血清胆红素水平预测急性心肌梗死患者经皮冠状动脉介入治疗的预后价值分析

Analysis on the prognostic value of serum bilirubin level in patients with acute myocardial infarction by percutaneous coronary intervention

目的:探讨血清胆红素水平对急性心肌梗死(acute myocardial infarction,AMI)患者经皮冠状动脉介入治疗预后的预测价值。方法:120例AMI患者设为观察组,30例同期体检的健康同龄人群设为对照组。所有患者均在发病12 h内接受经皮冠状动脉治疗(percutaneous coronary intervention,PCI)并住院观察,1个月后根据是否出现不良事件将观察组分为事件组和非事件组。PCI术后随访6个月,根据患者预后状况将其分为生存组和死亡组。检测各组血清胆红素指标[总胆红素(total bilirubin,TBIL)、直接胆红素(direct bilirubin,DBIL)、间接胆红素(indirect bilirubin,IBIL)]以及血压、血脂等相关指标,并运用Logistic回归分析法分析AMI患者PCI术后死亡风险因素。结果:观察组与对照组比较,SBP、SDP、FBG、DBIL差异无统计学意义(P>0.05),但观察组血清TBIL、IBIL显著低于对照组,差异有统计学意义(P<0.05);PCI术后不良事件发生率为40.83%,随访6个月死亡率为10.83%;不良事件组血清TBIL、IBIL显著低于非事件组,死亡组TBIL、IBIL显著低于生存组,差异均具有统计学意义(P<0.05);多变量Logistic回归分析显示血清TBIL、IBIL水平是AMI患者PCI术后死亡的危险影响因素(OR=1.158、1.473,P<0.05)。结论:血清胆红素水平和AMI患者PCI术后病情转归密切相关,术后积极监测血清TBIL、IBIL水平,可为临床评估不良事件风险和预后生存等提供重要依据。

Objective： To evaluate the prognostic value of serum bilirubin level in patients with acute myocardial infarction（ AMI） by percutaneous coronary intervention. Methods： A total of 120 patients with AMI were selected as the observation group. 30 healthy persons in the same period were selected as the control group. All patients were treated with percutaneous coronary intervention（ PCI） in the onset of 12 h and hospitalized. After 1 month,according to the occurrence of adverse events,the observation group was divided into event group and non event group. The patients were followed up for 6 months after PCI. According to the prognosis,patients were divided into survival group and death group. Serum bilirubin [total Bilirubin（ TBIL）,direct bilirubin（ DBIL）,indirect bilirubin（ IBIL） ],blood pressure,blood lipid and other related indexes were detected in each group,and the risk factors of death after PCI operation were analyzed by Logistic regression analysis. Results： There was no significant difference in SBP,SDP,FBG and DBIL between the observation group and the control group（ P〈0. 05）,but the serum TBIL and IBIL in the observation group were significantly lower than those in the control group,and the difference was statistically significant（ P〈0. 05）. The incidence of adverse events after PCI was 40. 83%,and the mortality rate of 6 months was 10. 83%. The serum TBIL and IBIL in the adverse event group were significantly lower than those in the non event group. The TBIL and IBIL in the death group were significantly lower than those in the survival group,and the difference was statistically significant（ P〈0. 05）. Multivariate Logistic regression analysis showed that serum TBIL and IBIL levels were the risk factors of death in AMI patients after PCI（ OR = 1. 158、1. 473,P〈0. 05）. Conclusion： The level of serum bilirubin is closely related to the prognosis of patients with AMI after PCI. The positive monitoring of serum levels of TBIL and IBIL after operation can provide an important basis for the clinical assessment of the risk of adverse events and the survival of the prognosis.