急性心肌梗死早期血清超敏C反应蛋白和前白蛋白与并发急性心力衰竭的关系

The relationship between serum C-reactive protein and pre-albumin and the acute heart failure duringthe early stage of acute myocardial infarction patients

目的研究急性心肌梗死患者发病早期血清超敏C反应蛋白（hs—CRP）和前白蛋白（PAB）水平与急性心力衰竭发生及其严重程度的关系。方法回顾性收集2010年9月至2012年9月间在苏州大学附属第一医院住院并确诊的181例急性心肌梗死患者病历资料，其中114例（63．0％）并发急性心力衰竭归为心力衰竭组并记录其Killip分级，另外67例（37．0％）未并发急性心力衰竭作为对照组。血清hs—CRP（mg／L）和PAB（mg／L）数值为人院次日早晨空腹静脉血样本测得。对血清hs-CRP和PAB等相关临床数据行Logistic回归分析、Spearman相关分析、ROC曲线分析。结果单因素Logistic回归分析显示心力衰竭组血清hs—CRP水平高于对照组（P：0．000），而PAB水平低于对照组（P：0．000）；Spearman相关分析显示心力衰竭组血清hs—CRP、PAB水平和Killip分级之间具有相关性（rhs-CRP，=0．234，Ph。mP=0．003；rPAB=-0．321，PPAB=0．000）；多因素Logistic回归分析提示血清hs—CRP（OR1．086，95％CI1．012～1．167，P=0．023）、PAB（OR0．991，95％a0．983～0．999，P=0．038）为急性心肌梗死并发急性心力衰竭的独立危险因素；ROC曲线分析得到两者曲线下面积（AUC）分别为：AUChs-CRPRP=0．722，95％C10．651～0．786，AUCPAH：0．723，95％C10．652—0．787。结论发病早期血清hs—CRP高或PAB低的急性心肌梗死患者更容易并发急性心力衰竭，两者均为并发急性心力衰竭的独立危险因素，且和心力衰竭的严重程度存在相关性。

Objective To investigate the relationship between the serum high sensitive c-reactive protein （hs-CRP） and prealbumin （PAB） and the acute heart failure during the early stage of acute myocardial infarction （MI） patients. Methods A total of 181 MI patients （male： n = 154, 85. 1% vs. female： n = 27, 14. 9% ）, admitted between Seppember 2010 and September 2012, were enrolled. They were divided into heart failure group （n = 114, 63.0% ） with Killip classification recorded and control group （n = 67, 37.0% ） without heart failure. The levels of serum hs-CRP and PAB were determined from the venous blood in the followed morning after admission. The clinical data were analyzed by logistic regression, Spearman correlation, and ROC curve. Results The serum level of hs-CRP （rag/L） in the heart failure group was significantly higher than that in the control group （P =0. 000）, while the serum level of PAB （rag/L） in the heart failure group was significantly lower than that in the control group （P = 0. 000）. High level of hs-CRP and low level of PAB were significantly correlated with Killip elassification （ rhs-CRP = 0. 234, Phi-caP = 0. 003 ; rpAs = --0. 321, PPAB =0. 000）. Serum hs-CRP （P =0. 023, OR 1. 086, 95% CI 1. 012-1. 167） and PAB（P =0. 038, OR O. 991, 95% CI O. 983-0. 999） were the independent risk biomarkers of acute heart failure subsequent to myocardial infarction determined by multivariate logistic regression analysis. The area under the ROC curve： AUChs-CRP = 0.722, 95% C1 0.651-0.786; AUCPAB = 0.723, 95% CI 0.652-0.787. Conclusions With high level of serum hs-CRP or low level of serum PAB during the early stage of acute myocardial infarction, patients were predisposed to the development of acute heart failure consequently. Both of them are the independent risk biomarkers of acute heart failure subsequent to myocardial infarction. Furthermore, they were significantly correlated with severity of the heart failure in terms of Killip classification.