急性ST段抬高型心肌梗死患者的hs-CRP/ALB变化对预后的预测价值

目的探讨急性ST段抬高型心肌梗死(STEMI)患者的高敏C-反应蛋白(hs-CRP)/白蛋白(ALB)变化对预后的预测价值.方法选取2014年7月至2018年7月收治的80例急性STEMI患者,收集患者一般资料、高危因素、相关检查结果和实验室指标.所有患者均予以介入治疗并术后随访,截至2019年7月,记录主要心血管不良事件(MACE)发生情况.根据患者随访结果,将患者分为MACE组(16例)与非MACE组(64例),比较两组一般资料、高危因素和实验室指标.采用多因素Logistic回归分析明确MACE的危险因素.绘制hs-CRP/ALB预测MACE的受试者工作特征(ROC)曲线,分析hs-CRP/ALB对MACE的预测价值.并以最佳截断值将患者分为两组,绘制Kaplan-Meier生存曲线,比较两组生存情况.结果80例患者随访结束后,MACE发生率20%(16/80).MACE组与非MACE组性别、体质量指数、心率、收缩压、舒张压、高血压史、冠心病史、吸烟史、甘油三脂(TG)、总胆固醇(TC)、血白细胞计数(WBC)、B型利钠肽(BNP)、D-二聚体(DD)及ALB比较差异无统计学意义(P>0.05).MACE组年龄、糖尿病史占比、血清BNP、hs-CRP及hs-CRP/ALB高于非MACE组,左室射血分数(LVEF)低于非MACE组,差异有统计学意义(P<0.05).经Logistic多元回归分析,年龄、糖尿病、BNP、hs-CRP及hs-CRP/ALB是MACE的危险因素,LVEF是MACE的保护因素(P<0.05).hs-CRP/ALB预测急性STEMI患者介入术后MACE的ROC曲线下面积(AUC)0.918(95%CI0.855~0.978),hs-CRP的AUC 0.741(95%CI0.697~0.845),hs-CRP/ALB对MACE的预测价值更高.当hs-CRP/ALB=0.58时的预测价值最高,此时敏感度为87.5%,特异度为79.7%.根据ROC曲线分析结果,将患者分为hs-CRP/ALB≥0.58组(31例)与hs-CRP/ALB<0.58组(49例).截至2019年7月,hs-CRP/ALB<0.58组的生存率为95.92%(47/49),较hs-CRP/ALB≥0.58组的80.65%(25/31)相对更高,且生存时间更长,Kaplan-Meier生存曲线的差异有统计学意义(Log-rank P=0.039).结论年龄、糖尿病史、BNP、hs-CRP/ALB是急性SIEMI患者介入术后MACE的危险因素,LVEF是MACE的保护因素,且hs-CRP/ALB对急性STEMI患者介入术后的MACE有较大预测价值,不同hs-CRP/ALB值的患者生存情况也不同,hs-CRP/ALB<0.58的患者生存率更高,生存时间更长.

Prognostic value of hs-CRP/ALB changes in the patients with acute ST-segment elevation myocardial infarction

Objective To predict the prognostic value of high-sensitivity C-reactive protein(h s-CRP)/albumin(ALB)changes in the patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 80 patients with acute STEMI were enrolled from July 2014 to July 2018,and general data,high—risk factors,related test results and laboratory test results were collected.All the patients underwent interventional therapy and were followed up.As of July 2019,major cardiovascular adverse events(MACE)were recorded.According to the follow-up results,the patients were divided into the MACE group(16 cases)and the non-MACE group(64 cases).The general data,high risk factors and laboratory indicators were compared between the two groups.Multivariate Logistic regression analysis was used to identify risk factors for MACE.The ROC curve of hs-CRP/ALB for predicting MACE was plotted and the predictive value of hs-CRP/ALB for MACE was analyzed.The patients were divided into two groups according to the best cut—off value,and the Kaplan-Meier survival curve was drawn to compare the survival of the two groups.Results After 80 patients were followed up,the incidence of MACE was 20%(16/80).There were no significant differences in gender,body mass index,heart rate,systolic blood pressure,diastolic blood pressure,hypertension history,coronary heart disease history,smoking history,TG,TC,WBC,BNP,DD,and ALB between the MACE group and the non-MACE group(P>0.05).The age,the proportion of diabetes,the serum BNP,hs-CRP,hs-CRP/ALB in the MACE group were higher than those in the non-MACE group,and the LVEF was lower than that in the non-MACE group(P<0.05).Logistic multiple regression analysis showed that age,diabetes,BNP,hs-CRP,hs-CRP/ALB were risk factors for MACE,and LVEF was a protective factor for MACE(P<0.05).hs-CRP/ALB predicted the area under the ROC curve of MACE was 0.918(95%C/0.855-0.978)in the patients with acute STEMI after intervention,and the area under the ROC curve of hs-CRP was 0.741(95%Cl 0.697-0.845),hs-CRP/ALB had a higher predictive value for MACE.When hs-CRP/ALB was 0.58,the predictive value was the highest,at this time the sensitivity was 87.5%and the specificity was 19.1%.According to the ROC results,the patients were divided into hs-CRP/ALB≧0.58 group(31 cases)and hs-CRP/ALB<0.58 group(49 cases).As of July 2019,the survival rate of hs-CRP/ALB<0.58 group was 95.92%(47/49),which was higher than 80.65%(25/31)of hs-CRP/ALB≧0.58 group,and had a long survival time.The difference in Kaplan-Meier survival curves was statistically significant(Log-rank P=0.039).Conclusion Age,diabetes,BNP,hs-CRP/ALB are risk factors for postoperative MACE in the patients with acute STEMI.LVEF is a protective factor for MACE,and hs-CRP/ALB has a greater predictive value for MACE in the patients with acute STEMI after intervention.In addition,the patients with different hs-CRP/ALB values have different survival conditions,and the patients with hs-CRP/ALB<0.58 have higher survival rate and longer survivaltime.