摘要： 目的 探讨单核细胞计数/高密度脂蛋白胆固醇比值（MHR）与急性肺栓塞（APE）患者病情严重程度和住院病死率的相关性。方法 选取经CT肺动脉造影确诊的APE患者256例，根据肺栓塞严重程度指数（PESI）评分标准分为低危组（n=112）、中危组（n=98）、高危组（n=46）；根据院内生存情况分为存活组（n=202）和死亡组（n=54）。收集所有患者的年龄、体质量指数、吸烟指数、基础疾病等基本信息，进行血白细胞（WBC）计数、单核细胞计数、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）和D-二聚体等实验室检查，计算PESI，比较不同病情严重程度APE患者的MHR水平，分析其与PESI等的相关性。结果 不同病情严重程度APE患者间血WBC计数、单核细胞计数、D-二聚体、LDL-C、HDL-C、MHR、PESI等的差异均有统计学意义（均P < 0.05）。随病情严重程度的增加，血WBC计数、单核细胞计数、LDL-C、D-二聚体、MHR、PESI呈升高趋势，HDL-C水平进行性下降（均P < 0.05）。相关性分析显示，年龄（r=0.618）、单核细胞计数（r=0.157）、MHR （r=0.646）与PESI呈正相关（均P < 0.05），HDL-C与PESI呈负相关（r=-0.238，P < 0.05）。多因素回归分析显示，年龄、单核细胞计数、MHR、PESI升高和HDL-C降低是APE患者住院死亡的独立危险因素（P < 0.05）。结论 MHR与APE病情严重程度密切相关，可用于预测APE患者的病情严重程度和生存情况，为临床诊治提供参考依据。

单核细胞计数/高密度脂蛋白胆固醇比值与急性肺栓塞的相关性

李惠萍¹, 胡安民², 高伟¹, 谭心娟¹, 汪艳¹, 李冰¹

1. 南方科技大学第一附属医院, 深圳市人民医院呼吸与危重症医学科, 广东 深圳 518020;
2. 南方科技大学第一附属医院, 深圳市人民医院麻醉科, 广东 深圳 518020

收稿日期:2021-11-10出版日期:2022-02-28发布日期:2022-01-05
通讯作者:李冰E-mail:liqifan918@163.com
作者简介:李惠萍(1975-),女,副主任医师,博士.
基金资助:广东省医学科学技术研究基金（A2021058）


关键词: 急性肺栓塞, 单核细胞计数/高密度脂蛋白胆固醇比值, 肺栓塞严重程度指数, 相关性, 预后
Abstract: Objective To investigate the association between monocyte count to high-density lipoprotein cholesterol ratio (MHR) and the severity of acute pulmonary embolism (APE) and in-hospital mortality. Methods A total of 256 patients with APE were divided into low-risk (n=112), medium-risk (n=98), and high-risk groups (n=46) according to the pulmonary embolism severity index (PESI) and into survival (n=202) and death groups (n=54) according to the 30-day survival. Basic information such as age, body mass index, smoking index, underlying diseases, white blood cell (WBC) count, monocyte count, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), D-dimer, and other results of laboratory tests were collected, and MHR was calculated. The levels of WBC count, monocyte count, LDL-C, HDL-C, D-dimer, and MHR were compared in patients with different severities, and their correlations with PESI were analyzed. Results There were significant differences in WBC count, monocyte count, D-dimer, LDL-C, HDL-C, MHR, and PESI in patients with different severities (all P < 0.05). The levels of WBC count, monocyte count, LDL-C, D-dimer, MHR, and PESI increased with the increase in disease severity, while HDL-C level decreased (P < 0.05). Correlation analysis showed that age, monocyte count, and MHR were positively correlated with PESI (r=0.618, r=0.157, r=0.646, all P < 0.05), while HDL-C level was negatively correlated (r=-0.238, P < 0.05). Logistic regression analysis showed that age, MHR, monocyte count, PESI, and HDL-C were independent risk factors for in-hospital mortality in patients with APE (P < 0.05). Conclusion MHR is closely related to the severity of APE and thus facilitates the clinical diagnosis and treatment.
Key words: acute pulmonary embolism, monocyte count to high-density lipoprotein cholesterol ratio, pulmonary embolism severity index, correlation, prognosis
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