血清白蛋白及球蛋白比值与慢性心力衰竭患者近期预后的相关性研究  

Correlation between serum albumin-globulin ratio and short-term prognosis in patients with chronic heart failure

作　　者：张圆玉 杨飞云 王立立[3] 陈淑霞[3] 谷剑[3] ZHANG Yuanyu;YANG Feiyun;WANG Lili;CHEN Shuxia;GU Jian(Graduate School,Hebei Medical University,Shijiazhuang,050017,China;Graduate School,Hebei North University;Department of Cardiology,Hebei Provincial People's Hospital)

机构地区：[1]河北医科大学研究生学院,石家庄050017 [2]河北北方学院研究生学院 [3]河北省人民医院心内科

出　　处：《临床心血管病杂志》2023年第8期636-643,共8页Journal of Clinical Cardiology

摘　　要：目的:探索白蛋白及球蛋白比值(AGR)与慢性心力衰竭(心衰)患者近期内发生主要不良心血管事件(MACE)的相关性。方法:选取2021年3月—2022年3月河北省人民医院心血管内科住院的心衰患者362例,随访出院后6个月内是否发生MACE,分为MACE组115例和非MACE组247例。对MACE组与非MACE组临床资料进行统计分析。采用Log Rank检验分析不同AGR分组MACE累积生存率的差异。采用Cox比例风险回归模型分析MACE的风险因素。采用ROC曲线评估AGR对MACE的预测价值。结果:基线资料分析,与非MACE组比较,MACE组AGR水平明显低于非MACE组,差异有统计学意义[1.24(1.09,1.39)vs 1.39(1.23,1.59),P<0.001]。AGR与心衰严重程度相关性分析中,整体心衰人群、MACE组及非MACE组分别发现AGR水平随着NHYA心功能分级的增加而降低,差异分别有统计学意义[P<0.001,P=0.008,P=0.003]。Log Rank检验中,AGR低水平组MACE累积生存率明显低于高水平组(Waldχ^(2)=19.593,P_(Log Rank)<0.001)。多因素Cox回归分析显示,AGR、尿酸、糖尿病、心房颤动是慢性心力衰竭患者近期MACE的独立预测因素[HR=0.171,95%CI(0.063~0.460),P<0.001;HR=1.003,95%CI(1.001~1.004),P=0.001;HR=1.75,95%CI(1.189~2.575),P=0.005;HR=1.821,95%CI(1.222~2.715),P=0.003]。ROC曲线分析中,AGR诊断MACE的ROC曲线下面积为0.681[95%CI(0.623~0.740),P<0.001],灵敏度及特异度分别为60.9%和68.8%。结论:AGR与慢性心衰患者近期预后相关,是慢性心衰近期MACE发生率的独立危险因素,对近期发生MACE有一定的预测价值。Objective To investigate the correlation between albumin to globulin ratio(AGR)and recent major adverse cardiovascular events(MACE)in patients with chronic heart failure.Methods A total of 362 patients with heart failure admitted to the Department of Cardiovascular Medicine,Hebei General Hospital from March 2021 to March 2022 were selected to follow up whether they developed MACE within 6 months after discharge.They were divided into two groups,115 patients in the MACE group and 247 patients in the non-MACE group.The clinical data of MACE group and non-MACE group were analyzed statistically.Log Rank test was used to analyze the difference of MACE cumulative survival in different AGR groups.Cox proportional hazard regression model was used to analyze the risk factors of MACE.The predictive value of AGR to MACE was evaluated by ROC curve.Results Based on baseline data analysis,AGR level in the MACE group was significantly lower than that in the non-MACE group,and the difference was statistically significant[1.24(1.09,1.39)vs 1.39(1.23,1.59),P<0.001].In the analysis of the correlation between AGR and severity of heart failure,it was found that the level of AGR decreased with the increase of NHYA cardiac function classification in the overall heart failure population,MACE group and non-MACE group,respectively,and the difference was statistically significant(P<0.001,P=0.008,P=0.003).In Log Rank test,the MACE cumulative survival rate of the low AGR group was significantly lower than that of the high AGR group(Waldχ^(2)=19.593,P_(Log Rank)=P<0.001).Multi-factor Cox regression analysis showed that AGR,uric acid,Diabetes Mellitus and Atrial Fibrillation were independent predictors of recent MACE in patients with chronic heart failure[HR=0.171,95%CI(0.063-0.460),P<0.001;HR=1.003,95%CI(1.001-1.004),P=0.001;HR=1.75,95%CI(1.189-2.575),P=0.005;HR=1.821,95%CI(1.222-2.715),P=0.003].In ROC curve analysis,the area under ROC curve for AGR diagnosis of MACE was 0.681[95%CI(0.623-0.740),P<0.001],and the sensitivity and specificity w

关 键 词：心力衰竭 白蛋白 球蛋白 白蛋白及球蛋白比值 预后 

分 类 号：R541.6[医药卫生—心血管疾病]