尿微量白蛋白水平对急性心肌梗死患者PCI术后心肌微循环障碍的预测价值  

Predictive value of urinary microalbumin level for myocardial microcirculation disturbance in patients with acute myocardial infarction after PCI

作　　者：赵美娜 王紫韫 苏玉芳 曹亚珍 宋雪晶 ZHAO Mei-na;WANG Zi-yun;SU Yu-fang;CAO Ya-zhen;SONG Xue-jing(Department of Cardiovascular Medicine,Shijiazhuang People's Hospital,Shijiazhuang 050000,Hebei,China;Department of Ultrasound,Shijiazhuang People's Hospital,Shijiazhuang 050000,Hebei,China;Department of Oncology,Shijiazhuang People's Hospital,Shijiazhuang 050000,Hebei,China)

机构地区：[1]石家庄市人民医院心血管内科,河北石家庄050000 [2]石家庄市人民医院超声科,河北石家庄050000 [3]石家庄市人民医院肿瘤科,河北石家庄050000

出　　处：《川北医学院学报》2023年第3期358-361,共4页Journal of North Sichuan Medical College

基　　金：河北省石家庄市科学技术研究与发展计划项目(211461023)。

摘　　要：目的:探讨尿微量白蛋白水平预测经皮冠状动脉介入治疗(PCI)的急性心肌梗死(AMI)患者术后心肌微循环障碍的临床价值。方法:根据患者术后心肌声学造影情况将98例行PCI治疗的AMI患者分为微循环障碍组(n=67)与正常组(n=31)。比较两组24 h尿微量白蛋白(24 h-UmAlb)等临床资料差异,分析PCI后心肌微循环障碍的影响因素,并构建24 h-UmAlb预测PCI术后心肌微循环障碍的受试者工作特征(ROC)曲线。结果:与正常组比较,微循环障碍组女性比例、合并高血压比例及术前TIMI血流<3级比例更高(P<0.05),微循环障碍组血清BNP水平和24 h-UmAlb水平均增高(P<0.05)。Logisitic回归分析显示,女性、合并高血压、术前TIMI血流<3级及24 h-UmAlb水平均是AMI患者PCI后心肌微循环障碍的危险因素(P<0.05)。ROC曲线分析显示,24 h-UmAlb预测PCI后心肌微循环障碍的曲线下面积(AUC)为0.943(95%CI:0.877~0.980),最佳临界点为15.9 mg/24 h,此时的敏感度为88.06%,特异度为90.32%。结论:24 h-UmAlb是AMI患者PCI后心肌微循环障碍的影响因素,其检测有重要预测价值。Objective:To investigate the clinical value of urinary microalbumin in predicting myocardial microcirculatory disturbance in patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).Methods:98 AMI patients treated with PCI were selected,according to the postoperative myocardial contrast echocardiography,they were divided into microcirculation disturbance group(n=67)and normal group(n=31).The clinical data such as 24 hour urinary microalbumin(24 h-UmAlb)were compared between the two groups.The influencing factors of myocardial microcirculation disturbance after PCI were analyzed.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of 24 h-UmAlb for myocardial microcirculation disturbance after PCI.Results:Compared with the normal group,the proportion of women,hypertension and preoperative TIMI flow<3 grade in the microcirculatory disturbance group were higher(P<0.05).The serum BNP level and 24 h-UmAlb level in the microcirculatory disturbance group were higher(P<0.05).Logistic regression analysis showed that female,hypertension,preoperative TIMI blood flow<grade 3 and 24 h-UmAlb level were risk factors for myocardial microcirculation disorder after PCI in AMI patients(P<0.05).ROC curve analysis showed that the curve(AUC)of 24 h-UmAlb for predicting myocardial microcirculation disorder after PCI was 0.943(95%CI:0.877-0.980),the optimal critical point was 15.9 mg/24 h,and the sensitivity was 88.06%and the specificity was 90.32%.Conclusion:24 h-UmAlb is an influencing factor of myocardial microcirculation disturbance in AMI patients after PCI,and its detection has important predictive value.

关 键 词：急性心肌梗死 心肌微循环障碍 经皮冠状动脉介入治疗 尿微量白蛋白 

分 类 号：R542.22[医药卫生—心血管疾病]