| BackgroundCoronary heart disease(CHD)is the most common type of cardiovascular disease in clinic.In recent years,statistical datas show that the incidence and death of coronary heart disease in our country have a significant upward trend.This trend is closely related to the significant increase in risk factors for coronary heart disease caused by the aging of the population and social and economic development.Therefore,the burden of coronary heart disease in the Chinese population will be heavy.The main risk factors for coronary heart disease include age,gender,dyslipidemia,hypertension,smoking,diabetes and impaired glucose tolerance,and psychological stress.Type 2 diabetes mellitus(T2DM)is an independent risk factor for coronary heart disease,and diabetes is also an equal risk factor for coronary heart disease.One of the main causes of death in patients with type 2 diabetes is vascular complications,especially cardiovascular and cerebrovascular events caused by atherosclerotic lesions of large blood vessels.Clinical practice shows that coronary artery disease is diffuse and severe in coronary heart disease patients with diabetes mellitus.Coronary angiography often shows multiple diffuse stenosis and severe calcification,which makes the implementation of interventional or surgical bypass surgery more difficult,resulting in poor prognosis.Previous studies have demonstrated that inflammation plays an important role in atherosclerotic thrombosis and rupture of atherosclerotic plaques.Some studies have reported that various inflammatory markers include C reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factor(TNF)is related to the severity and prognosis of coronary arterial disease.Cyclic monocytes serve as a source of various cytokines and molecules,mainly interact with platelets and endothelial cells,leading to inflammation and exacerbation of prethrombotic processes.In contrast,high-density lipoprotein-cholesterol(HDL-C)blocks the migration of macrophages,oxidation of low-density lipoprotein-cholesterol(LDL-C),and promotes sterols outflow of these cells to counteract the proinflammatory and pro-oxidative effects of monocytes.In addition to the well-known anti-inflammatory and anti-oxidant effects of HDL-C particles,these molecules have recently been found to inhibit the activation of monocytes and the proliferation and differentiation of monocyte progenitor cells.Therefore.The ratio of monocyte count to HDL(MHR)can reflect the extent of inflammation and oxidative stress in vivo.However,there is no study data on the relationship between this parameter and the severity of coronary artery disease,as well as the relationship between this parameter and the degree of coronary artery stenosis in patients with coronary heart disease combine with diabetes.ObjectiveThis study compared the changes of monocyte/high-density lipoprotein(MHR)levels in patients with coronary heart disease complicated with diabetes,coronary heart disease,and normal controls.This study also compare the relationship between MHR and glycosylated hemoglobin(HbA1c),high-sensitivity C-reactive protein(hs-CRP),and coronary artery stenosis to provide experimental evidence for clinical diagnosis and treatment of the disease.MethodsA total of 314 patients undergoing concurrent coronary angiography(CAG)examinations were selected from Department of Cardiology,First Affiliated Hospital of Zhengzhou University from May 2015 to April 2017.According to the CAG results of the patient,coronary artery disease is diagnosed as the follows:in the left main coronary artery,left anterior descending artery,left circumflex artery,right coronary artery,and its main branches as long as there is a diameter stenosis?50%and the symptoms of angina are typical recently.Diagnosis of type 2 diabetes was based on the 2013 American Diabetes Association(ADA)criteria.According to the results of CAG and whether there is diabetes,there are three groups:coronary heart disease and diabetes group(n=103:positive coronary angiography,diabetes,including 65 males and 38 females,age 60.2±9.7 years),coronary heart disease alone Group(n=114:positive coronary angiography,no diabetes,81 males and 33 females,age 58.8±9.1 years),control group(n=97:negative coronary angiography,no diabetes,55 males,42 females,aged 57.3±7.7 years old).All the selected cases were recorded with general clinical data such as age,history of hypertension,smoking history,blood routine,blood lipid,uric acid,fasting blood glucose(FDG),HbA1c,hs-CRP and other biochemical indicators.The results of coronary angiography were recorded,and the degree of coronary stenosis was calculated based on the results.The Gensini score was calculated.The MHR,HbA1c,hs-CRP,and Gensini scores were compared among the groups.The correlation between MHR values and HbA1c,hs-CRP,and Gensini scores in coronary heart disease patients with diabetes mellitus were analyzed.In two groups of coronary heart disease,the correlation between MHR values and Gensini scores were compared.Use the IBM SPSS Statistics 21.0statistical tool for statistics.All the main indicators were tested for normality,and quantitative data with approximately normality were expressed asx±s.The normal and quantitative data of the differences between groups were analyzed with one-way ANOVA,and non-normal quantitative data were tested with a non-parametric rank sum test.The correlation of qualitative data were fitted with the Pearson?~2 test for binormal distribution and Spearman rank was used for the non-binormal distribution.A P value of<0.05 was considered statistically significant.Results(1)In addition to statistical differences in fasting blood glucose,HbA1c,and hs-CRP in patients with coronary heart disease complicated with diabetes and coronary heart disease,there was no difference of general clinical datas in the three groups,included age,gender,history of hypertension,smoking history,white blood cells,triglycerides,and uric acid.(2)The serum MHR of coronary heart disease complicated with diabetes(0.546±0.219 vs 0.418±0.166,P<0.01)and coronary heart disease alone(0.482±0.186 vs 0.418±0.166,P<0.05)was significantly higher than that of the control group.The difference was statistically significant.The serum MHR in patients with coronary heart disease complicated with diabetes was higher than that in patients with coronary heart disease alone(0.546±0.219 vs 0.482±0.186,P<0.05).The difference was statistically significant.(3)The HbA1c(7.33±0.97 vs 5.63±0.35,P<0.01)and hs-CRP(4.19±5.28 vs2.45±2.87,P<0.01)were higher in coronary heart disease patients with diabetes than in patients with coronary heart disease alone.The difference was statistically significant.The serum MHR values in patients with coronary heart disease and diabetes were positively correlated with HbA1c(r=0.262,P=0.008)and hs-CRP(r=0.317,P=0.001).There was no correlation between serum MHR values and HbA1c(r=0.112,P=0.237)and hs-CRP(r=0.153,P=0.104)in patients with coronary heart disease alone.(4)Gensini score was higher in patients with coronary heart disease complicated with diabetes than in patients with coronary heart disease alone(50.9±33.3 vs 37.5±26.4,P<0.01).The difference was statistically significant.There was a positive correlation between serum MHR and Gensini scores in patients with coronary heart disease complicated with diabetes(r=0.257,P=0.009).There was no significant correlation between serum MHR and Gensini score in patients with coronary heart disease alone(r=0.125,P=0.184).Conclusion1.The serum MHR of coronary heart disease patients with diabetes was significantly higher than that of patients with coronary heart disease alone and those of controls.2.The serum MHR values in patients with coronary heart disease and diabetes mellitus are positively correlated with their HbA1c and hs-CRP levels,suggesting that the severity of diabetes and inflammatory response are closely related to the increase of MHR.3.The degree of coronary stenosis was higher in patients with coronary heart disease and diabetes than in patients with coronary heart disease alone,and the MHR value in coronary heart disease patients with diabetes was positively correlated with the degree of coronary stenosis,suggesting that MHR value may be used to assess the degree of coronary artery stenosis in patients with coronary heart disease and diabetes as a simple clinical indicators. |
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