基于炎症的格拉斯哥预后评分对急性ST段抬高型心肌梗死患者预后的预测价值分析

Predictive value of inflammation-based Glasgow prognostic score for the prognosis in patients with ST-segment elevation myocardial infarction

目的探究基于炎症的格拉斯哥预后评分(Glasgow prognostic score,GPS)对急性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2015年4月至2016年1月就诊于四川大学华西医院急诊科289例STEMI患者的临床资料,根据GPS评分标准分为三组:0分组190例[男150例、女40例,年龄(62.63±12.98)岁]、1分组78例[男58例、女20例,年龄(66.57±15.25)岁]和2分组21例[男16例、女5例,年龄(70.95±9.58)岁],采用Cox回归分析影响STEMI远期死亡的独立危险因素。结果GPS分值0分、1分和2分的远期死亡率差异有统计学意义(9.5%vs.23.1%vs.61.9%,P<0.001),住院死亡率差异有统计学意义(3.7%vs.7.7%vs.23.8%,P<0.001)。GPS分值越高,STEMI患者的全球急性冠状动脉登记事件(GRACE)评分以及Genisini评分越高,差异均有统计学意义(P<0.001)。多因素Cox回归分析显示,GPS是预测STEMI患者远期死亡的独立危险因素[1 vs.0,风险比为2.212,P=0.037;2 vs.0,风险比为8.286,P<0.001]。结论GPS评分可用于预测STEMI患者的住院和远期预后,有助于早期危险分层并指导临床精准干预。

Objective To analyze prognostic ability of inflammation-based Glasgow prognostic score(GPS)in patients with ST-segment elevation myocardial infarction(STEMI).Methods We retrospectively analyzed the clinical data of 289 patients with STEMI admitted to the Department of Emergency in West China Hospital from April 2015 to January 2016.All study subjects were divided into three groups:a group of GPS 0(190 patients including 150 males and 40 females aged 62.63±12.98 years),a group of GPS 1(78 patients including 58 males and 20 females aged 66.57±15.25 years),and a group of GPS 2(21 patients including 16 males and 5 females aged 70.95±9.58 years).Cox regression analysis was conducted to analyze the independent risk factors of predicting long-term mortality of patients with STEMI.Results There was a statistical difference in long-term mortality(9.5%vs.23.1%vs.61.9%,P<0.001)and in-hospital mortality(3.7%vs.7.7%vs.23.8%,P<0.001)among the three groups.The Global Registry of Acute Coronary Events(GRACE)scores and Gensini scores increased in patients with higher GPS scores,and the differences were statistically different(P<0.001).Multivariable Cox regression analysis showed that the GPS was independently associated with STEMI long-term all-cause mortality(1 vs.0,HR:2.212,P=0.037;2 vs.0,HR:8.286,P<0.001).Conclusion GPS score is helpful in predicting the long-term and in-hospital prognosis of STEMI patients,and thus may guide clinical precise intervention by early risk stratification.