乳酸检测和纠正休克指数在急诊对STEMI患者短期预后的预测价值

Predictive Value of Modified Level of Plasma Lactic Acid and Shock Index to Short-term Prognosis in Patients with ST-segment Elevation Myocardial Infarction

目的:研究血浆乳酸(LA)水平和修正休克指数(MSI)对急性ST段抬高型心肌梗死(STEMI)10d内预后判断价值。方法:收集2015年6月至2017年6月首诊于承德医学院附属医院急诊科的STEMI患者678例。依据LA和MSI结果将患者分为LA升高组(≥2 mmo L/L)与LA正常组(<2mmo L/L)和MSI≥1.3组与MSI<1.3组,记录患者一般资料,统计10d内全因死亡率及主要心脏不良事件(MACE)的发生率,分析LA和MSI对STEMI患者短期预后的影响,采用受试工作特征(ROC)曲线下面积(AUC),评价LA和MSI指标对STEMI患者的短期预测价值。结果:282例患者被纳入LA升高组,396例患者被纳入LA正常组,两组的Killip分级Ⅲ及Ⅳ级、心率、收缩压、舒张压的差异比较有统计学意义(P<0.05)。LA升高组的心源性休克、致命性心律失常及全因病死率的发生率显著高于LA正常组,差异有统计学意义(P<0.05)。210例患者被纳入MSI≥1.3组,468例患者被纳入MSI<1.3组,两组的Killip分级Ⅲ及Ⅳ级、心率、收缩压、舒张压的差异比较有统计学意义(P<0.05);MSI≥1.3组的心源性休克、致命性心律失常及全因病死率的发生率分别显著高于MSI<1.3组,差异有统计学意义(P<0.05);患者10d内的死亡率为7.52%,LA和MSI的ROC曲线下面积分别为0.823和0.789,对预测STEMI患者短期预后有统计学意义(P<0.001)。结论:LA和MSI可以作为评估STEMI患者短期预后的指标,LA的预测力可能略高。

Objective： To study the predictive value of level of plasma lactic acid（ LA） and modified shock index（ MSI） for 10-day outcome to short-term prognosis in patients with ST-segment elevation myocardial infarction（ STEMI）. Methods： STEMI patients（ n = 678） were chosen from the Department of Emergency in the Affiliated Hospital of Chengde Medical College from June 2015 to June 2017. According to the level of LA level and MSI,the patients were divided into higher group（ LA≥2 mmo L/L） and normal group and（ LA2 mmo L/L）,and MSI≥1.3 group and MSI1.3 group. The general data of the patients was recorded,and major cardiac adverse events（ MACE） in 10 days was reviewed and the incidence of all-cause mortality was observed,and predictive value of two 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,grades Ⅲ and Ⅳ of Killip grading had statistical significance between LA higher and normal group（ P〈0.05）. The incidence of fatal arrhythmias and cardiogenic shock and all-cause mortality were significantly LA higher group than those in LA normal group（ P〈0.05）. The difference in systolic blood pressure,diastolic blood pressure,heart rate,grades Ⅲ and Ⅳ of Killip grading had statistical significance between MSI≥1. 3 group and MSI 1. 3 group. The incidence of fatal arrhythmias and cardiogenic shock and all-cause mortality were significantly higher in MSI≥1.3 group than those in MSI1.3 group（ P〈0.05）. The hospital mortality was 7.52%. AUC of LA was 0.823 and AUC of MSI was 0.789,which had statistical significance in prediction of short-term prognosis in STEM patients. Conclusion： LA and MSI all have some predictive value to short-term prognosis in STEM patients,and LA has higher predictive value.