高敏C反应蛋白预测非体外循环下冠状动脉旁路移植术临床结局  

Predictive value of high-sensitivity C-reactive protein in clinical outcome of off-pump coronary artery bypass graft surgery

作　　者：范康钧 高铭鑫[1] 于文渊[1] 柳弘历 丁晓航 顾承雄[1] 于洋[1] Fan Kangjun;Gao Mingxin;Yu Wenyuan;Liu Hongli;Ding Xiaohang;Gu Chengxiong;Yu Yang(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心脏外科,100029

出　　处：《中华胸心血管外科杂志》2021年第3期163-167,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金(81770343);北京市教育委员会科技计划重点项目(KZ202010025044)。

摘　　要：目的探讨非体外循环冠状动脉旁路移植(OPCABG)术患者术前高敏C反应蛋白(Hs-CRP)水平与术后住院期间临床结局的关系。方法前瞻性纳入2019年1月至2019年10月123例在北京安贞医院择期接受OPCABG治疗的患者,收集术前和术后相关数据。以Hs-CRP水平2 mg/L为临界值,将患者分为Hs-CRP正常组(78例)和Hs-CRP升高组(45例)。比较两组患者数据,对存在差异的术后数据行回归分析,探究其独立影响因素。结果Hs-CRP升高组白细胞计数明显高于Hs-CRP正常组[(6.5±1.6)×10^(9)/ml对(7.4±2.1)×10^(9)/ml,t=-2.839,P=0.005];Hs-CRP升高组术后房颤患者占比(38%对19%,χ^(2)=5.100,P=0.024)、住院时间[(21.2±7.1)天对(16.0±4.6)天,t=-4.469,P=0.000]、住院费用[(14.31±3.07)万元对(12.37±2.18)万元,t=-4.090,P=0.000]明显高于Hs-CRP正常组。吸烟(OR=1.660,95%CI:1.186~1.993,P=0.031)和Hs-CRP水平(OR=1.170,95%CI:1.050~1.294,P=0.007)是术后发生房颤的独立危险因素。Hs-CRP水平(B=0.436,95%CI:0.197~0.675,P=0.000)和左心室射血分数(B=-0.180,95%CI:-0.289~-0.071,P=0.001)是住院时间的独立影响因素。高血压(B=-11.256,95%CI:-20.670~-1.842,P=0.020)、Hs-CRP水平(B=1.235,95%CI:0.217~2.254,P=0.018)和左心室射血分数(B=-1.168,95%CI:-1.634~-0.702,P=0.000)是住院费用的独立影响因素。结论OPCABG术前Hs-CRP水平是术后新发房颤、住院时间和住院费用的独立影响因素,这为Hs-CRP联合其他指标准确预测OPCABG预后、筛选高危患者提供了理论依据。Objective To investigate the relationship between preoperative high-sensitivity C-reactive protein(Hs-CRP)levels and clinical outcomes of patients undergoing off-pump coronary artery bypass graft(OPCABG)surgery.Methods We prospectively selected 123 patients who received OPCABG at Beijing Anzhen Hospital from January 2019 to October 2019,and collected relevant preoperative and postoperative data.Patients were divided into a normal Hs-CRP group(78 cases)and an elevated Hs-CRP group(45 cases)according to the cutoff value(2 mg/L)of Hs-CRP level.The data of the two groups were compared,and regression analysis was performed on the postoperative data with differences to define independent factors.Results The leukocyte count in the Hs-CRP group was significantly higher than that in the normal Hs-CRP group[(6.5±1.6)×10^(9)/ml vs.(7.4±2.1)×10^(9)/ml,t=-2.839,P=0.005].In the elevated Hs-CRP group,proportion of patients with atrial post-CABG atrial fibrillation(38%vs.19%,χ^(2)=5.100,P=0.024),duration of hospitalization[(21.2±7.1)days vs.(16.0±4.6)days,t=-4.469,P=0.000],hospital costs[(143.1±30.7)×10^(3) yuan vs.(123.7±21.8)×10^(3) yuan,t=-4.090,P=0.000]were significantly higher than those in the normal Hs-CRP level group.Smoking(OR=1.660,95%CI:1.186-1.993,P=0.031)and Hs-CRP(OR=1.170,95%CI:1.050-1.294,P=0.007)were independent risk factors for post-CABG atrial fibrillation.Hs-CRP(B=0.436,95%CI:0.197-0.675,P=0.000)and left ventricular ejection fraction(LVEF,B=-0.180,95%CI:-0.289--0.071,P=0.001)were independent influencing factors of duration of hospitalization.Hypertension(B=-11.256,95%CI:-20.670--1.842,P=0.020),Hs-CRP(B=1.235,95%CI:0.217-2.254,P=0.018)and LVEF(B=-1.168,95%CI:-1.634--0.702,P=0.000)were independent influencing factors of hospital costs.Conclusion The preoperative Hs-CRP level of OPCABG is an independent influencing factor of post-CABG atrial fibrillation,duration of hospitalization and hospital costs.This finding lays the foundation for Hs-CRP combined with other indicators to accurately predict the p

关 键 词：冠状动脉粥样硬化性心脏病 非体外循环冠状动脉旁路移植术 临床结局 炎症反应 高敏C反应蛋白 

分 类 号：R654.2[医药卫生—外科学]