血清铁降低对急性ST段抬高心肌梗死患者院内泵功能衰竭的预测价值  

Predictive value of serum iron level for in-hospital acute heart failure after acute ST-elevated myocardial infarction

作　　者：叶刚[1] 刘丽[2] 余健[1] 甘峰[3] 韦宏成[1] 

机构地区：[1]暨南大学附属第一医院内科,广东广州510632 [2]暨南大学附属第一医院校门诊部,广东广州510632 [3]中山大学化学与化学工程学院,广东广州510275

出　　处：《南方医科大学学报》2015年第4期610-614,共5页Journal of Southern Medical University

基　　金：广东省科技计划项目(2013B022000075);广东省中医药局建设中医药强省科研课题(20131152)

摘　　要：目的：探讨血清铁水平降低对急性ST段抬高心肌梗死患者发生院内急性心力衰竭的预测价值。方法对287名急性ST段抬高心肌梗死（STEMI）患者资料进行回顾性分析，按整个队列血清铁水平的四分位数将患者分为4组，比较不同血清铁水平组的院内急性心衰发病率；分析血清铁水平与Hb、BNP、cTnI、hsCRP水平等参数间的关系；比较血清铁水平、BNP、cTnI和hsCRP等生物标志物与住院期间急性心衰、心源性休克发病率和死亡率等不良后果的关系。结果全部287名STEMI患者的入院平均血清铁水平是10.20μmol/L（6.90，14.40μmol/L），血清铁水平的四分位数：Q1≤6.90μmol/L，Q26.91-10.19μmol/L，Q310.20-14.39μmol/L，Q4≥14.40μmol/L。从Q1到Q4组，院内急性心力衰竭发病率分别是Q179.5%，Q264.3%，Q350.0%和Q445.9%（P〈0.001）；单变量Logistic回归分析结果显示血清铁水平低于8.95μmol/L组患者发生院内急性心衰的危险度（OR）是血清铁高于8.95μmol/L组的近3倍（OR 3.358，95%CI 1.791-6.294，P〈0.001），多变量Logistic回归分析结果显示OR 2.316（95%CI 1.205-4.453，P=0.012）。结论血清铁水平降低是STEMI患者院内急性心力衰竭的独立危险因素。Objective To evaluate the predictive value of serum iron level for in-hospital acute heart failure （AHF） after acute ST-elevated myocardial infarction （STEMI）. Methods This retrospective study involved 287 patients with STEMI stratified by quartiles of admission serum iron concentration. The incidence of AHF was assessed by serum iron quartiles. We evaluated the association of serum iron levels with B-type natriuretic peptide （BNP）, cardiac troponin I （cTnI）, and high-sensitivity C-reactive protein （hs-CRP） levels on admission, and analyzed the correlation of serum iron levels with in-hospital AHF, death, and duration of hospital stay. Results The average serum iron level on admission of the 287 STEMI patients was 10.20μmol/L （6.90-14.40μmol/L）, and the quartiles （Q） of serum iron levels were≤6.90μmol/L （Q1）, 6.91-10.19μmol/L （Q2）, 10.20-14.39μmol/L （Q3）, and ≥14.40 μmol/L （Q4）. The incidences of in-hospital AHF from Q1 to Q4 were 79.5%, 64.3%, 50.0% and 45.9%, respectively （P〈0.001）. Univariate logistic regression analysis showed that low admission serum iron level （Q1） was an independent predictor for in-hospital AHF （OR=3.358, 95%CI 1.791- 6.294, P〈0.001）, and multivariate logistic regression analysis showed a similar result （OR=2.316, 95%CI 1.205-4.453, P=0.012）. Conclusion A lower admission serum iron level is an independent predictor of AHF in STEMI patients during hospitalization.

关 键 词：急性心力衰竭 血清铁 缺铁 急性心肌梗死 

分 类 号：R542.22[医药卫生—心血管疾病]