超敏C反应蛋白与前白蛋白比值对心肌梗死并发急性心衰的预测价值

Ratio of serum high sensitive C - reactive protein to preaibumin as an independent predictor for acute heart failure complicating myocardial infarction

目的研究血清超敏c反应蛋白与前白蛋白比值（hs—CRP／PAB）对急性心肌梗死（AMI）并发急性心衰（AHF）的预测价值。方法2010—09—2012—09在我院住院并确诊的AMI患者174例，男性149例（85．6％），年龄（66．4±13．6）岁。其中108例（62．1％）院内并发AHF归为心衰组，记录其Killip分级；另外66例（37．9％）作为对照组。记录患者的性别、年龄及是否患有高血压病、糖尿病、高脂血症等慢性基础疾病，同时记录入院早期（24h内）血清学指标，其中肌钙蛋白T及肌酸激酶同工酶（CK—MB）为入院时急诊检测值，血清hs—CRP、PAB等数值为入院次日晨空腹静脉血测得。对hs—CRP／PAB比值行自然对数转换，即ln（hs—CRP／PAB）。通过Logistic回归、Spearman相关、ROC曲线对相关数据进行统计分析。结果心衰组hs—CRP高于对照组，PAB低于对照组，ln（hs—CRP／PAB）高于对照组（-2．78±0．97VS-3．70±1．03）（P均〈0．01）。以ln（hs—CRP／PAB）均数-3．13为截断值，将所有患者分层比较，ln（hs—CRP/PAB）≥-3．13组的AHF发生率显著高于另一组（79．8％VS41．3％，P〈0．01）。将临床指标纳入多变量Logistic回归模型，通过前进法进行变量剔除，最终年龄、ln（hs—CRP／PAB）进入模型，其中ln（hs—CRP／PAB）的OR=2．201，95％CI1．456～3．329，P〈0．001，并且与Killip分级呈正相关（r=0．313，P〈0．001）。ROC曲线分析提示，ln（hs—CRP／PAB）预测AHF发生的曲线下面积为0．752，95％C10．681～0．814，优于hs—CRP、PAB及年龄。取敏感度和特异度之和最大时对应的-3．05作为最佳截断值，预测AHF的敏感度69．44％，特异度72．73％。结论血清hs～CRP／PAB比值是心肌梗死并发AHF的独立预测因素，其水平越高发生心衰的风险越大、症状越重。

Objective To investigate predictive value of the ratio of serum high sensitive C - reactive protein （ hs - CRP ） to prealhumin （ PAB ） for acute heart failure （ AHF ） complicating myocardial infarction （AMI）. Methods A total of 174 patients with AMI [ male ： n = 149, 85.6% ; age： （66.4 ± 13.6 ） years] admitted to the First Affiliated Hospital of Sooehow University from Sep. 2010 to Sep. 2012 were enrolled. They were divided into a heart failure group （ n = 108, 62.1% ） and a control group. The values of hs - CRP and PAB were measured from the vein blood in the morning of the second day after admission. Clinical data were analyzed by Logistic regression, Spearman correlation, and ROC curve using STATA and MedCalc. Results The serum level of In （ hs - CRP/PAB） in the heart failure group was significantly higher than that of control group （ - 2.78 ± 0. 97 vs - 3.70 ± 1.03, P 〈0. 001 ） , and was positively correlated with Killip classification （r =0. 313 ,P 〈0. 001 ）. Age and In （hs - CRP/PAB ） were both independent predictors of AHF complicating AMI determined by multivariate Logistic regression model. The area under the ROC curve of ln（ hs -CRP/PAB） predicting AHF was 0. 752, 95% CI 0. 681 - 0. 814. Conclusion The level of ln（hs - CRP/PAB） could be used as an independent predictor for AHF complicating AMI, and was positively correlated with severity of heart failure.