纤维蛋白原与白蛋白比值对PCI术后的急性冠脉综合征患者预后的影响  

Prognostic value of the ratio of fibrinogen to albumin in patients with acute coronary syndrome undergoing PCI

作　　者：高秀鑫 刘逸翔 丁振江[1] 刘会玲[2] 张英[1] 司月乔 刘静怡[1] 孙王乐贤[1] GAO Xiuxin;LIU Yixiang;DING Zhenjiang;LIU Huiling;ZHANG Ying;SI Yueqiao;LIU Jingyi;SUN Lixian(Department of Cardiology,Chengde Cardiovascular Institute,The Affiliated Hospital of Chengde Medical College,Chengde,Hebei,067000,China;Department of Ultrasound,The Affiliated Hospital of Chengde Medical College,Chengde,Hebei,067000,China)

机构地区：[1]承德医学院附属医院心脏内科承德市心血管病研究所,河北承德067000 [2]承德医学院附属医院超声科

出　　处：《临床心血管病杂志》2021年第8期763-768,共6页Journal of Clinical Cardiology

基　　金：河北省科技厅指令性计划项目(No:17277769D)。

摘　　要：目的:探讨纤维蛋白原与白蛋白比值(FAR)对接受经皮冠状动脉介入(PCI)治疗的急性冠脉综合征(ACS)患者预后的影响,评价其对行PCI治疗的ACS患者不良预后的诊断与预测价值。方法:连续入选2016年1月—2018年12月于承德医学院附属医院心脏内科住院,白蛋白与纤维蛋白原数据完整,并符合纳入标准的患者910例,自患者完成PCI术起进行随访,随访截止日期为2020年10月19日,最终失访患者91例。将剩余的819例患者依据有无主要不良心血管事件(MACE,包括全因死亡、心源性死亡、严重心力衰竭再住院、非致死性心肌梗死、靶病变重建和靶血管重建)发生分为MACE组(93例)与非MACE组(726例)。收集研究对象的人口学特征、临床与辅助检验及随访资料。通过诊断试验及拟合Cox比例风险回归模型,评价FAR对行PCI治疗的ACS患者发生MACE的辅助诊断和预测价值。通过Kaplan-Meier曲线对FAR≥7.1%组与FAR<7.1%组患者的生存状况进行检验。结果:FAR诊断行PCI治疗的ACS患者MACE发生的受试者工作特征曲线下面积(ROC-AUC)为0.604(95%CI:0.539~0.668)(P=0.001)。FAR的最佳诊断界值为7.1%,敏感性、特异性分别为0.527、0.682。单因素分析显示,MACE组与非MACE组FAR≥7.1%与年龄≥75岁、缺血性脑卒中、心源性休克、肌酐升高及左心房增大均差异有统计学意义(均P<0.05)。Kaplan-Meier曲线显示,FAR≥7.1%组与FAR<7.1%组的中位生存时间分别为1467(1399,1535)d、1609(1573,1646)d(P<0.001)。Cox比例风险回归分析显示,年龄≥75岁、缺血性脑卒中、心源性休克、肌酐升高、FAR≥7.1%均为行PCI治疗的ACS患者MACE发生的独立危险因素(均P<0.05),HR分别为1.936、1.691、7.846、1.987、1.986。结论:FAR≥7.1%为行PCI治疗的ACS患者预后不良的独立危险因素,其致病风险与经典的危险因素年龄相近。Objective:To explore the effect of the ratio of fibrinogen to albumin(FAR)on the prognosis in patients with acute coronary syndrome(ACS)undergoing percutaneous coronary intervention(PCI),and to evaluate its diagnostic and predictive value in the poor prognosis.Methods:A total of 910 patients with complete albumin and fibrinogen data that met the inclusion criteria in the Department of Cardiology,Affiliated Hospital of Chengde Medical College from January 2016 to December 2018 were enrolled.All the patients were followed up from the completion of PCI to October 19,2020,and 91 patients were lost.The remaining 819 patients were divided into the MACE group(n=93)and the non-MACE group(n=726)based on the occurrence of major adverse cardiovascular events(MACE,including all-cause death,cardiogenic death,severe heart failure readmission,non-fatal myocardial infarction,target lesion reconstruction,and target vessel reconstruction).Demographic characteristics,clinical data,auxiliary tests,and follow-up data were collected.The diagnostic test and Cox proportional risk regression model were used to evaluate the auxiliary diagnostic and predictive value of FAR for the occurrence of MACE in patients with ACS undergoing PCI.Kaplan-Meier curve was used to test the survival status of patients in the FAR≥7.1%group and the FAR<7.1%group.Results:The area under the receiver operating characteristic curve(ROC-AUC)for MACE in patients with ACS undergoing PCI according to FAR was 0.604(95%CI:0.539-0.668)(P=0.001).The best diagnostic value of FAR was 7.1%,and the sensitivity and specificity were 0.527 and 0.682,respectively.Univariate analysis showed that there were statistically significant differences in FAR≥7.1%,age≥75 years,ischemic stroke,cardiogenic shock,increased creatinine,and left atrial enlargement between the MACE group and the non-MACE group(all P<0.05).Kaplan-Meier curve showed that the median survival time in the FAR≥7.1%group and FAR<7.1%group were 1467(1399,1535)days and 1609(1573,1646)days,respectively(P<0.001).C

关 键 词：纤维蛋白原/白蛋白比值 急性冠脉综合征 经皮冠脉介入治疗 预后 

分 类 号：R541.4[医药卫生—心血管疾病]