Hcy联合CRP/Alb比值对STEMI合并代谢综合征患者急诊PCI术后无复流的预测价值  

Predictive value of homocysteine combined with CRP/Alb ratio on the no-reflow phenomenon after emergency PCI in ST-segment elevation myocardial infarction patients with metabolic syndrome

作　　者：马娟[1] 严宁[2] 马学平 王默函 吴鹏[1] 马盛宗 贾绍斌[2] MA Juan;YAN Ning;MA Xueping;WANG Mohan;WU Peng;MA Shengzong;JIA Shaobin(Ningxia Medical University,Yinchuan,750004,China;Department of Cardiology,General Hospital of Ningxia Medical University;Department of Obstetrics and Gynecology,Yinchuan Maternal and Child Health Hospital)

机构地区：[1]宁夏医科大学,银川750004 [2]宁夏医科大学总医院心内科 [3]银川市妇幼保健院妇产科

出　　处：《临床心血管病杂志》2022年第4期308-314,共7页Journal of Clinical Cardiology

基　　金：宁夏回族自治区重点研发项目(No:2018BEG02006、2020BFG02002)。

摘　　要：目的:探究同型半胱氨酸(Hcy)联合C反应蛋白/白蛋白比值(CAR)对急性ST段抬高型心肌梗死(STEMI)合并代谢综合征(MS)患者急诊行经皮冠状动脉介入(PCI)术后无复流(NRP)的预测价值。方法:连续收集2017年12月—2019年10月于宁夏医科大学总医院行急诊PCI术的STEMI合并MS患者187例,根据冠脉造影结果分为正常血流组(152例)和NRP组(35例),比较2组一般资料及临床特征。采用单因素和多因素logistic回归分析NRP的影响因素,绘制ROC曲线评估Hcy、CAR及两者联合对NRP的预测效能。结果:纳入患者187例,NRP发生率为18.71%。通过调整混杂因素后,二元Logistic回归显示术前Hcy(OR=1.053,95%CI:1.027~1.081,P<0.001),CAR(OR=2.745,95%CI:1.029~7.322,P=0.044),舒张压(OR=0.959,95%CI:0.926~0.993,P=0.018)及梗死血管RCA(OR=0.378,95%CI:0.148~0.963,P=0.042)是NRP发生的危险因素。在NRP预测中,Hcy在ROC曲线下面积为0.761(95%CI:0.676~0.845),灵敏度为80%,特异度为65.2%,最佳临界值为18.86μmol/L;CAR在ROC曲线下面积为0.652(95%CI:0.549~0.755),灵敏度为77.1%,特异度为50%,最佳临界值为0.167。Hcy联合CAR(联合预测因子)在ROC曲线下面积为0.799(95%CI:0.719~0.878),灵敏度为71.4%,特异度为80.6%。结论:Hcy、CAR是STEMI合并MS患者发生NRP的危险因素,二者联合检测有助于NRP的早期识别。Objective:To investigate the predictive value of homocysteine(Hcy)combined with C-reactive protein/albumin ratio(CAR)on the no-reflow phenomenon(NRP)after emergency percutaneous coronary intervention in acute ST-segment elevation myocardial infarction with metabolic syndrome(MS).Methods:One hundred and eighty-seven STEMI patients with MS treated with emergency PCI at Ningxia Medical University General Hospital from December 2017 to October 2019 were consecutively selected.According to coronary angiography results,they were divided into two groups:the normal flow group(n=152)and the no-reflow group(n=35).The general dates and clinical characteristics of the two groups were compared.Binary-way logistic regression was used to analyze the independent factors of NRP,and ROC curves were performed to assess the predictive efficacy of HCY,CAR,and the combined factors on NRP.Results:The incidence of NRP was 18.71%in 187 included patients.After adjusting for confounding factors,binary-logistic regression showed that Hcy(OR=1.053,95%CI:1.027~1.081,P<0.001),CAR(OR=2.745,95%CI:1.029~7.322,P=0.044),diastolic blood pressure level(OR=0.959,95%CI:0.926~0.993,P=0.018)and infarct vessel RCA(OR=0.378,95%CI:0.148~0.963,P=0.042)were independent predictors of no-reflow.In the predictive value of no-reflow,the area under the ROC curve(AUC)of Hcy was 0.761(95%CI:0.676~0.845),its sensitivity was 80%and specificity was 65.2%,and the best critical value was 18.86μmol/L.The AUC of CAR was 0.652(95%CI:0.549~0.755),its sensitivity was 77.1%and specificity was 50%,and the critical value was 0.167.The AUC of Hcy combined with CAR was 0.799(95%CI:0.719~0.878),its sensitivity was 71.4%and specificity was 80.6%.Conclusion:Hcy and CRP/Alb are independent predictors of the no-reflow phenomenon.Hcy combined CAR is a better factor to predict the NRP in acute ST-elevation myocardial infarction with metabolic syndrome after PCI,and can help in the early identification of NRP.

关 键 词：同型半胱氨酸 C反应蛋白/白蛋白 无复流 代谢综合征 ST段抬高型心肌梗死 

分 类 号：R542.2[医药卫生—心血管疾病]