血清胆红素水平对高危非ST段抬高型心肌梗死的预测效能  

Predictive value of serum bilirubin level in high-risk non-ST elevation myocardial infarction

作　　者：李虹敏[1,2,3] 张跃 袁梦[1,2,3] 李广平 LI Hongmin;ZHANG Yue;YUAN Meng;LI Guangping(The Second Hospital of Tianjin Medical University,Tianjin 300211,China;不详)

机构地区：[1]天津医科大学第二医院,天津300211 [2]天津市心血管病离子与分子机能重点实验室 [3]天津心脏病研究所

出　　处：《山东医药》2021年第12期23-26,共4页Shandong Medical Journal

基　　金：国家自然科学基金资助项目(81800297);天津医科大学第二医院重点实验室项目(2019ZDSYS08)。

摘　　要：目的分析血清胆红素对高危非ST段抬高型心肌梗死(NSTEMI)的预测效能。方法127例NSTEMI患者按照全球急性冠状动脉事件注册评分(GRACE)分为低危组24例、中危组33例、高危组70例,采用单因素分析方法和多因素Logistic回归分析法分析NSTEMI患者病情严重程度的影响因素。绘制受试者工作特征曲线(ROC),分析血清总胆红素(TBIL)对高危NSTEMI患者的预测效能。结果低危组和中危组年龄比较,低危组和高危组年龄、男性、心肌肌钙蛋白(cTnI)、TBIL、间接胆红素(IBIL)比较,中危组和高危组年龄、男性、cTnI、TBIL、直接胆红素(DBIL)、IBIL比较,P均<0.05。Spearman相关分析发现,GRACE评分与TBIL、IBIL呈负相关(r分别为-0.338、-0.346,P均<0.05)。多因素Logistic回归分析显示,TBIL(B=-0.038,95%CI=-0.062~0.015,P=0.002)和cTNI(B=0.025,95%CI=0.003~0.046,P=0.025)水平是NSTEMI患者病情严重程度的影响因素。当TBIL预测临界值为12.05μmol/L时,其诊断NSTEMI高危患者的灵敏度为74%,特异度为73%,ROC下面积为0.715,95%CI为0.625~0.806,P<0.05。结论TBIL<12.05μmol/L是NSTEMI患者高危患者的有效预测指标。Objective To analyze the predictive value of serum bilirubin level in high-risk non-ST elevation myocardial infarction(NSTEMI).Methods A total of 127 patients with NSTEMI were divided into low-risk group(n=24),medium-risk group(n=33),and high-risk group(n=70)according to the Global Register of Acute Coronary Events(GRACE)score.Univariate analysis and multivariate Logistic regression analysis were used to analyze the factors influencing the severity of patients with NSTEMI.Receiver operating characteristic curve(ROC)was drawn to analyze the predictive value of serum total bilirubin(TBIL)level in patients with high-risk NSTEMI.Results Significant difference was found in age between the low-risk group and medium-risk group,and significant differences were found in age,male,cardiac troponin(cTnI),TBIL,indirect bilirubin(IBIL)between the low-risk group and high-risk group,as well as in age,male,cTnI,TBIL,direct bilirubin(DBIL),IBIL between the medium-risk group and high-risk group(all P<0.05).Spearman correlation analysis showed that GRACE score was negatively correlated with TBIL and IBIL(r=-0.338 and-0.346,both P<0.05).Multivariate Logistic regression analysis showed that TBIL(B=-0.038,95%CI=-0.062-0.015,P=0.002)and cTNI(B=0.025,95%CI=0.003-0.046,P=0.025)levels were risk factors for the severity of NSTEMI patients.When the predictive cut-off value of TBIL was 12.05μmol/L,the sensitivity and specificity of TBIL for the diagnosis of high-risk NSTEMI patients were 74%,73%,and area under ROC was 0.715,95%CI was 0.625-0.806(all P<0.05.Conclusion TBIL<12.05μmol/L is an effective prediction index of patients with high-risk NSTEMI.

关 键 词：总胆红素 直接胆红素 间接胆红素 非ST段抬高型心肌梗死 全球急性冠状动脉事件注册评分 

分 类 号：R541[医药卫生—心血管疾病]