Relationship Between Monocyte To HDL Ratio And The Cerebral Ischemic Stroke In Elderly Patient With Type 2 Diabetes

Research background:With an aging population in an ever more prosperous society,there is a significant increase of elderly patients with type 2 diabetes.Cardiovascular and cerebrovascular complications are the main cause of death in elderly patient with type 2 diabetes mellitus,which when induced to ischemic stroke has a high death and disability rate,leading to high economic costs to the family as well as social medical care.Although stroke events impose a heavy burden on society,cranial MRI(or CT)can not be used as routine examination items for screening stroke,because of their high price.therefore,it is necessary to find a cheap predictor for clinical diagnosis and treatment to help identify ischemic stroke early.MHR(Monocyte to High-Density Lipoprotein Ration)is a new type of inflammatory index at present,and its predictive value is more sensitive than that of MoNo,HDL indexes individually.High level MHR has more accurate response for inflammatory conditions and increased sensitivity for predicting risk assessment quickly.It is also an inexpensive index in clinic,which can reflect the high risk of disease in time,so as to take early preventive measures to effectively reduce the disease incidence and mortality,MHR has been confirmed to be crucial in hypertension,acute myocardial ridge death,renal injury after contrast agent,cerebral hemorrhage,Carotid atherosclerosis and other diseases.But there are few studies on the correlation between MHR and ischemic stroke in elderly type 2 diabetes.Purpose:A retrospective study was conducted to establish a relationship between MHR and ischemic stroke in elderly patients with type 2 diabetes,and providing a reliable indicator for warning early ischemic stroke.Method:151 patients with T2DM admitted into the Department of Endocrinology and Neurology in the First Affiliated Hospital of Zhengzhou University from January 2019 to January 2020 above the age of 60,of which 56 were not associated with ischemic stroke and 95 with ischemic stroke.In addition,40 healthy patients were selected as the healthy control group.To collect peoples’ age,sex,duration of diabetes,history of hypertension,history of alcohol consumption,etc;To detect biochemical indicators such as fasting blood glucose(FPG),glycosylated hemoglobin(HbAic),homocysteine,c-reactive protein(CRP),etc.Using spss25.0 software for statistical analysis,including the difference comparison,the correlation analysis,the Logistic regression analysis,and the ROC curve analysis.Results:3.1 Comparison of general data and biochemical indicatorsCompared with the healthy group,the level of age,BMI index and TC、TG、SBP、DBP、FPG、HbA1C、MoNo、MHR、Hcy、CRP in diabetes group were increased significantly,and the HDL-C’s level was decreased significantly(P<0.05).Compared with the ischemic stroke group,the course of diabetes,the prevalence of CAS and the level of SBP、DBP、FPG、HbA1C、MoNo、MHR、Hcy、CRP in non-ischemic stroke group were decreased significantly,and the HDL-C level was increased significantly(P<0.05).There were no significant statistical difference in UA、Cr、LDL-C、NE、PLT、sex and smoking history(P>0.05).3.2 The relationship between MHR and other various indexesThe correlation between MHR and other indexes was analyzed as follows:MHR was positively correlated with Hcy,CRP,NE and UA(P<0.05).3.3 Logistic regression analysisUsing single-factor analysis to select some meaningful index,for example,MHR,SBP,DBP,PLT,FPG,HbA1C,UA,TC,TC,TG,HDL-C,LDL-C,CRP,Hcy,MoNo(all P<0.05)as independent variables,and ischemic stroke as dependent variable,Logistic regression analysis was carried.The results showed that MHR,SBP,MoNo,CRP,HbA1C,Hcy were the risk factors for diabetes mellitus with ischemic stroke,and HDL-C was the protective factor for diabetes with ischemic stroke.3.4 ROC Curve AnalysisThe area under the MHR curve was the largest(AUC=0.806,95%CI:0.733-0.880,p<0.01),indicating that the diagnostic value of the MHR was higher than that of CRP、Hcy.the best CUT-OFF value of the ROC curve is 0.404.at this time,the MHR value is 0.374,its sensitivity is 70%,and the specificity is 80%.We can think that when MHR>0.374,an aging patient with type 2 diabetes can be considered susceptible to get Ischemic Stroke.Conclusion:1.MHR is a risk factor for diabetes with Ischemic Stroke,and MHR is positively correlated with Hcy and CRP(P<0.05),so it is an inflammatory marker for early warning of ischemic stroke.2.When the value of MHR is 0.374,it has a good predictive value for the prevalence of Ischemic Stroke in elderly type 2 diabetes mellitus.