黄朝发，李菊香，颜素娟，姜宇，游志刚，徐劲松，姜醒华，杨人强，吴延庆，吴清华，程晓曙

单核细胞/高密度脂蛋白胆固醇比值与急性心肌梗死患者介入术后慢血流或无复流的相关性分析

黄朝发，李菊香，颜素娟，姜宇，游志刚，徐劲松，姜醒华，杨人强，吴延庆，吴清华，程晓曙

目的：探讨急性心肌梗死患者中单核细胞/高密度脂蛋白胆固醇比值（MHR）与冠状动脉介入治疗（PCI）后慢血流或无复流的关系。

方法：纳入我院2014-10至2016-05符合入选标准的共216例急性ST段抬高型心肌梗死（STEMI）患者，分为慢血流或无复流组[心肌梗死溶栓治疗临床试验（TIMI）血流≤2级] 43例和正常血流组173例。采用受试者工作特征曲线（ROC曲线）评价MHR预测慢血流或无复流发生的最佳切点值及其评判慢血流或无复流的特异性和敏感性，此外，运用Logistic回归分析MHR是否可作为STEMI患者介入后冠状动脉慢血流或无复流的独立危险因素。

结果：与正常血流组相比，慢血流或无复流组MHR明显较高（18.6±9.8 vs 10.9±5.5，P＜0.001），单因素Logistic回归分析可知MHR是冠状动脉慢血流或无复流的危险因素（OR =2.22，95%CI：1.58～3.28），同时多因素Logistic回归分析得出：MHR是冠状动脉慢血流或无复流的独立危险因素（OR=1.55，95%CI：1.01～2.38）；ROC曲线计算MHR预测慢血流或无复流的最佳切点值为13.37，敏感性和特异性分别为67.4%和70.5%，曲线下面积（AUC）为0.734 （95%CI：0.646～0.822）。

结论：MHR是急性心肌梗死患者介入后冠状动脉慢血流或无复流的独立危险因素。

心肌梗死；血管成形术，经皮，经腔冠状动脉； 单核细胞/高密度脂蛋白胆固醇比值

Objective: To explore the correlation of monocyte to HDL-C ratio (MHR) and post-operative slow flow or no reflow in patients with ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI).

Methods: A total of 216 STEMI patients treated in our hospital from 2014-10 to 2016-05 were enrolled. The patients were divided into 2 groups: Slow flow or no reflow group, the patients with TIMI grade≤2, n=43 and Normal flow group, n=173. Receiver operating characteristic (ROC) curve was performed to assess the best cut-off value for MHR predicting slow flow or no reflow with its sensitivity and specificity; Logistic regression analysis was conducted to studied weather MHR could be used as an independent risk factor for coronary slow flow or no reflow in STEMI patients after PCI.

Results: Compared with Normal flow group, Slow flow or no reflow group had the higher MHR (18.6±9.8) vs (10.9±5.5), P＜0.001. Univariate Regression analysis indicated that MHR was a risk factor of slow flow or no reflow occurrence (OR=2.22, 95% CI 1.58-3.28); multivariate regression analysis presented that MHR was an independent risk factor of slow flow or no reflow occurrence (OR=1.55, 95% CI 1.01-2.38). ROC curve showed that the best cut-off value for MHR predicting slow flow or no reflow occurrence was 13.37 with the sensitivity and specificity at 67.4% and 70.5% respectively, the area undercurve (AUC) was 0.734, 95% CI 0.646-0.822.

Conclusion: MHR was an independent risk factor for slow flow or no reflow occurrence in STEMI patients after PCI.Key wordsMyocardial infarction; Angioplasty, percutaneous, transluminal coronary; Monocyte to HDL-C Ratio

(Chinese Circulation Journal, 2017,32: 737.)

急性心肌梗死 （AMI） 是威胁人类生命的一类急重症，ST段抬高型心肌梗死（STEMI）是AMI中常见的一种，在发病12 h内尽早行经皮冠状动脉（冠脉）介入治疗（PCI）开通梗死相关冠脉，已推荐为其首选的再灌注方法[1]。……