Clinical Study Of Predictive Value Of Monocyte To High-density Lipoprotein Cholesterol And Thyroid Stimulating Hormone In Menopausal Women With Acute Coronary Syndrome

Objectives:To explore the predictive value of monocyte to high-density lipoprotein cholesterol ratio(MHR)and thyroid stimulating hormone(TSH)in menopausal women with acute coronary syndrome(ACS),and study the relationship between two indexes and the degree of coronary artery stenosis of patients,finding biomarkers that can identify the onset of menopausal women with ACS and the severity of coronary artery lesions in the early stage,so as to provide guiding value for early clinical diagnosis,early intervention and improvement of prognosis.Methods:A total of 325 menopausal female patients were selected.They were all hospitalized in Department of Cardiology of Subei People’s Hospital of Jiangsu province from January2020 to December 2021.All patients underwent coronary angiography and were divided into ACS group(184 patients)and non-ACS group(141 patients)according to their clinical manifestations and angiography results.General clinical data,such as age,history of disease,height and weight were recorded,CAG results and blood test indexes including monocyte(MONO),brain natriuretic peptide(BNP),triglyceride(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),thyroid stimulating hormone were collected.The above indexes were compared between the ACS group and the non-ACS group.The risk factors of initial ACS in menopausal women were analyzed by univariate Logistic regression,and the index with P<0.05 in univariate analysis was included in multivariate Logistic regression analysis.ROC curve was used to map the value of MHR and TSH in the predictive of ACS.The internationally accepted Gensini scoring standard was used to score the angiographic results of the ACS group.According to the scoring results,59 patients in the low-risk group(Gensini score≤36.5),64 patients in the medium-risk group(36.6≤Gensini score≤66.5)and 61 patients in the high-risk group(Gensini score>66.5)were divided into three groups.The changes of MHR and TSH indexes among the three groups were compared,Spearman correlation analysis was used to analyze the correlation between MHR,TSH and Gensini score,and IBM SPSS 20.0 software was used for statistical processing and analysis of the data.P<0.05 was considered to be statistically significant.Research results:1.Comparison of General information and clinically relevant indicators between the ACS group and the non-ACS group: the proportion of smoking,diabetes,hypertension and BMI in the ACS group were significantly higher than those in the non-ACS group(P<0.05),and there was no statistical difference in the proportion of alcohol consumption and age between the two groups(P>0.05).The level of HDL-C and left ventricular ejection fraction were lower than those in non-ACS group(P<0.05).There were no significant differences in TG and TC levels between the two groups(P>0.05).2.Multivariate Logistic regression analysis with or without ACS as dependent variable showed that smoking,hypertension,BMI,LDL-C,TSH and MHR were all independent risk factors for the onset of ACS in menopausal women,and HDL-C was an independent protective factor for menopausal women with ACS.3.Predictive value of MHR and/or TSH for ACS: ROC curve results showed that the areas under the curve of MHR and TSH for predicting ACS in menopausal women were 0.777(95%CI: 0.725 to 0.830)and 0.747(95%CI: 0.694 to 0.800),respectively.The best diagnostic thresholds for MHR and TSH were 0.255 and 2.130,the sensitivities were 76.1% and 69.6%,and the specificity was 72.3% and 74.5% respectively.The area under the curve of TSH combined with MHR for ACS was 0.810(95%CI 0.764-0.857),the sensitivity was 77.7%,and the specificity was 73.0%.4.After further grouping of ACS patients according to Gensini score,it was found that the levels of MHR and TSH in low-risk group,medium-risk group and high-risk group gradually increased,and the pairwise comparison showed statistical difference(P<0.05).5.Spearman correlation analysis of MHR and TSH levels and Gensini scores showed that MHR level(correlation coefficient 0.497,P<0.01),TSH level(correlation coefficient0.498,P<0.01),MHR+TSH joint index(correlation coefficient 0.600,P<0.001)were positively correlated with Gensini score.Research conclusion:1.The serum MHR and TSH levels of menopausal women with ACS were significantly higher than those of non-ACS menopausal women,and the coronary artery lesions were gradually aggravated with the increase of MHR and TSH levels.2.As independent risk factors for ACS in menopausal women,MHR and TSH both have certain sensitivity and specificity in their independent and combined prediction,which has certain clinical application value for early identification and risk assessment of ACS in menopausal women.