超敏C反应蛋白回落缓慢与心肌梗死后心力衰竭的关系

Relationship between hs-CRP descending slowly and heart failure induced by acute myocardial infarction

目的 探讨超敏C反应蛋白（high-sensitivity C-reactive protein,hs-CRP）回落缓慢对急性心肌梗死后心力衰竭（HF）严重程度的诊断价值.方法 采用免疫散射比浊法检测63例行急诊PCI的急性心肌梗死患者入院时及术后1、3、7、14、21、30 d hs-CRP水平,应用超声心动图评价患者术前及随访时心脏功能;所有患者随访180 d,根据心脏功能将其分为无HF组（29例）、轻度HF组（21例）及严重HF组（13例）.根据hs-CRP水平绘制受试者工作特征（ROC）曲线,确定HF发生的最佳阈值,计算阈值的敏感性、特异性.结果 轻度HF组和严重HF组hs-CRP水平入院时及术后1、3 d均高于无HF组（P〈0.05）,轻度HF组与严重HF组比较差异无统计学意义.术后7 d三组hs-CRP水平显著下降,但轻度HF组和严重HF组hs-CRP水平尚高于无HF组（P〈0.05）,且严重HF组hs-CRP水平高于轻度HF组（P〈0.05）.术后10、14、21 d严重HF组hs-CRP水平显著高于无HF组（P〈0.05）,轻度HF组hs-CRP水平与无HF组比较差异无统计学意义.术后30 d三组hs-CRP水平比较差异无统计学意义（P〉0.05）.在预测HF中,术后1、3、7 d hs-CRP的ROC曲线下面积具有可靠性,其中术后7 d可靠性最高.在预测HF的严重程度中,仅有术后7 d hs-CRP的ROC曲线下面积有可靠性.结论 hs-CRP回落缓慢可用于评价心肌梗死后HF的严重程度.

Objective To evaluate the value of high -sensitivity C -reactive protein （hs- CRP） descending slowly in severity degree of heart failure（HF） induced by acute myocardial infarction （AMI）. Methods A total of 63 patients with AMI, who received successful treatment of primary PCI were included in this study. The levels of hs - CRP were determined by nephelometry test before PCI and 1st, 3rd, 7th, 14th, 21st and 30th day after PCI. Ventricular function was evaluated by echocardiography . All the patients were followed -up for 180 days , these patients were divided into three groups： non - HF group（n =29）, mild HF group（n =21） and severe HF group （n = 13） according to the severity degree of heart failure. The receiver operative characteristic （ROC） curve was calculated, and all those informations were studied and compared between three groups Results In mild HF group and severe HF group, the levels of hs - CRP were higher than in non - HF group at 1st, 3rd, 7th day after operation and before operation（ P 〈 0.05 ）. The levels of hs - CRP were higher in severe HF group than in mild HF group at 7th day after operation（ P 〈 0.05 ）. Compared with non -HF group, the patients＇hs - CRP in severe HF group were still higher at 10th, 14th, 21st day after operation （P 〈 0. 05 ）. The patients＇hs -CRP had no significant difference in three groups at 30th day after operation. It presented the predictive value for HF that the area under ROC curve of hs - CRP at 1 st, 3rd, 7th day, especially 7th day. However, the area under ROC curve of hs - CRP at 7th day could predictive the degree of HF. Conclusion Hs - CRP descending slowly could evaluate the severity degree of HF induced by AMI.