摘要
目的探讨高敏C反应蛋白(hs-CRP)/白蛋白(ALB)对急性ST段抬高型心肌梗死(STEMI)急诊经皮冠状动脉介入治疗(PCI)术后发生主要不良心血管事件(MACE)的预测价值。方法选择急性STEMI患者143例,根据急诊PCI术后6个月内是否发生MACE分为MACE组54例、非MACE组89例。收集所有患者一般临床资料(如性别、年龄、BMI等)、疾病相关资料(如病变位置、病变狭窄程度、病变支数)、治疗相关资料(如β受体阻断剂、氯吡格雷、替格瑞洛基础用药情况和植入支架数)、实验室检测资料(如PCR术前血清hs-CRP、ALB水平和hs-CRP/ALB以及PCI术后LVEF等),采用COX回归模型分析急性STEMI急诊PCI术后发生MACE的危险因素。采用受试者工作特征(ROC)曲线评估hs-CRP/ALB对急性STEMI急诊PCI术后发生MACE的预测价值。结果单因素分析显示,年龄、糖尿病史、病变狭窄程度、病变支数、B型利钠肽(BNP)、hs-CRP/ALB、LVEF可能与急性STEMI急诊PCI术后发生MACE有关(P均<0.05);COX回归模型分析显示,年龄、糖尿病史、病变狭窄程度、病变支数、BNP、hs-CRP/ALB是急性STEMI急诊PCI术后发生MACE的危险因素(HR分别为1.604、1.173、1.291、1.422、1.286、1.512,P均<0.05),LVEF是急性STEMI急诊PCI术后发生MACE的保护因素(HR=0.924,P<0.05)。采用ROC曲线评估hs-CRP/ALB对急性STEMI急诊PCI术后发生MACE的预测价值,结果显示,hs-CRP/ALB预测急性STEMI急诊PCI术后发生MACE的曲线下面积为0.925(95%CI:0.862~0.987,P<0.05),最佳截断值为2.89,此时其预测急性STEMI急诊PCI术后发生MACE的敏感性为82%、特异性为88%、准确性为92%。以hs-CRP/ALB=2.89时为临界值,将急性STEMI患者分为hs-CRP/ALB≥2.89者51例、hs-CRP/ALB<2.89者92例。hs-CRP/ALB≥2.89者急诊PCI术后MACE的发生率明显高于hs-CRP/ALB<2.89者(P<0.05)。结论hs-CRP/ALB是急性STEMI急诊PCI术后发生MACE的危险因素,并可作为临床早期预测急性STEMI急诊PCI术后发生MACE的生物标志物。
Objective To investigate the predictive value of high-sensitivity C-reactive protein(hs-CRP)/albumin(ALB)for major adverse cardiovascular events(MACE)after emergency percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods Totally 143 cases of acute STEMI patients were selected and divided into the MACE group of 54 cases and non-MACE group of 89 cases according to whether MACE occurred within 6 months after emergency PCI.General clinical data(such as gender,age,BMI,etc.),disease-related data(such as lesion location,stenosis degree,number of lesions),treatment related data(such as βreceptor blocker,clopidogrel,basic drug use of tegrarol and number of implanted stents),and laboratory test data(such as serum hs-CRP,ALB level and hs-CRP/ALB and LVEF after PCI)were collected.Cox regression model was used to analyze the risk factors of MACE after STEMI emergency PCI.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of hs-CRP/ALB for MACE in STEMI patients after emergency PCI.Results Single factor analysis showed that age,diabetes history,lesion stenosis degree,number of lesions,BNP,hs-CRP/ALB,and LVEF might be related to MACE after acute STEMI emergency PCI(all P<0.05).Cox regression model analysis showed that age,diabetes history,stenosis degree,number of lesions,BNP,and hs-CRP/ALB were risk factors for MACE after acute STEMI emergency PCI(HR=1.604,1.173,1.291,1.422,1.286,1.512,respectively;all P<0.05).LVEF was the protective factor of MACE after acute STEMI emergency PCI(HR=0.924,P<0.05).ROC curve was used to evaluate the predictive value of hs-CRP/ALB for MACE after acute STEMI emergency PCI.The results showed that the area under the curve of hs-CRP/ALB for MACE after acute STEMI emergency PCI was 0.925(95%CI:0.862-0.987,P<0.05),and the optimal cut-off value was 2.89.At this time,the sensitivity,specificity and accuracy of hs-CRP/ALB in predicting MACE after acute STEMI emergency PCI were 82%,88%,and 92%,respectively.When we took the hs-CRP/ALB=2.89 as the cut-off value,all patients with acute STEMI were divided into 51 cases with hs-CRP/ALB≥2.89 and 92 cases with hs-CRP/ALB<2.89.The incidence of MACE in patients with hs-CRP/ALB≥2.89 was significantly higher than that in patients with hs-CRP/ALB<2.89(P<0.05).Conclusion The hs-CRP/ALB is a risk factor for MACE after acute STEMI emergency PCI,and it can be used as a biomarker for the early clinical prediction of MACE after STEMI emergency PCI.
作者
周青
吴校林
润琦
ZHOU Qing;WU Xiaolin;RUN Qi(Xiangyang Central Hospital(The Affiliated Hospital of Hubei University of Arts and Sciences),Xiangyang 441021,China)
出处
《山东医药》
CAS
2020年第7期21-25,共5页
Shandong Medical Journal
基金
湖北省卫生和计划生育委员会科研项目(WJ2015MB189)。
关键词
急性ST段抬高型心肌梗死
主要不良心血管事件
高敏C反应蛋白/白蛋白
acute ST-segment elevation myocardial infarction
major adverse cardiovascular events
high-sensitivity c-reactive protein/albumin
