C反应蛋白和尿蛋白排泄率对急性心肌梗死远期死亡率的预测

The predictive value of C-reactive protein and urine albumin excretion rate for long-term mortality after acute myocardial infarction

目的探讨尿蛋白排泄率对急性心肌梗死(AMI)远期预后的预测价值是否优于C反应蛋白(CRP)。方法连续入选2001年1月至2005年12月确诊AMI并收住我院心脏重症监护室的患者。于入院第1、3、7天检测CRP和24 h尿蛋白排出量,并计算尿蛋白/肌酐比率(ACR)。随访时间为5年。结果共入选209例患者,年龄47～83岁,平均(68.3±15.6)岁,女性62例(29.7%),合并心力衰竭81例(38.8%)。校正年龄、高血压、糖尿病、入院延迟时间、肌酸激酶同工酶(CK-MB)峰值、心力衰竭及肌酐清除率后,CRP和ACR均与5年全因死亡率风险增加独立相关。但CRP与远期死亡率不相关[HR 95%CI:1.1(0.7～1.8),P=0.65],而ACR与近期和远期死亡率均独立相关[OR 95%CI:3.9(2.0～9.0),P<0.0001;1.4(1.1～1.8),P=0.01]。结论 ACR对AMI远期死亡率的预测价值优于CRP。

Objective To compare the predictive value of C-reactive protein（CRP） and urine albumin excretion rate for long-term mortality after acute myocardial infarction（AMI）. Methods From January 2001 to December 2005,209 consecutive patients with AMI were enrolled in this study.CRP,albumin excretion rate and albumin-to-creatinine ratio（ACR） were measured at day 1,day 3,and day 7 after admission in all subjects.All the patients were followed up for 5 years. Results Off the 209 patients（age from 47 to 83 years old）,62 were female（29.7%） and 81 with heart failure（38.8%）.Survival analysis showed that,after adjusting for age,hypertension,diabetes mellitus,pre-hospital time delay,creatine kinase-MB isoenzyme peak,heart failure,and creatinine clearance,both CRP and ACR were associated with increased risk of 5-year all-cause mortality.CRP was not correlated with long-term mortality [HR（95%CI）： 1.1（0.7-1.8）,P=0.65],while ACR was independently correlated with both short-term and long-term mortality [OR（95%CI）： 3.9（2.0-9.0）,P0.0001;1.4（1.1-1.8）,P=0.01]. Conclusions ACR is a better predictor than CRP for long-term mortality after AMI.