血清AST/ALT比值与急性冠脉综合征合并肾功能不全患者预后的相关性研究  

Relationship between serum AST/ALT ratio and prognosis in patients with acute coronary syndrome complicated with renal insufficiency

作　　者：翟亚丽 王志刚 武晓云 ZAI Yali;WANG Zhigang;WU Xiaoyun(Zhangjiakou Xuangang Hospital,Zhangjiakou Hebei 075100,China)

机构地区：[1]张家口宣钢医院,河北张家口075100

出　　处：《中国急救复苏与灾害医学杂志》2024年第5期636-640,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：河北省重点研发计划自筹项目(编号:182777143)。

摘　　要：目的探讨血清天氡氨酸转氨酶/丙氨酸转氨酶(AST/ALT)与急性冠脉综合征合并肾功能不全患者的远期临床预后的关系。方法回顾性分析2016年—2019年期间在张家口宣钢医院住院治疗的100例急性冠脉综合征合并肾功能不全患者临床资料,随访12~48个月,随访的首要终点为全因死亡。根据血清AST/ALT高低分为低AST/ALT组和高AST/ALT组,对两组患者的临床资料、主要心血管不良事件风险因素进行单多因素分析。结果随访12~48个月过程中,Logistic回归分析显示,年龄、左主干病变、经皮冠状动脉介入、白细胞计数、高血压病、糖尿病、吸烟、血红蛋白、低分子肝素以及氯吡格雷是急性冠脉综合征合并肾功能不全患者预后的影响因素;低AST/ALT组(n=50)共有1例患者死亡(2.0%),高AST/ALT组(n=50)共有4例患者死亡(8%)(P<0.05);Logistic回归分析显示,全因死亡、再次血运重建、卒中、心力衰竭与血清AST/ALT主要心血不良事件有关(OR=0.869、0.823、0.816、0.791,95%CI=0.235~0.993、0.302~1.853、0.261~0.981、0.349~0.962,P<0.05)。Kaplan-Meier生存分析显示高AST/ALT组死亡、再次血运重建、卒中和心力衰竭的风险较低AST/ALT组显著升高(P=0.015、0.037、0.016、0.023)。Cox风险分析显示,年龄,经皮冠状动脉介入治疗和使用低分子肝素可作为心力衰竭的独立风险因素。结论血清AST/ALT与合并有慢性肾功能不全的急性冠脉综合征患者的远期临床预后存在显著的相关性。Objective To explore the relationship between serum aspartate AST/ALT ratio and long-term clinical prognosis in patients with acute coronary syndrome complicated with chronic renal insufficiency.Methods A retrospective analysis was conducted on the clinical data of 100 patients with acute coronary syndrome complicated with chronic renal insufficiency who were hospitalized at Zhangjiakou Xuangang Hospital from 2016 to 2019.They were followed up for 12-48 months,with the primary endpoint being all cause death.According to the ratio of serum aspartate AST/ALT,patients were divided into a low AST/ALT group and a high AST/ALT group.A single multiple factor analysis was conducted on the clinical data and major cardiovascular adverse event risk factors of the two groups of patients.Results During the 12-48 month follow-up,logistic regression analysis showed that age,left main coronary artery disease,percutaneous coronary intervention,white blood cell count,hypertension,diabetes,smoking,hemoglobin,low molecular weight heparin and clopidogrel were the prognostic factors of patients with acute coronary syndrome complicated with renal insufficiency;One patient died(2.0%)in the low ratio group(n=50),while four patients died(8%)in the high ratio group(n=50)(P<0.05);Logistic regression analysis showed that all cause death,revascularization,stroke,and heart failure were associated with major adverse cardiac events in the AST/ALT of serum aspartate AST/ALL(OR=0.869,0.823,0.816,0.791,95%CI 0.235-0.993,0.302-1.853,0.261-0.981,0.349-0.962,P<0.05).Kaplan-Meier survival analysis showed that the high AST/ALT group had a significantly higher risk of death,revascularization,stroke,and heart failure compared to the low AST/ALT group(P=0.015,0.037,0.016,0.023).Cox hazared analysis showed that age,percutaneous coronary intervention,and the use of low molecular weight heparin can be independent risk factors for heart failure.Conclusion There was a significant correlation between the serum AST/ALT ratio and the long-term clinical outcome of

关 键 词：天氡氨酸转氨酶/丙氨酸转氨酶比值 急性冠脉综合征 慢性肾功能不全 预后 

分 类 号：R58[医药卫生—内分泌]