高敏C反应蛋白/前白蛋白比值对ST段抬高型心肌梗死患者经皮冠状动脉介入术后无复流的影响

Effect of high⁃sensitivity C⁃reactive protein/prealbumin ratio on no⁃reflow after percutaneous coronary intervention in patients with ST⁃segment elevation myocardial infarction

目的探讨高敏C反应蛋白(hs⁃CRP)/前白蛋白比值对ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入(PCI)术后无复流的影响。方法回顾性选取2010年1月至2013年1月在首都医科大学附属北京安贞医院接受治疗的902例STEMI患者,根据术中有无无复流现象将患者分为无复流组(184例)和复流组(718例)。收集患者的临床资料,分析各指标与无复流的相关性。结果无复流组PCI术前心率、随机血糖、hs⁃CRP、hs⁃CRP/前白蛋白比值和中性粒细胞计数以及心功能Killip分级>1级、术中主动脉内球囊反搏(IABP)、血栓抽吸术比例均高于复流组,PCI术前前白蛋白水平低于、发病到PCI时间短于复流组,差异均有统计学意义(均P<0.05)。多因素Logistic回归分析结果显示,糖尿病、心率、随机血糖、hs⁃CRP/前白蛋白比值(比值比=1.012,95%置信区间:1.004~1.019)、中性粒细胞计数、心功能Killip分级、术中IABP和血栓抽吸术是STEMI患者PCI术后无复流的独立影响因素(均P<0.05)。结论hs⁃CRP/前白蛋白比值是STEMI患者PCI术后无复流的独立影响因素。

Objective To investigate the effect of high⁃sensitivity C⁃reactive protein(hs⁃CRP)/prealbumin(PAB)ratio on no⁃reflow after percutaneous coronary intervention(PCI)in patients with ST⁃segment elevation myocardial infarction(STEMI).Methods From January 2010 to January 2013,902 patients with STEMI admitted to Beijing Anzhen Hospital,Capital Medical University were retrospectively enrolled.Patients were divided into no⁃reflow group(184 cases)and reflow group(718 cases)according to whether there was no⁃reflow during the operation.The clinical data of patients were collected and the relationship of various indicators to no⁃reflow was analyzed.Results Before PCI,levels of heart rate,random blood glucose,hs⁃CRP,hs⁃CRP/PAB ratio and neutrophil count,as well as proportions of Killip grade of cardiac fanction>1,intraoperative intra aortic balloon counterpulsation(IABP)and thrombus aspiration in the no⁃reflow group were higher than those in the reflow group,and the prealbumin level before PCI was lower and the time from onset to PCI was shorter than those in the reflow group(all P<0.05).Multivariate Logistic regression analysis showed that diabetes mellitus,heart rate,random blood glucose,hs⁃CRP/PAB ratio(odds ratio=1.012,95%confidence interval:1.004⁃1.019),neutrophil count,Killip grade of cardiac fanction,intraoperative IABP and thrombus aspiration were independent influencing factors of no⁃reflow after PCI in patients with STEMI(all P<0.05).Conclusion The hs⁃CRP/PAB ratio is an independent influencing factor of no⁃reflow after PCI in patients with STEMI.