目的 探讨单核细胞/高密度脂蛋白胆固醇比值(monocyte/high-density lipoprotein cholesterol ratio, MHR)对老年急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction, STEMI)患者PCI术后新发心房颤动(new-onset atrial fibrillation, NOAF)的预测价值。方法 回顾性分析某院2012-01至2018-06就诊的老年STEMI患者181例,根据入院7 d内是否发生NOAF分成房颤组(31例)和非房颤组(150例),比较两组MHR。同时通过Logsitic回归分析及绘制受试者工作特征(ROC)曲线,评估MHR预测老年STEMI患者术后NOAF的能力。结果 (1)多因素Logistic回归分析发现,MHR、入院心率、LAD是老年急性STEMI患者PCI术后 NOAF的独立危险因素(OR=1.837,1.160,1.736,95%CI:1.200~2.812,1.041~1.292,1.007~2.990,P<0.05);(2)ROC曲线分析提示,MHR预测老年急性STEMI术后NOAF的最佳截点为15.81,预测的敏感性为81.8%,特异性为90.3%,AUC曲线下面积为0.923(95%CI:0.859~0.987;P<0.01)。结论 MHR是老年急性STEMI术后NOAF的独立预测因子。
Abstract
Objective To investigate the predictive value of monocyte/high-density lipoprotein cholesterol ratio (MHR) for new-onset atrial fibrillation after PCI in patients with acute ST-segment elevation myocardial infarction. Methods A retrospective analysis was conducted of 181 elderly STEMI patients treated between January 2012 and June 2018 in a hospital. According to the occurrence of atrial fibrillation within 7 days after admission, they were divided into the atrial fibrillation group (31 cases) and non-atrial fibrillation group (150 cases). MHR was compared between the two groups. The ability of MHR to predict new postoperative AF in elderly STEMI patients was evaluated by Logsitic regression analysis and ROC curve assessment. Results (1) Multivariate logistic regression analysis found that MHR, admission heart rate, and LAD were independent risk factors for atrial fibrillation after acute ST-segment elevation myocardial infarction in elderly patients (OR=1.837, 1.160, 1.736, 95% CI: 1.200-2.812, 1.041-1.292, 1.007-2.990, P<0.05).(2) ROC curve analysis suggested that the best cut-off point of new-onset atrial fibrillation after acute STEMI in elderly patients predicted by MHR was 15.81, the predicted sensitivity was 81.8%, the specificity was 90.3%, and the AUC was 0.923 (95%CI: 0.859-0.987; P<0.01). Conclusions MHR is an independent predictor of new-onset atrial fibrillation after acute ST-segment elevation myocardial infarction in the elderly. The mechanism may be related to inflammatory response and oxidative stress.
关键词
单核细胞/高密度脂蛋白胆固醇比值 /
老年急性ST段抬高型心肌梗死 /
心房颤动
Key words
monocyte/high-density lipoprotein ratio /
elderly patients with acute ST segment elevation myocardial infarction /
atrial fibrillation
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参考文献
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