血红蛋白水平及CAMI-STEMI评分对急性ST段抬高型心肌梗死患者PCI术后预后的预测价值  

Prognostic value of hemoglobin level and CAMI-STEMI score in patients with acute ST segment elevation myocardial infarction after PCI

作　　者：罗二飞 鄢高亮[2] 钱昊 秦雨涵 刘钜川 马长乐 彭中兴 汤成春[2] LUO Er-fei1, YAN Gao-liang2, QIAN Hao1, QIN Yu-han1,LIU Ju-chuan1,MA Chang- le1 , PENG Zhong- xing1, TANG Cheng- chun2(1. School of Medicine, Southeast University, Nanjing 210009, China; 2. Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing 210009, Chin)

机构地区：[1]东南大学医学院,江苏南京21009 [2]东南大学附属中大医院心内科,江苏南京21009

出　　处：《东南大学学报（医学版）》2018年第3期471-476,共6页Journal of Southeast University(Medical Science Edition)

摘　　要：目的:评价血红蛋白(Hb)水平及中国心肌梗死注册登记研究-ST段抬高型心肌梗死(CAMI-STEMI)评分对STEMI患者经皮冠状动脉介入治疗(PCI)术后预后的预测价值。方法:纳入接受PCI的STEMI患者360例,记录患者的临床特点并计算CAMI-STEMI评分、记录Hb值及其他生化指标、冠脉病变程度、随访期间(30 d、6个月)主要不良心脑血管事件(MACCE)发生情况,根据患者入院第1次Hb值分为3组。结果:3组PCI术后30 d、6个月MACCE发生率均随Hb水平的降低而增高。多因素Cox逐步回归显示,在校正其他因素后,CAMI-STEMI评分是患者术后30 d MACCE发生率的独立预测因子(OR为1.225,95%CI为1.067~1.406,P=0.004);贫血是患者术后6个月MACCE发生率的独立预测因子(OR为2.071,95%CI为1.178~3.461,P=0.011),无糖尿病的患者术后6个月MACCE发生率较低(OR为0.585,95%CI为0.363~0.944,P=0.028)。结论:CAMI-STEMI评分是患者术后30 d MACCE发生率的独立预测因子;贫血是STEMI患者PCI术后6个月MACCE的独立预测因子,且贫血的STEMI患者发生MACCE的风险明显高于正常Hb水平患者;糖尿病是STEMI患者PCI术后6个月MACCE发生率的独立预测因子。Objective： To evaluate the prognostic value of hemoglobin（Hb） level and the China Acute Myocardial Infarction registry-ST segment elevation myocardial infarction（CAMI-STEMI） score in the prognosis of patients with STEMI after percutaneous coronary intervention（PCI）. Methods： This study included 360 patients with STEMI who received PCI. The clinical characteristics of the patients,the CAMI-STEMI score,Hb and other biochemical indicators,severity of coronary artery disease and the incidence of major adverse cardiovascular and cerebral events（MACCE） during the follow-up period（30 days,6 months） were recorded. The patients were divided into 3 groups according to the first Hb value after hospitalization. Results： The incidence of MACCE in the 3 groups at 30 days and 6 months after PCI increased with the decrease of Hb levels. Multivariate regression analysis showed that the CAMI-STEMI score was an independent predictor of MACCE incidence at 30 days after PCI（OR 1. 225,95% CI 1.067-1. 406,P = 0. 004）. Anemia was an independent predictor of MACCE incidence at 6 months after PCI（OR 2.071,95% CI 1. 178-3. 461,P = 0. 011）. The incidence of MACCE in patients without diabetes at 6 months after PCI was lower（OR 0. 585,95% CI 0. 363-0. 944,P = 0. 028）. Conclusion： The CAMI-STEMI score was an independent predictor of MACCE incidence at 30 days after PCI. Anemia was an independent predictor of MACCE in STEMI patients at 6 months after PCI,and the risk of MACCE in STEMI patients with anemia is significantly higher than that in STEMI patients with normal Hb levels. Diabetes is an independent predictor of MACCE in STEMI patients at 6 months after PCI.

关 键 词：心肌梗死 血红蛋白 CAMI-STEMI评分 预后 

分 类 号：R541.4[医药卫生—心血管疾病]