尿蛋白和血红蛋白结合分析对冠状动脉介入治疗术预后价值的初步探讨

Preliminary study on the analysis of proteinuria and hemoglobin for the prognosis in patients undergoing percutaneous coronary intervention

目的探讨术前尿蛋白和血红蛋白水平联合分析对冠状动脉介入治疗术预后的预测价值。方法选择行冠状动脉介入治疗的1 195例患者,依据术前尿蛋白定性分级和血红蛋白情况分组,A组701例:非贫血,尿蛋白正常;B组247例:非贫血,轻度尿蛋白;C组41例:非贫血,重度尿蛋白;D组134例:贫血,尿蛋白正常;E组52例:贫血,轻度尿蛋白;F组20例:贫血,重度尿蛋白。采用Cox比例风险模型分析患者PCI术后发生心血管事件的影响因素,运用ROC曲线分析尿蛋白和血红蛋白对冠状动脉介入治疗术后心血管事件的预测价值,联合指标用Logistic模型得到拟合变量后进行ROC曲线分析。所有患者随访3年,采用Kaplan-Meier法绘制各组的生存曲线,比较生存率的差异。结果各组年龄、糖尿病、既往有无心肌梗死、左室射血分数(LVEF)差异有统计学意义(均P<0.05)。多因素Cox回归分析结果显示,尿蛋白阳性、贫血,病变支数多于1支是PCI术后发生心血管事件的危险因素。尿蛋白、血红蛋白两者联合在PCI预后评估中的约登指数最高,尿蛋白预测临床不良事件的cut-off值为0.125 g/L,血红蛋白的cut-off值为130 g/L。生存分析显示,贫血组与非贫血组2组间,尿蛋白正常组、轻度组与重度组3组间,6个组间累积生存率差异均有统计学意义(均P<0.05)。其中,F组累积生存率低于其余5组;在贫血和非贫血两个层面,随着蛋白尿的严重程度加重,每一层面患者的累积生存率逐渐降低,且贫血组的生存率低于相同尿蛋白情况的非贫血组。结论术前尿蛋白和血红蛋白均与冠心病介入治疗患者预后相关,两者联合评估对指导临床治疗有重要意义。

Objective To investigate the predictive value of treatment outcome combined analysis of preoperative urinary protein and hemoglobin （HB） levels for percutaneous coronary intervention （PCI）. Methods One thousand one hundred and ninety-five PCI patients were divided into six groups by qualitative determination of urine albumin and HB levels. The proteinuria was defined as normal （urine dipstiek negative）, mild （urine dipstiek traee or ＋ ）, or heavy （urine dipstiek≥＋＋）. A group： urine albumin negative, no anemia （n=701）; B group： mild urine albumin （＋）, no anemia （n=247） ; C group： heavy urine albumin （＋＋ ~ ＋＋＋＋）, no anemia （n=41）; D group： urine albumin negative, anemia （n=134）; E group： mild urine albumin, anemia （n=52）; F group： heavy urine albumin （＋＋ ~ ＋＋＋＋）, anemia （n=20）. The prognostie faetors of PCI patients were analyzed by Cox proportional hazards models. The predietion value of eardiae events after PCI was evaluated by the area under the ROC eurve. Logistic model was earried out to get the fitting variable for ROC eurve analysis. Kaplan- Meier survival analysis was used to eompare survival eurves belween groups with different levels of urine protein, different levels of hemoglobin, and joint analysis. Results There were signifieant differenees in age, diabetes, myoeardial infaretion and left ventrieular ejeetion fraetion （LVEF） between six groups （P 〈 0.05）. Multiple faetors regression analysis showed that positive urine protein, anemia, and more than one vessel eount of lesion were the risk faetors for eardiovaseular events after PCI surgery. The eombination of urine protein and hemoglobin showed the highest Jordan index in the prognosis evaluation of PCI. The best eut-off value for predieting elinieal adverse events of urinary protein was 0.125 g/L. The best eut-off value for hemoglobin was 130 g/L. Survival analysis showed there were signifieant differenees in the eumulative survival rates between the anemia group and the non-anemia group, the negative urinary protein group, the positive ＋ group, the positive≥＋＋group （P 〈 0.05）. The eumulative survival rate of F group with anemia and urinary protein-positive ≥＋＋ was signifieantly lower than that of other groups. With the aggravation in urinary protein and appearanee of anemia, the eumulative survival rate was gradually redueed in eaeh level. Conclusion Preoperative urinary protein and hemoglobin are eorrelated with the prognosis of eoronary hearl disease in patients after interventional therapy, and their eombined evaluation is of great signifieanee in guiding elinieal treatment.