尿免疫球蛋白G与急性ST段抬高型心肌梗死患者院内全因死亡的关系研究

Relationship between urinary immunoglobulin G and all-cause mortality in patients with acute ST-segment elevation myocardial infarction

目的探讨尿免疫球蛋白G(UIgG)与急性ST段抬高型心肌梗死(STEMI)患者院内死亡的关系。方法回顾性纳入首都医科大学附属北京友谊医院2013—2019年入院的1854例STEMI患者,收集患者UIgG及其他基线资料。据UIgG三分位数分为三组,其中低UIgG组668例,中UIgG组570例,高UIgG组616例。主要临床终点为院内全因死亡,次要终点为心血管死亡及心血管不良事件。比较三组各临床指标差异,分析院内死亡的相关因素,并绘制ROC曲线。结果三组年龄、男性比例、高血压史、白细胞、血肌酐、总胆红素、高敏C反应蛋白、糖化血红蛋白比较,差异有统计学意义(P<0.05)。高UIgG组上述指标高于低UIgG组,差异有统计学意义(P<0.05)。三组院内死亡、心源性死亡、MACE比例以及N末端脑钠肽前体、肌酸激酶同工酶、心肌肌钙蛋白、左室射血分数比较,差异有统计学意义(P<0.05)。高UIgG组NT-proBNP、CK-MB、cTnI的峰值高于低UIgG组,LVEF低于低UIgG组,差异有高度统计学意义(P<0.01)。高UIgG组院内死亡、心源性死亡及MACE发生率高于低UIgG组,差异有高度统计学意义(P<0.01)。UIgG为STEMI患者发生院内死亡的独立危险因素(OR=1.042,95%CI:1.002~1.083,P=0.042)。UIgG的截断点为2.09 mg/dL时,AUC为0.75(95%CI:0.67~0.82,P<0.01),灵敏度为67.4%,特异度为76.5%。结论UIgG是与STEMI患者院内死亡相关的独立危险因素。

Objective To explore the relationship between urine immunoglobulin G(UIgG) and in-hospital death in patients with acute ST elevation myocardial infarction(STEMI). Methods A total of 1854 STEMI patients admitted to Beijing Friendship Hospital from 2013 to 2019 were retrospectively included, UIg G and other baseline data were collected. According to the UIg G tertiles, they were divided into three groups, including 668 cases in the low UIg G group,570 cases in the medium UIg G group, and 616 cases in the high UIg G group. The primary clinical endpoint was allcause death in the hospital, and the secondary endpoint was cardiovascular death and adverse cardiovascular events.The differences in the clinical indicators of the three groups were compared, while the related factors of hospital death were analyzed, and the ROC curve was draw. Results The three groups of age, male ratio, history of hypertension, white blood cells, blood creatinine, total bilirubin, high-sensitivity C-reactive protein, and glycosylated hemoglobin were compared, and the differences were statistically significant(P < 0.05). The above indicators in the high UIg G group were higher than those in the low UIg G group, and the difference was statistically significant(P < 0.05). The three groups of hospital death, cardiogenic death, MACE ratio, N-terminal pro-brain natriuretic peptide, creatine kinase isoenzyme-MB, cardiac troponin, and left ventricular ejection fraction were compared, and the differences were statistically significant(P < 0.05). The peaks of NT-pro BNP,CK-MB, and c Tn I in the high UIg G group were higher than those in the low UIg G group, while LVEF was lower than that in the low UIg G group, and the differences were highly statistically significant(P < 0.01).The incidence of in-hospital death, cardiogenic death and MACE in the high UIg G group were higher than those in the low UIg G group, and the differences were highly statistically significant(P < 0.01). UIg G was an independent risk factor for in-hospital death in STEMI patients(OR = 1.042, 95%CI: 1.002-1.083, P = 0.042). When UIg G was the cut point of 2.09 mg/d L, the AUC was 0.75(95%CI: 0.67-0.82, P < 0.01), the sensitivity was 67.4%, and the specificity was 76.5%. Conclusion UIg G is an independent risk factor associated with hospital death in STEMI patients.