可溶性肿瘤坏死因子样凋亡弱诱导因子和高敏C反应蛋白与急性心肌梗死患者出院后短期主要不良心血管事件发生的关系及预测模型构建  

Relationship between soluble tumor necrosis factor-like weak inducer of apoptosis,high-sensitivity C-reactive protein levels and short-term major adverse cardiovascular events after discharge in acute myocardial infarction patients and the construction of a prediction model

作　　者：井河江 张鸿梅[1] 李雪 JING Hejiang;ZHANG Hongmei;LI Xue(Department of Cardiovascular Medicine,Nanyang Second General Hospital,Nanyang 473000,Henan Province,China)

机构地区：[1]南阳市第二人民医院心血管内科,河南南阳473000

出　　处：《新乡医学院学报》2024年第10期946-951,共6页Journal of Xinxiang Medical University

摘　　要：目的探讨可溶性肿瘤坏死因子样凋亡弱诱导因子(sTWEAK)、高敏C反应蛋白(hs-CRP)水平与急性心肌梗死(AMI)患者出院后短期主要不良心血管事件(MACE)发生的关系,并构建风险预测模型。方法选择2019年10月至2022年10月南阳市第二人民医院收治的135例AMI患者为研究对象,出院后随访6个月,统计MACE发生情况,将发生MACE的患者纳入MACE组,未发生MACE的患者纳入无MACE组。比较2组患者的血清sTWEAK、hs-CRP水平及年龄、性别、体质量指数(BMI)、吸烟史、饮酒史、贫血、糖尿病史、高血压史、高脂血症史、脑卒中史、陈旧性心肌梗死、前壁梗死、Killip心功能分级、冠状动脉病变支数、冠状动脉Gensini积分、急性生理学及慢性健康状况评分系统(APACHEⅡ)评分、白细胞计数、血清肌酸激酶同工酶(CK-MB)、血清心肌肌钙蛋白T(cTnT)及发病至再灌注时间等临床资料;采用logistic回归模型分析AMI出院后短期MACE发生的危险因素,将logistic回归模型分析结果作为依据建立预测AMI出院后短期MACE发生风险的模型,应用受试者操作特征(ROC)曲线、校准曲线评估模型预测效能及校准能力。结果AMI患者出院后6个月MACE发生率为27.73%(33/135)。MACE组患者>60岁占比、有吸烟史占比、冠状动脉病变支数≥2占比、APACHEⅡ评分及血清cTnT、sTWEAK、hs-CRP水平显著高于无MACE组(P<0.05);MACE组与无MACE组患者的性别分布、BMI、饮酒史、贫血、糖尿病史、高血压史、高脂血症史、脑卒中史、陈旧性心肌梗死、心房纤颤、前壁梗死、Killip心功能分级、发病至再灌注时间、冠状动脉Gensini积分、白细胞计数、血清CK-MB比较差异无统计学意义(P>0.05)。Logistic回归模型分析显示,年龄>60岁、冠状动脉病变支数≥2、高APACHEⅡ评分、高血清cTnT水平、高血清sTWEAK水平、高血清hs-CRP水平是AMI出院后短期MACE发生的危险因素(P<0.05)。基于年龄、�Objective To explore the relationship between soluble tumor necrosis factor-like weak inducer of apoptosis(sTWEAK),high-sensitivity C-reactive protein(hs-CRP)levels and the occurrence of major adverse cardiovascular events(MACE)in the short term after discharge in patients with acute myocardial infarction(AMI),and to construct a risk prediction model.Methods A total of 135 patients with AMI admitted to Nanyang Second General Hospital from October 2019 to October 2022 were selected as the research subjects.They were followed up for 6 months after discharge,and the occurrence of MACE was recorded.Patients with MACE were included in the MACE group,and the patients without MACE were included in the non-MACE group.The serum levels of sTWEAK and hs-CRP,as well as clinical data such as age,gender,body mass index(BMI),smoking history,drinking history,anemia,diabetes history,hypertension history,hyperlipidemia history,stroke history,old myocardial infarction,anterior wall infarction,Killip heart function classification,coronary artery lesion number,coronary artery Gensini score,acute physiology and chronic health evaluation II(APACHE II),white blood cell count,serum creatine kinase isoenzyme(CK-MB)level,serum cardiac troponin T(cTnT)level,and the time from onset to reperfusion were compared between the two groups.The risk factors for short-term MACE after discharge of AMI patients were analyzed by using a logistic regression model.Based on the logistic regression analysis results,a model for predicting the risk of short-term MACE after discharge of AMI patients was established,and its prediction efficiency and calibration capability were evaluated by using the receiver operating characteristic(ROC)curve and calibration curve.Results The incidence rate of MACE within 6 months after discharge in AMI patients was 27.73%(33/135).The proportion of patients over 60 years old,proportion of patients with smoking history,percentage of coronary artery lesions in two or more branches,APACHE II score,and serum cTnT,sTWEAK and hs-CRP

关 键 词：急性心肌梗死 可溶性肿瘤坏死因子样弱诱导因子 高敏C反应蛋白 主要不良心血管事件 

分 类 号：R542.22[医药卫生—心血管疾病]