降钙素原和超敏C反应蛋白与急性冠脉综合征患者GRACE评分的相关性及其对预后的评估价值

The correlation and value in assessment of prognosis between procalcitonin,hs-CRP and GRACE risk score in patients with acute coronary syndrome

目的探讨降钙素原（PCT）和超敏C反应蛋白（hs-CRP）与急性冠脉综合征（ACS）患者全球急性冠状动脉事件注册（GRACE）评分的相关性,以及PCT、hs-CRP对ACS预后的评估价值。方法回顾性分析2013年1月~2014年12月甘肃省人民医院心内科确诊为ACS的患者192例,根据院内发生心血管事件情况分为未发生心血管事件组和发生心血管事件组,比较两组间基线资料以及PCT、hs-CRP和GRACE评分等指标;所有研究对象按照GRACE评分分为低危组、中危组、高危组,比较各组间PCT、hs-CRP水平;PCT、hs-CRP与GRACE评分的相关性采用Pearson相关分析;绘制受试工作者特征曲线（ROC）,评价PCT、hs-CRP对ACS预后的判断价值。结果 192例ACS患者中,住院期间19例发生心血管事件;PCT[（0.098±0.038）ng/ml vs（0.053±0.036）ng/ml,P=0.000]、hs-CRP（12.50±16.11）mg/L vs（2.68±3.55）mg/L,P=0.016]、GRACE评分[（183.9±46.8）vs（137.6±37.4）,P=0.000]心血管事件组明显高于未发生心血管事件组。随着GRACE评分升高,PCT、hs-CRP水平逐渐升高,低危组、中危组、高危组PCT分别为（0.042±0.024）ng/ml、（0.057±0.043）ng/ml、（0.071±0.036）ng/ml,hs-CRP分别为（0.85±1.99）mg/L、（2.32±2.48）mg/L、（7.90±10.43）mg/L,PCT、hs-CRP在GRACE评分各分层间两两比较差异均有统计学意义（P均〈0.05）。PCT、hs-CRP水平与GRACE评分均呈显著正相关（r=0.399,r=0.605,P均〈0.01）。PCT、hs-CRP评价ACS预后的ROC曲线分析显示,PCT曲线下面积（AUC）：0.827,95%可信区间：0.757~0.897,P〈0.001,敏感度：84.2%,特异度：76.5%;hs-CRP曲线下面积：0.812,95%可信区间：0.722~0.903,P〈0.001,敏感度：89.5%,特异度：66.5%。结论 PCT、hs-CRP与ACS患者GRACE评分显著相关,对预测ACS预后具有一定价值。

Objective To investigate the correlation between procalcitonin （PCT）, hs-CRP and GRACE risk score, and explore the value of PCT, hs-CRP in assessment of prognosis in patients with ACS. Methods A total of 192 patients with ACS from Jan 2013 to Dee 2014 in cardiovascular department of Gansu Provincial Hospital were prospectively included. All patients were divided into cardiovascular events group and without cardiovascular events group according to the occurrence of cardiovascular events, then divided into low risk group, moderate risk group and high risk group according to the GRACE risk score. The relationships between PCT, hs-CRP and GRACE risk score were analyzed by Pearson correlation analysis. Receiver operating characteristic （ROC） curve was plotted to assess the prognostic value of PCT and hs-CRP for prognosis of patients with ACS. Results During the in-hospital period, 19 patients presented cardiovascular events. The blood level of PCT [（0.098±0.038）ng/ml vs （0.053±0.036）ng/ml, P=0.000], hs-CRP [（12.50±16.11）mg/L vs （2.68±3.55）mg/L, P=0.016）] and GRACE risk score [（183.9±46.8） vs （137.6±37.4）, P=0.000] in cardiovascular events group were significantly higher than without cardiovascular events group. The values of PCT, hs-CRP rose significantly as the GRACE risk score became higher. Inthe low risk group, moderate risk group and high risk group, the value of PCT was （0.042±0.024）ng/ml, （0.057±0.043）ng/ml, （0.071±0.036）ngtml, and the value of hs-CRP was （0.85±1.99）mg/L, （2.32±2.48）mg/L, （7.90±10.43）mg/L respectively. There were significant differences in PCT and hs-CRP between any two groups with different GRACE risk score. The values of PCT and hs-CRP were significantly correlated with GRACE risk score （r=0.399, r=0.605, both P〈0.01）. ROC curve presented that PCT （AUC： 0.827, 95%CI： 0.757-0.897, P〈0.001, sensitivity： 84.2%, specificity： 76.5%） and hs-CRP （AUC： 0.812, 95% CI： 0.722-0.903, P〈0.001, sensitivity： 89.5%, specificity： 66.5%） were related to prognosis in patients with ACS. Conclusion The levels of PCT and hs-CRP are significantly correlated with GRACE risk score, which has a certain value in assess- ment of prognosis in patients with ACS.