ST段抬高型心肌梗死患者病变动脉自发再通影响因素及与纤维蛋白原与白蛋白比值的关系

Influencing factors of spontaneous recanalization of the diseased artery in patients with ST-segment elevation myocardial infarction and the relationship with fibrinogen to albumin ratio

目的 探讨ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者病变动脉自发再通的影响因素及与纤维蛋白原(fibrinogen,FIB)与白蛋白(albumin,ALB)比值(fibrinogen to albumin ratio,FAR)的关系。方法 纳入2012年1月至2020年12月于邯郸市第一医院接受动脉造影检查的STEMI患者共510例,根据是否出现病变动脉自发再通分组,采用单因素和多因素分析评价STEMI患者病变动脉自发再通的独立影响因素,描绘受试者工作特征曲线(receiver operating characteristic curve,ROC)评价FAR用于STEMI患者病变动脉自发再通预测临床效能。结果 非自发再通组和自发再通组ALB、FIB、FAR、血尿酸(serum uric acid,SUA)、超敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)及左心室射血分数(left ventricular ejection fraction,LVEF)比较,差异有统计学意义(P<0.05)。多因素分析结果显示,基线FAR和hs-CRP浓度均是STEMI患者病变动脉自发再通的独立影响因素(P<0.05)。ROC分析结果显示,基线FAR用于STEMI患者病变动脉自发再通预测的曲线下面积为0.83,95%CI:0.66~0.81,敏感度和特异度分别为77.24%,78.90%(P<0.05)。结论 STEMI患者病变动脉自发再通发生与基线FAR和hs-CRP浓度关系密切,其中基线FAR可用于STEMI患者病变动脉自发再通预测。

Objectives To investigate the influencing factors of spontaneous recanalization of the diseased artery in patients with ST-segment elevation myocardial infarction(STEMI)and the relationship with fibrinogen(FIB)to albumin(ALB)ratio(FAR). Methods Totally 510 STEMI patients with arteriography examination were chosen in the period from January 2012 to December 2020 in Handan First Hospital. All the patients were grouped according to whether spontaneous recanalization occurred or not. Univariate and multivariate analysis were used to evaluate the independent influencing factors of spontaneous recanalization in patients with STEMI. Receiver operating characteristic curve(ROC)was drawn to evaluate the clinical efficacy of FAR in predicting spontaneous recanalization of diseased arteries in patients with STEMI. Results There were significant differences in ALB,FIB,FAR,serum uric acid(SUA),highsensitivity C-reactive protein(hs-CRP) and left ventricular ejection fraction(LVEF) between non-spontaneous recanalization group and spontaneous recanalization group(P<0.05). Multivariate analysis showed that the baseline FAR and concentration of hs-CRP were independent factors of spontaneous recanalization in patients with STEMI(P<0.05).ROC analysis showed that the area under the curve(AUC)of baseline FAR for predicting spontaneous recanalization of diseased arteries in patients with STEMI was 0.83,95%CI:0.66~0.81,and the sensitivity and specificity were 77.24%and 78.90% respectively(P<0.05). Conclusions The incidence of spontaneous recanalization in patients with STEMI closely relates to the baseline FAR and concentration of hs-CRP. The baseline FAR can be used to predict spontaneous recanalization in patients with STEMI.