C反应蛋白/白蛋白比值对2型糖尿病合并急性心肌梗死患者远期不良心脑血管事件的预测价值研究  

Predictive Effect of C-reactive Protein Albumin Ratio on Long-term Adverse Cardiovascular Events in Patients with Type 2 Diabetes Mellitus and Acute Myocardial Infarction

作　　者：马娟[1] 马盛宗 燕茹[1] 马学平 贾绍斌[1] MA Juan;MA Shengzong;YAN Ru;MA Xueping;JIA Shaobin(Department of Cardiovascular Medicine,General Hospital of Ningxia Medical University,Yinchuan 750000,China;Department of Obstetrics and Gynecology,Ningxia Hui Autonomous Region People's Hospital,Yinchuan 750000,China)

机构地区：[1]宁夏医科大学总医院心血管内科,宁夏回族自治区银川市750000 [2]宁夏回族自治区人民医院妇产科,宁夏回族自治区银川市750000

出　　处：《中国全科医学》2025年第6期705-712,共8页Chinese General Practice

基　　金：国家自然科学基金资助项目(82260086);宁夏自然科学基金资助项目(2023AAC02069)

摘　　要：背景急性心肌梗死(AMI)是威胁全球公众健康的主要原因之一。虽然已有相应的再灌注治疗策略,但AMI相关的主要不良心脑血管事件(MACCEs)仍然是全世界人口死亡的原因之一。尤其合并糖尿病的AMI患者,因冠状动脉病变复杂,病变程度严重,尽早发现和判断该部分患者远期预后相对困难,因此寻找相对简便、易获得的实验室指标,有利于为2型糖尿病(T2DM)合并AMI患者经皮冠状动脉介入(PCI)术后MACCEs的预测提供依据。目的探讨血清C反应蛋白(CRP)/白蛋白(Alb)比值(CAR)对T2DM合并AMI患者PCI术后远期MACCEs的预测价值。方法纳入2014—2019年就诊于宁夏医科大学总医院心血管内科1683例T2DM合并AMI患者为研究对象,收集患者的一般临床资料与检查结果。对所有患者进行电话或门诊随访,以全因死亡、非致死性心肌梗死、再发不稳定型心绞痛、非致死性脑卒中、新发心力衰竭或心力衰竭加重再入院、再次血运重建作为MACCEs。根据患者随访期间是否发生MACCEs分为MACCEs组(508例)和非MACCEs组(1175例)。采用单因素及多因素Logistic回归分析探讨T2DM合并AMI患者MACCEs事件的影响因素。采用Kaplan-Meier法绘制患者的生存曲线,生存曲线的比较采用Log-rank检验。采用受试者工作特征(ROC)曲线分析CAR对T2DM合并AMI患者远期发生MACCEs的预测效能,使用净重分类改善指标(NRI)和综合判别指数(IDI)评价CAR对T2DM合并AMI患者预后评估的改善效果。结果1683例患者中508例(30.18%)患者发生MACCEs。多因素Logistic回归分析显示高血压病[OR(95%CI)=1.994(1.142~3.483)]、冠状动脉植入支架长度[OR(95%CI)=1.031(1.002~1.062)]、CRP[OR(95%CI)=0.950(0.915~0.986)]、Alb[OR(95%CI)=0.933(0.880~0.989)]及CAR[OR(95%CI)=5.582(1.705~18.277)]是T2DM合并AMI患者PCI术后发生MACCEs的影响因素(P<0.05)。根据CAR中位表达水平(0.86),将患者分为CAR<0.86组和CAR≥0.86组,Log-rank检验结果显示,CAR≥Background Acute Myocardial Infarction(AMI)remains one of the leading threats to global public health.Despite available reperfusion therapies,major adverse cardiovascular and cerebral events(MACCEs)associated with AMI continue to be a leading cause of death worldwide.This is particularly true for patients with AMI and concomitant diabetes mellitus,where coronary artery disease is more complex and severe,making early detection and prognosis of long-term outcomes for these patients challenging.Therefore,the identification of simple and accessible laboratory markers could facilitate the prediction of post-percutaneous coronary intervention(PCI)MACCEs in patients with type 2 diabetes mellitus(T2DM)and AMI.Objective To investigate the predictive value of the serum C-reactive protein(CRP)/albumin(Alb)ratio(CAR)for long-term MACCEs following PCI in patients with T2DM and AMI.Methods A total of 1683 patients with T2DM and AMI treated at the Department of Cardiovascular Medicine,General Hospital of Ningxia Medical University between 2014 and 2019 were enrolled.General clinical data and test results were collected for these patients.Follow-ups were conducted via telephone or outpatient visits,with a median follow-up period of 5.6 years.MACCEs were defined as all-cause mortality,non-fatal myocardial infarction,recurrent unstable angina,non-fatal stroke,new-onset heart failure,or rehospitalization for worsening heart failure,and revascularization.Patients were divided into the MACCEs group(508 cases)and the non-MACCEs group(1175 cases)based on the occurrence of MACCEs during the follow-up period.Univariate and multivariate Logistic regression analyses were performed to identify factors influencing MACCEs in patients with T2DM and AMI.Kaplan-Meier survival curves were plotted,and the Log-rank test was used for comparisons.Receiver operating characteristic(ROC)curve analysis assessed the predictive efficacy of CAR for long-term MACCEs in patients with T2DM and AMI,while the net reclassification improvement(NRI)and integrated d

关 键 词：心肌梗死 糖尿病 2型 主要不良心脑血管事件 C反应蛋白 白蛋白 预测 

分 类 号：R542.22[医药卫生—心血管疾病]