MHR与2型糖尿病患者发生急性心肌梗死及冠状动脉狭窄严重程度的相关性分析

Analysis of the correlation between MHR and acute myocardial infarction and the severity of coronary stenosis in patients with type 2 diabetes mellitus

摘要:

目的]探讨单核细胞与高密度脂蛋白胆固醇(HDLC)比值(MHR)对2型糖尿病(T2DM)患者发生急性心肌梗死(AMI)及冠状动脉狭窄程度的预测价值。 [方法]采用回顾性病例对照研究,纳入自2022年1月至2023年3月期间因胸痛就诊于山西医科大学第二医院的137例合并AMI的T2DM患者(心肌梗死组),并通过倾向性评分匹配法选取137例未合并AMI的T2DM患者(非心肌梗死组),两组均行冠状动脉造影术。分析MHR与T2DM患者发生AMI的风险及冠状动脉狭窄程度的相关性。 [结果]心肌梗死组单核细胞计数和MHR显著高于非心肌梗死组(P＜0.001),而HDLC水平显著低于非心肌梗死组(P＝0.005)。多因素Logistic回归分析结果显示,MHR是T2DM患者发生AMI的独立危险因素(OR＝62.30,95%CI:12.21～317.78,P＜0.001)。ROC曲线分析表明,MHR预测T2DM患者发生AMI的曲线下面积为0.704(灵敏度为0.796,特异度为0.540)。基于MHR二分位数的多变量Logistic回归分析显示,在调整混杂因素后,T2DM患者中高MHR组(MHR≥0.38)较低MHR组(MHR＜0.38)发生AMI的风险增加了1.978倍(OR＝2.978,95%CI:1.744～5.086,P＜0.001)。多因素线性回归分析结果表明,T2DM患者MHR每上升1.0,其Gensini评分相应增加47.177分(β＝47.177,95%CI:25.165～69.188,P＜0.001)。 [结论]MHR与T2DM患者AMI发生风险呈正相关,且与T2DM患者冠状动脉狭窄的严重程度呈正相关。通过监测MHR水平,能够实现对T2DM患者发生AMI及其冠状动脉狭窄程度的早期预测。

Abstract:

Aim To investigate the predictive value of monocyte to high density lipoprotein cholesterol ratio (MHR) for acute myocardial infarction (AMI) and the severity of coronary stenosis in patients with type 2 diabetes mellitus (T2DM). Methods A retrospective case-control study was conducted. 137 T2DM patients with AMI (myocardial infarction group) who were hospitalized in the Second Hospital of Shanxi Medical University due to chest pain from January 2022 to March 2023 were included, and 137 T2DM patients without AMI (non-myocardial infarction group) were selected by propensity score matching method. Coronary angiography was performed in both groups. The correlation between MHR and the risk of AMI occurrence and the severity of coronary stenosis was analyzed. Results The monocyte count and MHR in the myocardial infarction group were significantly higher than those in the non-myocardial infarction group (P＜0.001), while the level of high density lipoprotein cholesterol (HDLC) was significantly lower than that in the non-myocardial infarction group (P＝0.005). Multivariate Logistic regression showed that MHR was an independent risk factor for AMI in T2DM patients (OR＝62.0,5%CI:12.21～317.78, P＜0.001). ROC curve analysis showed that the area under the curve of MHR for predicting AMI in T2DM patients was 0.704 (sensitivity was 0.796, specificity was 0.540). Further analysis of multivariate Logistic regression based on binary division of MHR showed that after adjusting for confounding factors, the risk of AMI in T2DM patients with high MHR group (MHR≥0.38) was 1.978 times higher than that in T2DM patients with low MHR group (MHR＜0.38) (OR＝2.8,5%CI:1.744～5.086, P＜0.001). Multivariate linear regression analysis showed that the Gensini score of T2DM patients increased by 47.177 points for every 1.0 increase in MHR (β＝47.7,5%CI:25.165～69.188, P＜0.001). Conclusions MHR is positively correlated with the risk of AMI in T2DM patients, and positively correlated with the severity of coronary stenosis in T2DM patients. By monitoring MHR levels, early prediction of AMI and the severity of coronary stenosis in T2DM patients can be achieved.