血清胱抑素C及左心室射血分数对经皮冠状动脉介入治疗的急性心肌梗死患者的预后评估价值  

Estimated value of serum cystatin C and left ventricular ejection fraction in prognosis of patients with acute myocardial infarction after percutaneous coronary intervention

作　　者：张杰[1] 马礼坤 张理想 冯克福 胡昊[1] 叶青[1] 周俊岭 孔祥勇 吴佳纬 李丹[1] Zhang Jie;Ma Likun;Zhang Lixiang;Feng Kefu;Hu Hao;Ye Qing;Zhou Junling;Kong Xiangyong;Wu Jiawei;Li Dan(Cardiovascular Medicine Department,the First Affiliated Hospital of University of Science and Technology of China,Hefei 230001,China)

机构地区：[1]中国科学技术大学附属第一医院心血管内科,合肥230001

出　　处：《心脑血管病防治》2021年第4期316-319,共4页CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT

基　　金：国家重点研发计划项目精准医学研究(2017YFC0909400);安徽省合肥市自主创新政策借转补项目(J2019Y02)。

摘　　要：目的探讨血清胱抑素C及左心室射血分数(LVEF)对经皮冠状动脉介入治疗(PCI)的急性心肌梗死(AMI)患者1年全因死亡的预测价值。方法选取2017年1月至2018年12月中国科学技术大学附属第一医院住院且行急诊PCI的AMI患者306例,对患者进行为期12个月的随访,随访结束后根据患者是否死亡分为存活组280例和死亡组26例。收集患者住院期间的相关临床资料、实验室检查及超声心动图检查指标,采用多因素Logistic回归分析AMI患者术后1年全因死亡的风险因素,采用ROC曲线分析血清胱抑素C及LVEF对AMI患者术后1年全因死亡率的预测价值。结果两组患者Gensini评分、年龄、肌酐、尿素氮、胱抑素C、N端B型脑钠肽前体(NT-proBNP)、LVEF、红细胞计数、吸烟及合并糖尿病情况比较差异均有统计学意义(t/χ^(2)=-2.498、-3.610、-4.661、-3.812、-5.356、-4.812、6.843、-2.564、8.052、5.326,P<0.05)。多因素Logistic回归分析显示,胱抑素C是AMI患者术后1年死亡的危险因素[OR(95%CI)=4.382(1.331~14.428),P<0.05],LVEF是AMI患者术后1年死亡的保护因素[OR(95%CI)=0.894(0.853~0.936),P<0.05]。血清胱抑素C及LVEF对AMI术后患者1年全因死亡的预测界值分别为1.205 mg/L、54.5%,敏感度分别为0.69,0.88,特异度分别为0.81,0.63。结论胱抑素C和LVEF是AMI患者PCI术后1年全因死亡的重要影响因素,能够有效预测AMI患者术后1年死亡的发生。Objective To investigate the predictive value of serum cystatin C and left ventricular ejection fraction(LVEF)for one-year all-cause mortality in patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).Methods A total of 306 patients with AMI underwent emergency percutaneous coronary intervention who were hospitalized in the first affiliated hospital of university of science and technology of China from January 2017 to December 2018 were selected.The patients were followed up for 12 months.At the end of follow-up,according to whether the patients died or not,they were divided into survival group(280 cases)and death group(26 cases).Relevant clinical data,laboratory examinations and indicators of echocardiography during the hospitalization of patients were collected.Multivariate logistic regression was used to analyze the risk factors of all-cause mortality in AMI patients after one year after operation,and receiver operating characteristic curve was used to analyze the predictive value of serum cystatin C and LVEF for allcause mortality in AMI patients after one year after operation.Results There were significant differences in Gensini scores,age,creatinine,urea nitrogen,cystatin C,N-terminal B-type brain natriuretic peptide precursor(NT-proBNP),LVEF,red blood cell count(RBC),smoking,and diabetes between the two groups(t/χ^(2)=-2.498,-3.610,-4.661,-3.812,-5.356,-4.812,6.843,-2.564,8.052,5.326;P<0.05).Multivariate logistic regression analysis showed that cystatin C was a risk factor for one year postoperative death in AMI patients[OR(95%CI)=4.382(1.331-14.428),P<0.05],and LVEF was a protective factor for 1 year postoperative death in AMI patients[OR(95%CI)=0.894(0.853-0.936),P<0.05].The predictive cut-off values of serum cystatin C and LVEF for 1-year all-cause mortality in patients with AMI after PCI were 1.205 mg/L and 54.5%,sensitivities were 0.69 and 0.88,specificities were 0.81 and 0.63.Conclusion Cystatin C and LVEF are important influencing factors of all-cause mortality

关 键 词：急性心肌梗死 全因死亡 胱抑素C 左心室射血分数 

分 类 号：R542.22[医药卫生—心血管疾病]