评估急性心肌梗死患者短期内死亡风险的四种指标比较

Evaluation of prognosis of early mortality in patients with acute myocardial infarction

目的:评价第二代急性生理学及慢性健康状况(APACHE II)评分、全球急性冠状动脉事件注册(GRACE)风险评分、游离三碘甲状腺原氨酸(FT3)水平和反T3水平对急性心肌梗死(AMI)患者短期内死亡风险的预测价值。方法:入选240例AMI患者,对其进行APACHE II评分、GRACE风险评分,检测其FT3水平和反T3水平。统计患者住院期间病死率,患者出院1个月后电话随访其生存情况。结果:死亡患者的APACHE II评分、GRACE风险评分均高于存活患者(19.7±2.9 vs.14.4±3.0,P<0.01;260±51 vs.209±34,P<0.01),死亡患者与存活患者间的FT3水平、反T3水平差异有统计学意义[(3.6±1.2)pmol/L vs.(4.9±1.5)pmol/L,P<0.01;(1.4±0.3)nmol/L vs.(1.2±0.4)nmol/L,P<0.05]。Cox回归风险比例模型分析:APACHE II评分、GRACE风险评分和FT3水平是AMI患者短期内死亡的影响因素(HR=1.459,95%CI:1.227-1.734,P<0.01;HR=0.997,95%CI:0.987-1.008,P<0.01;HR=0.6,95%CI:0.418-0.862,P<0.01)。APACHE II评分标准偏回归系数大于GRACE评分和FT3水平的标准偏回归系数(1.321,0.611,-0.573)。受试者工作特征曲线(ROC)下面积(AUC)分析:APACHE II评分的AUC大于GRACE风险评分和反T3水平的AUC(0.893,95%CI:0.834-0.952;0.822,95%CI:0.757-0.866;0.681,95%CI:0.590-0.771,P<0.01)。结论:APACHE II评分对AMI患者短期内死亡风险的预测价值高于GRACE风险评分、FT3水平和反T3水平。

AIM：To evaluate the performance of Acute Physiology and Chronic Health Evaluation II（APACHE II） scores,Global Registry of Acute Coronary Events（GRACE） risk scores,free triiodothyronine（FT3） levels,and reverse T3（rT3） levels in patients with acute myocardial infarction（AMI）.METHODS：A total of 240 patients with AMI were enrolled.Blood samples were obtained for serum levels of FT3 and rT3 measurements at the time of admission.APACHE II scores and GRACE risk scores were calculated for each patient.Mortality during hospitalization was evaluated.Information regarding survival was obtained by telephone inquiry 1 month after discharge.RESULTS：APACHE II scores and GRACE risk scores were higher in nonsurvivors in comparison with survivors（19.7±2.9 vs.14.4±3.0,260±51 vs.209±34,P0.01）.Significant differences in FT3 and rT3 levels were observed between nonsurvivors and survivors [（3.6±1.2） vs.（4.9±1.5） pmol/L,P0.01 and（1.4±0.3） vs.（1.2±0.4） nmol/L,P0.05].In a multivariate Cox proportional hazards model,APACHE II scores,GRACE risk scores and FT3 levels were independent predictors of early mortality（HR=1.459,95%CI：1.227-1.734,P0.01;HR=0.997,95% CI：0.987-1.008,P0.01;HR=0.6,95% CI：0.418-0.862,P0.01）.Standard partial regression coefficient of APACHE II scores was higher than those of GRACE risk scores and FT3 levels（1.321,0.611,-0.573）.Area under the curve for APACHE II scores was higher than that for GRACE risk scores and rT3 levels（0.893,95% CI：0.834-0.952;0.822,95% CI：0.757-0.866;0.681,95% CI：0.590-0.771,P0.01）.CONCLUSIONS：APACHE II scores are of the highest value for mortality prediction in patients with AMI.