急性心肌梗死患者血清hsCRP水平与急诊冠脉介入治疗后心衰的关系

目的：探讨急性心肌梗死（AMI）患者接受急诊冠状动脉介入治疗（PCI）术后心力衰竭与术前高敏C反应蛋白（hsCRP）水平之间的关系。方法：对于170例首次AMI患者根据入院hsCRP的水平分为G1组（hsCRP≤5.1mg/L,44例）,G2组（5.2mg/L38.6mg/L,37例）,比较各组心力衰竭发生率。采用Logistic逐步回归法分析急诊PCI术后心力衰竭发生的危险因素。结果：两年中34例（20%）发生心力衰竭。随着PCI术前hsCRP水平的升高,心力衰竭的发生率逐渐上升（G1组～G4组分别为：9.1%比16.0%比28.2%比29.7%,P均〈0.05）;与同组PCI术后1周比较,术后1年时G3组、G4组的左室舒张末期容积指数（58.61±10.10）ml/m2比（61.84±9.92）ml/m2,（59.70±11.88）ml/m2比（66.46±10.52）ml/m2]、左室收缩末期容积指数（28.20±6.55）ml/m2比（31.06±7.14）ml/m2,（27.40±6.49）ml/m2比（31.62±8.03）ml/m2]明显增加,左室射血分数明显减低（52.56±7.58）%比（49.56±9.63）%,（53.19±8.12）%比（48.73±7.11）%],P〈0.05～0.01。Logistic逐步回归分析显示术前hsCRP水平是AMI患者发生心衰的预测因素（相对危险度为1.052,P=0.003）。结论：高敏C反应蛋白是急性心肌梗死患者PCI术后心力衰竭发生的预测因子之一。

Relationship between serum level of hsCRP and heart failure after primary PCI in AMI patients

Objective: To investigate relationship between preoperative serum level of high sensitive C reactive protein(hsCRP) and chronic heart failure(CHF)after primary percutaneous coronary intervention(PCI) in patients with acute myocardial infarction(AMI).Methods:According to hsCRP level at admission,a total of 170 patients with first AMI onset were divided into group G1(hsCRP≤5.1 mg/L,n=44),group G2(5.2 mg/L38.6 mg/L,n=37).CHF incidence rate of each group was compared.Logistic gradual regression method was used to analyze risk factors for heart failure after primary PCI.Results:A total of 34(20%) cases occurred CHF within two years.As preoperative hsCRP level increased,CHF incidence rate gradually increased(from group G1 to G4 was 9.1% vs.16.0% vs.28.2% vs.29.7% respectively,P<0.05 all);Compared with one week after PCI,there were significant increase in left ventricular end-diastolic volume index (58.61±10.10) ml/m2 vs.(61.84±9.92) ml/m2,(59.70±11.88) ml/m2 vs.(66.46±10.52) ml/m2]and left ventricular end-systolic volume index (28.20±6.55) ml/m2 vs.(31.06±7.14) ml/m2,(27.40±6.49) ml/m2 vs.(31.62±8.03) ml/m2],and significant decrease in LVEF (52.56±7.58)% vs.(49.56±9.63)%;(53.19±8.12)% vs.(48.73±7.11)%]after PCI one year in group G3 and group G4,P<0.05~<0.01.Logistic gradual regression indecated that preoperative hsCRP level was a predictive factor for CHF in AMI patients(relative risk=1.052,P=0.003).Conclusion: hsCRP is one of predictive factors for CHF after PCI in AMI patients.