Previous studies have found associations between monocyte count, high-density lipoprotein cholesterol (HDL-C), and thyroid-stimulating hormone (TSH) with acute coronary syndrome (ACS). However, research on the correlation between the monocyte count to high-density lipoprotein cholesterol ratio (MHR) and the onset of ACS is limited. The association between MHR, TSH, and the onset of ACS in postmenopausal women remains unclear.

To explore the predictive value of MHR and TSH for the onset of ACS in postmenopausal women and to investigate the correlation between these indicators and the degree of coronary artery stenosis in patients.

A total of 325 postmenopausal women hospitalized in the Department of Cardiology at Northern Jiangsu People's Hospital, from 2020 to 2021 and who underwent coronary angiography were selected as the study subjects. Patient general information was collected through the electronic medical record system. Venous blood was collected upon admission to measure monocyte count, total cholesterol (TC), triglycerides (TG), HDL-C, low-density lipoprotein cholesterol (LDL-C), and TSH. Left ventricular ejection fraction (LVEF) was measured using the biplane Simpson method, and coronary artery lesions were observed through coronary angiography. The Gensini scoring system was used to uniformly measure the extent of coronary artery lesions. Patients meeting the diagnostic criteria for ACS were classified as the ACS group (n=184), and non-ACS patients as the control group (n=141). The ACS group was further divided into subgroups based on the tertiles of the Gensini score: ≤36.5 as the low-risk subgroup (n=59), 36.6-66.5 as the moderate-risk subgroup (n=64), and >66.5 as the high-risk subgroup (n=61). Univariate and multivariate Logistic regression analyses were used to explore the influencing factors of ACS. The receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic value of TSH, MHR, and combined detection for ACS and to calculate the area under the curve (AUC). Spearman's rank correlation analysis was used to explore the correlation between TSH, MHR, and combined detection indicators with the Gensini score.

The baseline data of patients in the ACS and control groups showed that BMI, smoking rate, hypertension, diabetes, LDL-C, monocytes, TSH, and MHR in the ACS group were higher than in the control group, while LVEF and HDL-C were lower (P<0.05). Multivariate Logistic regression analysis showed that smoking, hypertension, BMI≥24.0 kg/m², LDL-C≥3.30 mmol/L, TSH≥2.1 mU/L, and MHR≥0.25 were risk factors for the occurrence of ACS in postmenopausal elderly women, and HDL-C≥1.2 mmol/L was a protective factor (P<0.05). The ROC curve analysis demonstrated that the AUC for MHR, TSH, and the combined predictive index in diagnosing ACS in postmenopausal women were 0.777 (95%CI=0.725-0.830, P<0.001), 0.747 (95%CI=0.694-0.800, P<0.001), and 0.810 (95%CI=0.764-0.857, P<0.001), respectively. In the moderate and high-risk subgroups, MHR and TSH were higher than in the low-risk subgroup, and the high-risk subgroup had higher MHR and TSH than the moderate-risk subgroup (P<0.05). Spearman's rank correlation analysis showed that in the ACS group, MHR (r_s=0.497, P<0.01), TSH (r_s=0.498, P<0.01), and the combined predictive indicators were positively correlated with the Gensini score (r_s=0.600, P<0.001) .

Elevated TSH and MHR are independent risk factors for the occurrence of ACS in postmenopausal women. Both indicators and their combination have certain sensitivity and specificity for disease prediction and are correlated with the extent of coronary artery lesions in patients, which has certain clinical application value for the early identification and risk assessment of ACS in postmenopausal women.

既往研究发现单核细胞计数、高密度脂蛋白胆固醇（HDL-C）、促甲状腺激素（TSH）与急性冠脉综合征（ACS）相关，然而单核细胞计数/高密度脂蛋白胆固醇（MHR）与ACS发病的相关性研究较少，绝经期女性MHR、TSH与ACS发病是否存在关联仍不明确。

探讨MHR、TSH对绝经期女性ACS患者发病的预测价值，并研究上述指标与患者冠状动脉狭窄程度的相关性。

选择2020—2021年在苏北人民医院心血管内科住院诊治并行冠状动脉造影的325例绝经期女性作为研究对象。通过电子病历系统收集患者一般资料，研究对象入院后采集静脉血检测单核细胞计数、总胆固醇（TC）、三酰甘油（TG）、HDL-C、低密度脂蛋白胆固醇（LDL-C）、TSH等。以双平面Simpson法测量左心室射血分数（LVEF），通过冠状动脉造影术观察冠状动脉病变情况。采用Gensini评分标准统一衡量冠状动脉病变情况。符合ACS诊断标准的患者为ACS组（n=184），非ACS者为对照组（n=141）。同时依据Gensini评分三分位数将ACS组进行分组：≤36.5分为低危亚组（n=59），36.6~66.5分为中危亚组（n=64），>66.5分为高危亚组（n=61）。采用单因素及多因素Logistic回归分析探究ACS的影响因素。绘制受试者工作特征（ROC）曲线评估TSH、MHR及联合检测对ACS的诊断价值并计算ROC曲线下面积（AUC）。采用Spearman秩相关分析探究TSH、MHR及联合检测指标与Gensini积分的相关性。

ACS组与对照组患者基线资料结果示，ACS组BMI、吸烟比例、高血压、糖尿病、LDL-C、单核细胞计数、TSH、MHR高于对照组，LVEF、HDL-C低于对照组（P<0.05）。多因素Logistic回归分析结果示，吸烟、高血压、BMI≥24.0 kg/m²、LDL-C≥3.30 mmol/L、TSH≥2.1 mU/L、MHR≥0.25是绝经期女性发生ACS的危险因素，HDL-C≥1.2 mmol/L为保护因素（P<0.05）。ROC曲线结果显示，MHR、TSH及联合预测指标诊断绝经期女性ACS的AUC分别为0.777（95%CI=0.725~0.830，P<0.001）、0.747（95%CI=0.694~0.800，P<0.001）、0.810（95%CI=0.764~0.857，P<0.001）。中危亚组、高危亚组MHR、TSH均高于低危亚组，高危亚组MHR、TSH高于中危亚组（P<0.05）。Spearman秩相关分析结果示，ACS组患者MHR（r_s=0.497，P<0.01）、TSH（r_s=0.498，P<0.01）及联合预测指标与Gensini评分均呈正相关（r_s=0.600，P<0.001）。

TSH及MHR升高是绝经期女性发生ACS的独立危险因素，两指标及联合对病情预测具有较高的灵敏度和特异度，并与患者冠状动脉病变程度相关，对绝经期女性ACS的早期识别及风险评估具有一定的临床应用价值。