血清铁降低对急性ST段抬高心肌梗死患者院内泵功能衰竭的预测价值

目的探讨血清铁水平降低对急性ST段抬高心肌梗死患者发生院内急性心力衰竭的预测价值。方法对287名急性ST段
抬高心肌梗死（STEMI）患者资料进行回顾性分析，按整个队列血清铁水平的四分位数将患者分为4组，比较不同血清铁水平组
的院内急性心衰发病率；分析血清铁水平与Hb、BNP、cTnI、hsCRP水平等参数间的关系；比较血清铁水平、BNP、cTnI和hsCRP
等生物标志物与住院期间急性心衰、心源性休克发病率和死亡率等不良后果的关系。结果全部287名STEMI患者的入院平均
血清铁水平是10.20 μmol/L（6.90，14.40 μmol/L），血清铁水平的四分位数：Q1≤6.90 μmol/L，Q2 6.91~10.19 μmol/L，Q3 10.20~
14.39 μmol/L，Q4≥14.40 μmol/L。从Q1到Q4组，院内急性心力衰竭发病率分别是Q1 79.5%，Q2 64.3%，Q3 50.0%和Q4 45.9%（P<
0.001）；单变量Logistic回归分析结果显示血清铁水平低于8.95 μmol/L 组患者发生院内急性心衰的危险度（OR）是血清铁高于
8.95 μmol/L 组的近3 倍（OR 3.358，95% CI 1.791-6.294，P<0.001），多变量Logistic 回归分析结果显示OR 2.316（95%CI
1.205-4.453，P=0.012）。结论血清铁水平降低是STEMI患者院内急性心力衰竭的独立危险因素。

Predictive value of serum iron level for in-hospital acute heart failure after acute ST-elevated myocardial infarction

Objective To evaluate the predictive value of serum iron level for in-hospital acute heart failure (AHF) after acute
ST-elevated myocardial infarction (STEMI). Methods This retrospective study involved 287 patients with STEMI stratified by
quartiles of admission serum iron concentration. The incidence of AHF was assessed by serum iron quartiles. We evaluated the
association of serum iron levels with B-type natriuretic peptide (BNP), cardiac troponin I (cTnI), and high-sensitivity
C-reactive protein (hs-CRP) levels on admission, and analyzed the correlation of serum iron levels with in-hospital AHF, death,
and duration of hospital stay. Results The average serum iron level on admission of the 287 STEMI patients was 10.20 μmol/L
(6.90-14.40 μmol/L), and the quartiles (Q) of serum iron levels were ≤6.90 μmol/L (Q1), 6.91-10.19 μmol/L (Q2), 10.20-14.39 μmol/L
(Q3), and ≥14.40 μmol/L (Q4). The incidences of in-hospital AHF from Q1 to Q4 were 79.5% , 64.3% , 50.0% and 45.9% ,
respectively (P<0.001). Univariate logistic regression analysis showed that low admission serum iron level (Q1) was an
independent predictor for in-hospital AHF (OR=3.358, 95% CI 1.791- 6.294, P<0.001), and multivariate logistic regression
analysis showed a similar result (OR=2.316, 95%CI 1.205-4.453, P=0.012). Conclusion A lower admission serum iron level is an
independent predictor of AHF in STEMI patients during hospitalization.