急诊动脉血乳酸、TIMI危险评分对老年NSTE-ACS患者院内发生MACE的预测价值  

Predictive Value of Emergency Arterial Blood Lactic Acid Combined with TIMI Risk Score for In-hospital MACE in Elderly Patients with NSTE-ACS

作　　者：闫博[1] 邢绣荣[1] 王春源[1] 王晶[1] YAN Bo;XING Xiurong;WANG Chunyuan;WANG Jing(Department of Emergency,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院急诊科,北京100053

出　　处：《医学综述》2022年第16期3291-3296,共6页Medical Recapitulate

基　　金：北京市属医院科研培育计划项目(PX2019028);首都医科大学宣武医院院级课题(XWJL-2018038)。

摘　　要：目的探讨急诊动脉血乳酸、心肌梗死溶栓(TIMI)危险评分对老年非ST段抬高型急性冠脉综合征(NSTE-ACS)患者院内发生主要不良心血管事件(MACE)的预测价值。方法回顾性分析2016年10月至2020年10月首都医科大学宣武医院急诊科收治的200例老年NSTE-ACS患者的临床资料,记录急诊时患者动脉血乳酸水平、TIMI危险评分,且后续均接受临床规范化治疗。根据患者在急诊科室至经皮冠状动脉介入治疗(PCI)术前在院期间是否发生MACE分为MACE组和非MACE组,比较两组患者的临床资料,采用Logistic回归分析老年NSTE-ACS患者院内发生MACE的危险因素,绘制受试者工作特征曲线(ROC曲线)评估血乳酸、TIMI危险评分对老年NSTE-ACS患者院内发生MACE的预测价值。结果急诊科室至PCI术前在院期间,200例老年NSTE-ACS患者共42例发生MACE。MACE组患者年龄大于非MACE组(P<0.01),血乳酸、白细胞计数、cTnI水平、TIMI危险评分高于非MACE组(P<0.01),两组TIMI危险分层分布比较差异有统计学意义(P<0.01)。Logistic回归分析结果显示,血乳酸、心肌肌钙蛋白I、TIMI危险评分是老年NSTE-ACS患者院内发生MACE的危险因素(OR=2.147,95%CI 1.999~2.295;OR=2.184,95%CI 2.050~2.317;OR=2.179,95%CI 2.051~2.308)(P<0.01)。ROC曲线结果显示,血乳酸、TIMI危险评分及血乳酸联合TIMI危险评分预测老年NSTE-ACS患者院内发生MACE的灵敏度分别为86.37%、81.25%、80.08%,特异度分别为80.47%、83.91%、86.28%,曲线下面积分别为0.839、0.784、0.813。结论急诊动脉血乳酸、TIMI危险评分是影响老年NSTE-ACS患者院内发生MACE的独立危险因素,且血乳酸水平升高可预警老年NSTE-ACS患者院内MACE。Objective To investigate the predictive value of emergency arterial blood lactic acid combined with thrombolysis in myocardial infarction(TIMI)risk score for in-hospital major adverse cardiovascular events(MACE)in elderly patients with non-ST-segment elevation acute coronary syndrome(NSTE-ACS).Methods The clinical data of 200 elderly patients with NSTE-ACS admitted to the Department of Emergency of Xuanwu Hospital,Capital Medical University from Oct.2016 to Oct.2020 were retrospectively analyzed,and the arterial blood lactic acid level and TIMI risk score of the patients at emergency were recorded,and they all received following standardized clinical treatment.The patients were divided into a MACE group and a non-MACE group according to whether MACE occurred during the period from emergency department to percutaneous coronary intervention(PCI)in hospital,the clinical data of the two groups were compared.Logistic regression analysis was used to identify the risk factors for in-hospital MACE in elderly NSTE-ACS patients,and the receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of lactic acid and TIMI risk score for in-hospital MACE in elderly NSTE-ACS patients.Results MACE occurred in 42 of the 200 elderly patients with NSTE-ACS between the emergency department and PCI in hospital.The patients of the MACE group were older than those in the non-MACE group(P<0.01),blood lactic acid,white blood cell count,cTnI level and TIMI risk score were higher than the non-MACE group(P<0.01),and there was statistical significance in the risk stratification distribution of TIMI between the two groups(P<0.01).Logistic regression analysis showed that lactic acid,cTnI and TIMI risk score were the independent risk factors for in-hospital MACE in the elderly patients with NSTE-ACS(OR=2.147,95%CI 1.999-2.295;OR=2.184,95%CI 2.050-2.317;OR=2.179,95%CI 2.051-2.308)(P<0.01).The ROC curve results showed that the sensitivities of lactic acid,TIMI risk score and lactic acid combined with TIMI risk score for

关 键 词：非ST段抬高型急性冠脉综合征 动脉血乳酸 急诊 心肌梗死溶栓危险评分 院内主要不良心血管事件 

分 类 号：R542.22[医药卫生—心血管疾病]