多种血清学指标与老年急性心肌梗死合并心源性休克患者院内死亡的相关性  

Correlation between multiple serological indicators and in-hospital mortality in elderly patients with acute myocardial infarction and cardiogenic shock

作　　者：丛冬瑶 戴晨光 潘玉娇 CONG Dong-yao;DAI Chen-guang;PAN Yu-jiao(Department of Cardiology,First Affiliated Hospital of Harbin Medical University,Harbin 150001,Heilongjiang,China)

机构地区：[1]哈尔滨医科大学附属第一医院心内科,黑龙江哈尔滨150001

出　　处：《心脏杂志》2025年第1期35-40,共6页Chinese Heart Journal

基　　金：黑龙江省卫生健康委科研课题(2020-106)。

摘　　要：目的评估多种血清学指标在老年急性心肌梗死(AMI)合并心源性休克(CS)患者院内死亡预测中的作用。方法回顾性纳入2018年1月~2023年6月哈尔滨医科大学附属第一医院住院治疗的326例AMI合并CS患者,根据住院期间是否死亡,分为院内死亡组(n=120)和院内存活组(n=206)。采用多因素Logistic回归法筛选老年AMI合并CS患者院内死亡的危险因素,并采用ROC曲线对血清学标志物识别AMI合并CS患者院内死亡的区分度进行评估。结果与院内存活组比较,院内死亡组年龄(P<0.01)、尿酸(P<0.05)、纤维蛋白原(P<0.05)、乳酸(P<0.01)、C反应蛋白(P<0.05)、中性粒细胞淋巴细胞比值(NLR)(P<0.01)、应激性高血糖比值(SHR)(P<0.01)水平更高,左心室射血分数(P<0.01)、TIMI血流3级比例(P<0.01)更低。多因素Logistic回归分析显示,年龄(OR=1.292,95%CI:1.002~1.666,P<0.05)、NLR(OR=1.616,95%CI:1.185~2.205,P<0.01)、乳酸(OR=1.401,95%CI:1.054~1.862,P<0.05)、SHR(OR=1.480,95%CI:1.110~1.973,P<0.01)是AMI合并CS患者院内死亡的独立危险因素,而TIMI血流3级为保护因素(OR=0.528,95%CI:0.372~0.749,P<0.01)。ROC曲线显示,NLR、乳酸、SHR预测AMI并CS患者院内死亡的AUC分别为0.831(95%CI:0.784~0.878)、0.719(95%CI:0.660~0.777)和0.670(95%CI:0.609~0.730)。结论NLR、乳酸、SHR均与老年AMI合并CS患者院内死亡具有一定相关性,对院内死亡风险具有一定的预测能力,其中以NLR的预测能力最佳。AIM To assess the role of multiple serological indicators in the prediction of in-hospital death in patients with acute myocardial infarction(AMI)and cardiogenic shock(CS).METHODS Three hundred and twenty-six patients with AMI combined with CS in our hospital from January 2018 to June 2023 were retrospectively included,and they were divided into in-hospital death group(120 cases)and in-hospital survival group(206 cases)according to whether they died during hospitalization.Multifactorial logistic regression was used to screen the risk factors for in-hospital death in patients with AMI and CS,ROC curves were used to assess the differentiation of serological markers for identifying in-hospital death in patients with AMI and CS,and the results were expressed as AUC.RESULTS Compared with the in-hospital live group,the in-hospital death group had higher levels of age(P<0.01),uric acid(P<0.05),fibrinogen(P<0.05),lactate(P<0.01),C-reactive protein(P<0.05),neutrophil lymphocyte ratio(NLR)(P<0.01),stress hyperglycemia ratio(SHR)(P<0.01),and lower levels of left ventricular ejection fraction(P<0.01)and TIMI grade 3 blood flow ratio(P<0.01).Multivariate logistic regression analysis showed that age(OR=1.292,95%CI:1.002~1.666,P<0.05),NLR(OR=1.616,95%CI:1.185~2.205,P<0.01),lactate(OR=1.401,95%CI:1.054~1.862,P<0.05),and SHR(OR=1.480,95%CI:1.110~1.973,P<0.01)were independent risk factors for in-hospital mortality in patients with AMI and CS,while TIMI blood flow level 3 was a protective factor(OR=0.528,95%CI:0.372~0.749,P<0.01).The ROC curve shows that the AUC of NLR,lactate,and SHR predicting inhospital mortality in AMI patients with CS is 0.831(95%CI:0.784~0.878),0.719(95%CI:0.660~0.777),and 0.670(95%CI:0.609~0.730),respectively.CONCLUSION NLR,lactate and SHR are all correlated with in-hospital death in patients with AMI with CS and they are of some predictive ability for in-hospital mortality risk,with NLR having the best predictive ability.

关 键 词：急性心肌梗死 心源性休克 炎症 血糖 

分 类 号：R541.4[医药卫生—心血管疾病] R541.6[医药卫生—内科学]