修正休克指数与血浆乳酸水平对非ST段抬高型心肌梗死短期预后预测价值的研究

Predictive value of modified shock index and level of plasma lactic acid to short-term prognosis in patients with non-ST-segment elevation myocardial infarction

目的研究修正休克指数与血浆乳酸水平对非ST段抬高型心肌梗死(NSTEMI)短期预后的预测价值。方法选取2014年1月~2017年1月于承德医学院附属医院急诊科收治的急性NSTEMI患者312例,依据修正休克指数(MSI)和乳酸(LA)水平将患者分组,分别为MSI≥1.2组与MSI<1.2组,和LA≥2 mmol/L组与LA<2 mmol/L组。记录所有患者的一般资料,评估患者的短期预后情况,统计患者的院内死亡率,并采用受试工作特征(ROC)曲线下面积(AUC),分析各指标对NSTEMI患者短期预后的预测价值。结果 MSI≥1.2组与MSI<1.2组的的收缩压、舒张压、心率、左室射血分数及Killip分级的Ⅲ、Ⅳ级的差异比较有统计学意义(P<0.05);LA≥2组与LA<2组的左室射血分数、肌钙蛋白I及Killip分级的Ⅲ、Ⅳ级的差异比较有统计学意义(P<0.05)。MSI≥1.2组的致命性心律失常发生率、心源性休克发生率及全因病死率分别显著高于MSI<1.2组,差异有统计学意义(P<0.05);LA≥2组的致命性心律失常发生率、心源性休克发生率及全因病死率显著高于LA<2组,差异有统计学意义(P<0.05)。患者院内死亡率为18.59%。MSI和LA的AUC分别为0.794和0.822,对NSTEM患者的短期预后预测有统计学意义(P<0.001)。结论 MSI和LA均对NSTEMI患者的短期预后有一定的预测价值,且LA的预测力更高。

Objective To study the predictive value of modified shock index （MSI） and level of plasma lactic acid （LA） to short-term prognosis in patients with non-ST-segment elevation myocardial infarction （NSTEMI）. Methods NSTEMI patients （n=312） were chosen from the Department of Emergency in the Affiliated Hospital of Chengde Medical College from Jan. 2014 to Jan. 2017, and all patients were divided, according to MSI and LA level, into MSI≥1.2 group and MSI〈1.2 group, and LA≥2 mmol/L group and LA〈2 mmol/L group. The general data of the patients was recorded, short-term prognosis was reviewed and hospital mortality was observed, and predictive value of all indexes to short-term prognosis was analyzed by using area under curve （AUC） of receiver operating characteristic curve （ROC）. Results The difference in systolic blood pressure, diastolic blood pressure, heart rate, left ventricular ejection fraction （LVEF） and grades Ⅲ and Ⅳ of Killip grading had statistical significance between MSI≥1.2 group and MSI〈1 group （P〈0.05）. The difference in LVEF, cardiac troponin I （cTnI） and grades Ⅲ and Ⅳ of Killip grading had statistical significance between LA≥2 mmol/L group and LA〈2 mmol/L group （P〈0.05）. The incidence of fatal arrhythmias and cardiogenic shock and all-cause mortality were significantly higher in MSI≥1.2 group than those in MSI〈1.2 group （P〈0.05）. The incidence of fatal arrhythmias and cardiogenic shock and all-cause mortality were significantly higher in LA≥2 mmol/L group than those in LA〈2 mmol/L group （P〈0.05）. The hospital mortality was 18.59%. AUC of MSI was 0.794 and AUC of LA was 0.822, which had statistical significance in prediction of short-term prognosis in NSTEM patients. Conclusion MSI and LA all have some predictive value to short-term prognosis in NSTEM patients, and LA has higher predictive value.