HbA1c和hs-CRP与急性冠状动脉综合征预后的相关性研究

Evaluation on the correlation between prognosis of acute coronary syndrome and HbA1c and hs-CRP level

目的探讨联合检测糖化血红蛋白（HbAlc）和hs-CRP对于急性冠状动脉综合征患者预后的预测价值。方法选取该院2009年8月至2011年8月收治的141例急性冠状动脉综合征患者。根据患者血中HbAlc和hs-CRP水平，将研究对象分为以下4组：高HbAlc高hs-CRP组，高HbAlc组，高hs-CRP组，低HbAlc低hs-CRP组（对照组）。随访至2012年8月，收集患者的临床资料并进行统计分析。结果与对照组相比，高HbAlc组患者在2年内、其他两组患者在整个随访时间内的累积生存率都有明显的下降（P〈0．05）。将HbAlC和hs-CRP作为协变量，对患者的生存时间进行Cox回归分析，得出回归方程为h（t，x）=h0（t）exp（0．092×HbAlc＋0．610×hs-cRP）。上述方程经拟合优度检验，在α=0．05水平下，χ2=10．326，P〈0．01。HbAlc和hs-CRP的RR值分剐为1．971，95％CI（1．245～2．539），P〈0．05和3．398，95％CI（2．879-3．917），P〈0．05。该回归模型的灵敏度为75．4％，特异度为83．3％，Kappa值为0．446。结论联合检测HbAlc和hs-CRP对于急性冠状动脉综合征患者的预后具有中等程度的预测价值。

Objective To investigate the prognostic value of HbAlc and hs-CRP in patients with acute coronary syndrome. Methods A total of 141 patients diagnosed as acute coronary syndrome from August 2009 to August 2011 in this hospital were col- lected. According to the levels of HbAlc and hs-CRP, patients were divided into the following four groups., the high H bAlc and hs- CRP group,the high HbAlc group, the high hs-CRP group, the low HbAlc and hs-CRP group（control group）. After receiving standard treatment and being discharged from hospital, all patients were followed up every two month until death or the end of the study. Clinical data from all patients were statistically analyzed. Results Compared with the control group, the cumulative survival of the high HbAlc group was much lower in 2 years（P〈0.05） and the difference between the two groups was not significant 2 years later（P〈0.05）. However,the cumulative survival in high HbAlc and high hs-CRP group and the high hs-CRP group were significantly lower than the control group through the whole follow-up time. A Cox regression modal with HbAlc and hs-CRP as the covariates established and the formula was.. h（t, x） =h0 （t） exp （0. 092 × HbAlc ＋ 0. 610× hs-CRP） （ χ2 = 10. 326, P〈0.01 ）. The value of HbAlc and hs-CRP were associated with increased risk of mortality [RR 1. 971,95%CI（1. 245-2. 539）, P〈0.05 and RR 3. 398,95 %CI（2. 879-3. 917） ,P〈0. 05, respectively]. The specificity and sensitivity of that modal was 75% and 83.6 %, respectively. The Kappa value was 0. 446. Conclusion The combined detection of HbAlc and hs-CRP level can predict the progno- sis of patients with acute coronary syndromes.