgrad Med, 2021, 133(7): 822-829. doi: 10.1080/00325481.2021.1957265 pmid: 34281466
[20]	Lorkowski SW, Smith JD. HDL is not dead yet[J]. Biomedicines, 2022, 10(1): 128. doi: 10.3390/biomedicines10010128 URL
[21]	Xiang L, Zhang M, Wu H, et al. The expression and prognostic value of ischemia modified albumin (IMA), red blood cell distribution width (RDW), and lipoprotein (LP) in patients with diabetes mellitus complicated with coronary heart disease[J]. Ann Palliat Med, 2021, 10(4): 4463-4471. doi: 10.21037/apm URL
[22]	孔祥勇, 余华, 冯克福, 等. 单核细胞与高密度脂蛋白胆固醇比值在冠心病合并高尿酸血症患者中的变化及其与冠心病患者冠状动脉狭窄程度的关系研究[J]. 实用心脑肺血管病杂志, 2020, 28(7): 37-40+53.
[23]	Guo G, Huang Z, Wang S, et al. Sex differences in uric acid and NT-pro BNP assessments during coronary severity[J]. Medicine (Baltimore), 2020, 99(15): e19653.
[24]	Çanga Y, Emre A, Karataş MB, et al. Prognostic value of serum uric acid levels in patients with non-STEMI undergoing percutaneous coronary intervention[J]. Herz, 2020, 45(4): 389-396. doi: 10.1007/s00059-019-04849-3 pmid: 31485775
[25]	Kumbhalkar S, Deotale R. Association between Serum uric acid level with presence and severity of coronary artery disease[J]. J Assoc Physicians India, 2019, 67(4): 29-32. pmid: 31311215