C反应蛋白与白蛋白比值对急性冠状动脉综合征患者预后的影响

The effects of C-reactive protein and albumin ratio on the prognoses in patients with acute coronary syndrome

目的探讨C反应蛋白与白蛋白比值对行经皮冠状动脉介入治疗(percutaneous coronaryintervention,PCI)的急性冠状动脉综合征(acute coronary syndrome,ACS)患者预后的影响。方法连续入选2015年1月1日至2016年12月31日期间在中国医科大学附属盛京医院心内科住院诊断为ACS且行PCI的患者553例,基于ROC曲线确定的全因死亡的C反应蛋白(cRP)与白蛋白比值最佳界值将患者分为两组:低CRP/白蛋白比值组(n=508,CRP/白蛋白≤1.0787]和高CRP/白蛋白比值组(n=45,CRP/白蛋白>1.0787),收集患者临床资料、冠状动脉造影及介入结果,记录终点事件,分析两组患者临床特点及预后差异。结果在随访期间,两组患者全因死亡率、心源性死亡率比较差异有统计学意义(高CRP/白蛋白比值组全因死亡率为24.4%、心源性死亡率为24.4%,低CRP/白蛋白比值组分别为3.9%、2.2%,P<0.05)。Cox分析显示,CRP/白蛋白比值与全因死亡(HR=4.699,95%CI 1.836-12.028,P=0.001)和心源性死亡HR=9.641,95%CI3.258-28.529,P<0.001)独立相关。ROC曲线分析示,CRP/白蛋白、CRP、白蛋白曲线下面积分别为0.644、0.634、O.377,CRP/白蛋白比值截断值为1.079,敏感度为0.355,特异度为0.935。结论CRP/白蛋白比值对行PCI治疗的ACS患者预后有一定预测价值且优于CRP和白蛋白。

Objective To evaluate the role of CRP,albumin and CRP/albumin ratio in predicting the outcome in patients with acute coronary syndrome who had undergone coronary intervention treatment.Methods 553cases of newly diagnosed patients with acute coronary syndrome were enrolled from January 1,2015to December 3I,2016.Based on ROC curve,patients were divided into two groups:low CRP/albumin ratio group (n=508,CRP /albumin≤l.0787)and high CRP/albumin ratio group (n=45,CRP /albumin>l.0787).Their general date,coronary intervention data,postoperative medication and end-point events were recorded.The clinical characteristics and outcomes of the two groups were analyzed.Results There were significant differences in all-cause mortality and cardiac mortality between the two groups during the follow-up period (all-cause mortality :high CRP/albumin ratio group was 24.4%,low CRP/albumin ratio group was 3.9%;cardiac mortality : high CRP/albumin ratio group was 24.4%,low CRP/albumin ratio group was 2.2%,P<0.05).Cox analysis demonstrated that the ratio of CRP/albumin were independently associated with all-cause mortality (HR=4.699, 95%CI 1.836-12.028,P=0.001)and cardiac mortality(HR=9.641,95%CI 3.258-28.529,P<0.001).Conclusion The ratio of CRP/albumin in patients with acute coronary syndrome treated with PCI has certain prognostic value and is superior to CRP and albumin.