阴离子间隙对急性冠脉综合征患者短期预后的预测价值

Predictive value of anion gap on short-term prognosis in patients with acute coronary syndrome

目的探讨阴离子间隙(AG)对急性冠脉综合征(ACS)患者短期预后的预测价值。方法根据1年随访期间的主要不良心血管事件(MACE)发生情况,将161例ACS患者分为无MACE组86例和MACE组75例。分别于入院次日检测并比较两组患者血清AG.HCO;、氨基末端脑钠肽前体(NT-proBNP)、超敏C反应蛋白、人血浆脂蛋白磷脂酶A2、血乳酸、心肌肌钙蛋白I、肌酸激酶同工酶、左心室舒张末期内径、左心室射血分数(LVEF)、GRACE评分及TIMI评分。采用多元logistic回归分析评估ACS患者随访1年期间发生MACE的危险因素。采用受试者工作特征(ROC)曲线评估血清AG水平对ACS患者随访1年期间发生MACE的诊断性能。结果MACE组患者血清AG.NT-proBNP.LVEF.GRACE评分及TIMI评分均高于无MACE组(P<0.05)。多元Zog沁氏回归分析结果显示,血清AG.GRACE评分及TIMI评分是ACS患者随访1年期间发生MACE的危险因素(P<0.05)。血清AG水平Mil.15mmol/L预测ACS患者随访1年期间发生MACE的ROC曲线下面积为0.824(P=0.024),敏感度为88.2%,特异度为80.6%。结论血清AG水平与ACS患者随访1年期间发生MACE呈正相关,血清AG水平对ACS患者短期预后的早期预测具有较高的临床价值。

Objective To explore the predictive value of anion gap (AG) on short-term prognosis in patients with acute coronary syndrome ( ACS). Methods A total of 161 patients with ACS were divided into non-major adverse cardiac events( MACE) group(86 cases) and MACE group(75 cases) according to occurrence of MACE during 1-year follow-up. Serum AG,HCOj ,amino tenninal brain natriuretic peptide precursor( NT-proBNP), hypersensitive C-reactive protein, human plasma lipoprotein phospholipase A2, arterial lactate, cardiac troponin I and creatine kinase MB, left ventricular end diastolic diameter, left ventricular ejection fraction(LVEF), GRACE score and TIMI score of two groups were detected at the first day after admission respectively and compared. Risk factors of occurrence of MACE during 1-year follow-up were evaluated by multivariate logistic regression analysis. Receiver operating characteristic (ROC) curve was used to evaluate diagnostic efficiency of serum AG level on occurrence of MACE during 1-year follow-up. Results Serum AG, NT-proBNP, LVEF, GRACE score and TIMI score in MACE group were higher than those in non-MACE group ( P < 0.05 ). Results of multivariate logistic regression analysis showed that serum AG, GRACE score and TIMI score were risk factors of occurrence of MACE during 1-year follow-up in patients with ACS(P<0.05). Area under ROC curve of serum AG level≥11.15 mmol/L predicting the occurrence of MACE during 1?year follow-up was 0.824 with the sensitivity of 88.2% and specificity of 80.6%(P=0.024) in patients with ACS. Conclusion Serum AG level is postive related with the occurrence of MACE during 1 -year follow-up. There is high clinical value for serum AG level on early predicting short-term prognosis in patients with ACS.