急性心肌梗死患者住院病死率和纤维蛋白原水平的非线性关系  

Non-linear relationship between in-hospital mortality and fibrinogen levels in patients with acute myocardial infarction

作　　者：赵宁[1] 陈娟媚 杨其霖[3] 莫沛[3] Zhao Ning;Chen Juanmei;Yang Qilin;Mo Pei(Guangzhou Institute of Cardiovascular Disease,The Second Affiliated Hospital of Guangzhou Medical University,Guangzhou Guangdong 510260,China;The Second Clinical College of Guangzhou Medical University,Guangzhou Guangdong 510180,China;Department of Critical Care,The Second Affiliated Hospital of Guangzhou Medical University,Guangzhou Guangdong 510260,China)

机构地区：[1]广州医科大学附属第二医院心血管内科,广东广州510260 [2]广州医科大学第二临床学院2018级,广东广州510180 [3]广州医科大学附属第二医院重症医学科,广东广州510260

出　　处：《中华临床实验室管理电子杂志》2023年第1期32-37,共6页Chinese Journal of Clinical Laboratory Management(Electronic Edition）

基　　金：广州市卫生和计划生育科技项目(20181A010055);广州医科大学第二附属医院新技术项目(2020-LCYJXJS-08)。

摘　　要：目的:探讨入住ICU的急性心肌梗死患者住院病死率和纤维蛋白原水平之间的关系。方法:选取2008年至2019年,美国重症监护数据库(MIMIC-Ⅳ)中的急性心肌梗死患者1163例,根据纤维蛋白原正常值进行分组:低纤维蛋白原组(<1.8 g/L),正常纤维蛋白原组(1.8~4.0 g/L),高纤维蛋白原组(>4.0 g/L)。研究结局为住院病死率。应用限制性立方样条模型和Cox比例风险回归模型评估急性心肌梗死患者住院病死率和纤维蛋白原水平的关系。结果:在调整相关危险因素后,住院病死率和纤维蛋白原水平之间呈“U”型关系。住院病死风险在低纤维蛋白原组和高纤维蛋白原组调整后HR(95%CI)分别为2.23(1.49~3.34)和1.63(1.12~2.28),总体住院病死风险在正常纤维蛋白原组最低。结论:ICU中急性心肌梗死患者的住院病死率和纤维蛋白原水平呈“U”型关系。过高和过低的纤维蛋白原均会导致急性心肌梗死患者的住院病死率升高。ObjectiveTo investigate the relationship between in-hospital mortality and fibrinogen levels in patients with acute myocardial infarction admitted to the intensive care unit.Methods From 2008 to 2019,1163 patients with acute myocardial infarction in the Medical Information Mart for Intensive Care(MIMIC-IV)database were selected and grouped according to fibrinogen level quartiles:low fibrinogen group(<1.8 g/L),normal fibrinogen group(1.8~4.0 g/L),and high fibrinogen group(>4.0 g/L).The outcome was mortality in hospital.A restricted cubic spline model and a Cox proportional risk regression model were applied to evaluate the relationship between in-hospital mortality and fibrinogen level in patients with acute myocardial infarction.Results After adjusting for associated risk factors,a"U"shaped relationship was observed between in-hospital mortality and fibrinogen levels.The adjusted HR(95%CI)of low-fibrinogen and highfibrinogen groups were 2.23(1.49~3.34)and 1.63(1.12~2.28)respectively.The overall risk of hospital death was the lowest in the normal-fibrinogen group.Conclusions There was a"U"shaped relationship between fibrinogen levels and in-hospital mortality in patients with acute myocardial infarction in the ICU.Both high and low fibrinogen were associated with increased in-hospital mortality in patients with acute myocardial infarction.

关 键 词：纤维蛋白原 急性心肌梗死 住院病死率 重症监护病房 

分 类 号：R542.22[医药卫生—心血管疾病]