高敏C-反应蛋白与白蛋白比值对急性STEMI患者预后的预测价值

The predictive value of high-sensitivity C-reactive protein and albumin ratio on the prognosis of the patients with acute ST segment elevation myocardial infarction

目的:研究血清高敏C-反应蛋白(high sensitivity C-reactive protein,hs-CRP)与白蛋白(albumin,ALB)比值对预测急性ST段抬高型心肌梗死(STEMI)患者预后的预测价值。方法:回顾性分析新疆医科大学第一附属医院收治的225例急性STEMI患者的病例资料,采集患者急诊入院后首管静脉血,检测血清hs-CRP与ALB,并计算出hs-CRP/ALB比值。对所有患者进行随访,平均随访3年,观察并记录患者主要不良心血管事件(MACE)的发生情况。应用Cox单因素及多因素回归分析包括年龄、性别、吸烟史、冠心病家族史、高血压、糖尿病、血脂异常、体质指数(BMI)、心率、收缩压、舒张压、白细胞(WBC)、B型利钠肽(BNP)、总胆固醇(TC)、三酰甘油(TG)、hs-CRP/ALB、左室射血分数(LVEF)等多项因素与急性STEMI患者MACE发生的关系。结果:hsCRP/ALB预测急性STEMI患者随访期发生MACE的受试者工作特征曲线下面积(AUC)为0.70(95%CI:0.598~0.90,P<0.001),最佳截点为0.38,灵敏度为68.1%、特异度为84.7%,hs-CRP/ALB≥0.38组发生MACE的比例显著高于hs-CRP/ALB<0.38组(P<0.05)。多因素Cox回归分析显示:hs-CRP/ALB≥0.38是急性STEMI患者随访期发生不良预后的独立危险因素。Kaplan-Meier生存分析显示,hs-CRP/ALB≥0.38组MACE发生率显著高于hs-CRP/ALB<0.38组(log-rank=5.68,P=0.017)。结论:hs-CRP/ALB对急性STEMI患者预后有较高的预测价值,可作为此类患者不良临床结局的预测指标。

Objective：To study the predictive value of serum high sensitivity C-reactive protein（hs-CRP）and albumin（ALB）ratio on the prognosis of the patients with acute ST elevation myocardial infarction（STEMI）.Method：We selected 225 patients in emergency admission with acute STEMI in the first affiliated hospital of Xinjiang Medical University from September 2012 to September 2013,who all have hs-CRP and ALB,hs-CRP/ALB.All patients were followed up,observed and recorded with major adverse cardiovascular events（MACE）.Cox Univariate and Multivariate regression analysis were used.Result：Multivariate Cox regression analysis showed：hsCRP/ALB≥0.38 was the independent risk factors of patients with acute STEMI occurring adverse prognosis during follow-up period.Kaplan-Meier Survival Analysis showed that hs-CRP/ALB≥0.38 group had a significantly higher incidence of MACE than hs-CRP/ALB0.38 groups（Log-rank=5.68,P=0.017）.Conclusion：hs-CRP/ALB has a high predictive value in adverse clinical outcomes of patients with STEMI.