临床特征及实验室指标联合预测急性ST段抬高型心肌梗死患者梗死相关动脉自发再通风险的价值  

Value of clinical features and laboratory indicators in predicting the risk of spontaneous recanalization of infarct-related arteries in patients with acute ST-segment elevation myocardial infarction

作　　者：刘志东[1] 王贤方 余丽琼 钟炜[1] LIU Zhi-dong;WANG Xian-fang;YU Li-qiong;ZHONG Wei(Department of Cardiology, People′s Hospital of Meizhou City, Guangdong Province, Meizhou 514031, China)

机构地区：[1]广东省梅州市人民医院心内科,广东梅州514031

出　　处：《河北医科大学学报》2022年第7期754-758,780,共6页Journal of Hebei Medical University

基　　金：广东省自然科学基金资助项目(2017A030313745);梅州市人民医院科研培育项目(PY-C2020001)。

摘　　要：目的研究临床特征及实验室指标联合预测急性ST段抬高型心肌梗死(acute ST-segment elevation myocardial infarction,STEMI)患者梗死相关动脉(infarction related artery,IRA)自发再通风险的价值。方法选择本院收治的375例急性STEMI患者作为研究对象,患者入院后行急诊冠状动脉造影,将IRA血流心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)2~3级患者纳入自发再通组(114例),将IRA血流TIMI 0~1级患者纳入非自发再通组(261例)。收集患者临床资料,包括性别、年龄、体重指数(body mass index,BMI)、是否吸烟、有无高血压或糖尿病、有无梗死前心绞痛等,记录患者心率、病变支数和梗死部位,检测血清空腹血糖、纤维蛋白原(fibrinogen,FIB)、白蛋白(albumin,Alb)、肌酸激酶同工酶(creatine kinase isoenzyme,CK-MB)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、脂蛋白α[Lipoprotein alpha,Lp(α)]水平,计算FIB/Alb比值(fibrinogen to albumin ratio,FAR)值;以ROC曲线分析FIB、CK-MB、FAR、Lp(α)预测急性STEMI患者IRA自发再通风险的价值;采取非条件Logistic逐步回归分析急性STEMI患者IRA自发再通的影响因素;以一致性分析多项预测因素联合预测急性STEMI患者IRA自发再通风险的价值。结果经单因素分析,与非自发再通组相比,自发再通组吸烟患者比例较低、梗死前心绞痛患者比例较高,并且自发再通组患者FIB、CK-MB、FAR、Lp(α)水平较低(P<0.05);经ROC分析证实,FIB≤359.440 mg/L、CK-MB≤73.460 U/L、FAR值≤9.585、Lp(α)≤150.947 nmol/L是急性STEMI患者IRA自发再通的最佳截断值,且均有P<0.05;多因素Logistic回归性分析显示,吸烟、梗死前心绞痛、FIB水平≤359.440 mg/L、CK-MB水平≤73.460 U/L、FAR值≤9.585、Lp(α)≤150.947 nmol/L是急性STEMI患者IRA自发再通的影响因素(P<0.05);经一致性分析,多项预测因素联�Objective To study the value of clinical features and laboratory indicators in predicting the risk of spontaneous recanalization of infarct-related artery(IRA)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods In total,375 patients with acute STEMI treated in our hospital were selected as the research subjects.After admission,patients underwent emergency coronary angiography.Patients with IRA TIMI grade 2-3 were included in spontaneous recanalization group(n=114),and patients with IRA TIMI grade 0-1 were included in non-spontaneous recanalization group(n=261).Clinical data of patients were collected,including age,sex,body mass index(BMI),smoking,hypertension or diabetes,and preinfarction angina.Heart rate,number of lesions and infarct sites were recorded.Serum fasting blood glucose(FBG),fibrinogen(FIB),albumin(Alb),creatine kinase isoenzyme(CK-MB),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),lipoproteinα[Lp(α)]levels were detected,and FAR values were calculated.ROC curve was used to analyze the value of FIB,CK-MB,FAR and Lp(α)in predicting the risk of spontaneous recanalization of IRA in patients with acute STEMI.Unconditional Logistic stepwise regression analysis was used to analyze the independent predictors of spontaneous recanalization of IRA in patients with acute STEMI.Consistency analysis was used to evaluate the value of multiple predictors in predicting the risk of spontaneous recanalization of IRA in patients with acute STEMI.Results Univariate analysis showed that compared with non-spontaneous recanalization group,the proportion of smoking patients in spontaneous recanalization group was lower,the proportion of patients with preinfarction angina was higher,and the levels of FIB,CK-MB,FAR and Lp(α)in spontaneous recanalization group were lower(all P<0.05).ROC analysis confirmed that FIB level≤359.440 mg/L,CK-MB level≤73.460 U/L,FAR value≤9.585,and Lp(α)≤150.947 nmol/L were the optimal cut-off values of IRA spontaneous r

关 键 词：心肌梗死 冠状动脉狭窄 预测 

分 类 号：R542.22[医药卫生—心血管疾病]