急性冠脉综合征患者炎症因子水平联合全球急性冠状动脉事件注册风险评分对近期预后的评估价值

Evaluation value of inflammatory factor level combined with GRACE score in short-term prognosis of patients with acute coronary syndrome

目的探讨急性冠脉综合征患者炎症因子水平联合全球急性冠状动脉事件注册(GRACE)风险评分对近期预后的评估价值。方法选择2019年1月至2019年5月在郑州人民医院心内科、心脏重症监护室收治住院并经过冠状动脉造影确诊的急性冠脉综合征(ACS)患者120例,同时按性别、年龄相匹配选取同期住院冠状动脉造影正常患者60例为对照组。根据GRACE评分将ACS组分为:高危组(>140分)34例,中危组(109~140分)48例,低危组(<108分)38例。所有患者入院后抽取Lp-PLA2、hs-CRP等指标。分析各组间的一般资料及随访6个月时(主要不良心脏事件)MACE情况。结果ACS组中各亚组与对照组在TC、LDL-C、HDL-C、hs-CRP、Lp-PLA2比较,差异有统计学意义(P<0.05);不同GRACE评分组与对照组比较在TC、LDL-C、HDL-C、hs-CRP、Lp-PLA2比较,差异有统计学意义(P<0.05);随访6个月发现GRACE高危组MACE发生率较GRACE低危组升高且差异具有统计学意义(P<0.05)。Logistic回归分析显示:hs-CRP、Lp-PLA2水平升高是MACE发生的独立危险因素。结论监测Lp-PLA2、hs-CRP水平联合GRACE评分能更精准的对ACS患者进行危险分层,对提供个性化治疗,降低死亡率具有重要临床意义。

【Objetive】To investigate the expression of Lp-PLA2 and hs-CRP in plasma of patients with acute coronary syndrome(ACS)and the value of GRACE score in evaluating the short-term prognosis.【Methods】From January 2019 to May 2019,120 ACS patients(42 patients with STEMI,30 patients with NSTEMI,and 48 patients with UAP)who were admitted to the Department of Cardiology and Cardiac Intensive Care Unit of Zhengzhou People's Hospital and confirmed by coronary angiography were selected.At the same time,according to gender and age,60 patients with SAP diagnosed during the same period were selected as the control group.In addition,according to the CRACE score,the ACS components were:34 cases in the high-risk group(>140 points),48 cases in the intermediate-risk group(109-140 points),and 38 cases in the low-risk group(<108 points).All patients were taken Lp-PLA2,hs-CRP and other indicators after admission.The general data of each group were compared and the MACE situation at 6 months of follow-up was analyzed.【Results】There were significant differences in TC,LDL-C,HDL-C,hs-CRP,and Lp-PLA2 between the subgroups of the ACS group and the control group(P<0.05);the comparisons of different GRACE score groups with the control group in TC,LDL-C,HDL-C,hs-CRP,and Lp-PLA2 were statistically different(P<0.05);after 6 months of follow-up,it was found that the incidence of MACE in GRACE high-risk groups was higher than that in GRACE low-risk groups(P<0.05).Logistic regression analysis showed that elevated hs-CRP、Lp-PLA2 levels were independent risk factors for MACE occurrence.【Conclusion】Lp-PLA2,hs-CRP levels and GRACE scores can more accurately stratify risk for ACS patients,predict MACE,and have important clinical significance for providing personalized treatment and reducing mortality.