摘要
目的探讨心肌梗死溶栓治疗临床试验(TIMI)危险评分对ST段抬高型心肌梗死(STEMI)患者院内1型心肾综合征(CRS)的预测价值。方法选取2015年8—11月于河北医科大学第二医院心血管内科住院的STEMI患者93例为研究对象。根据患者院内是否发生1型CRS分为非CRS组69例和CRS组24例,收集两组患者的一般临床资料、实验室检查资料、介入治疗情况及主要不良心脏事件(MACE)发生情况,计算患者的TIMI、全球急性冠状动脉事件注册(GRACE)、CRUSADE危险评分,比较两组上述指标的差异。采用Logistic回归分析STEMI患者院内1型CRS发生的影响因素,采用受试者工作特征(ROC)曲线评估TIMI危险评分对STEMI患者院内1型CRS发生的预测价值。结果 CRS组患者入院心率较非CRS组快,肌酐水平、肌酸激酶水平、MACE发生率及TIMI、GRACE、CRUSADE危险评分均高于非CRS组,差异有统计学意义(P<0.05)。Logistic回归分析显示,TIMI评分是STEMI院内发生1型CRS的影响因素(P<0.05)。ROC曲线分析显示,TIMI评分对STEMI患者院内1型CRS发生预测的ROC曲线下面积为0.905[95%CI(0.840,0.969)]。最佳截断点为3分,对应的灵敏度和特异度分别为97.9%和62.3%,约登指数为0.602。结论 TIMI危险评分是STEMI患者院内1型CRS发生的良好预测指标。
Objective To evaluate the value of thrombolysis in myocardial infarction(TIMI)risk score in predicting type 1 cardiorenal syndrome(CRS)in hospitalized patients with ST-segment elevation myocardial infarction(STEMI).Methods Ninety-three consecutive STEMI patients who received inpatient treatment in Department of Cardiology,The Second Hospital of Hebei Medical University from August to November 2015 were enrolled,including 24 with type 1 CRS(CRS group)and 69 without type 1 CRS(non-CRS group).We collected the baseline clinical characteristics,laboratory findings,PCI treatment,and incidence of major adverse events(MACE),and calculated the TIMI risk score,global registry of acute coronary events(GRACE)risk score,and CRUSADE risk score.Logistic regression analysis was preformed to explore the associated factors for the incidence of type 1 CRS.ROC curve analysis was conducted to evaluate the TIMI risk score in predicting the incidence of type 1 CRS.Results Compared with non-CRS patients,CRS patients showed faster heartbeat,elevated creatinine and creatine kinase levels,and higher incidence of MACE,higher risk scores of TIMI,GRACE and CRUSADE(P<0.05).Logistic regression analysis showed that the TIMI risk score was significantly associated with type1 CRS in hospitalized patients with STEMI(P<0.05).For detecting type 1 CRS in hospitalized STEMI patients,the optimal cut-off value o f TIMI risk score was 3,at which point its AUC was 0.905〔95%CI(0.840,0.969)〕,yielding a 97.9%sensitivity,62.3%specificity and 0.602 Youden index.Conclusion TIMI risk score is a good tool for predicting type 1 CRS in hospitalized STEMI patients.
作者
汪雁博
谷新顺
郝国贞
姜云发
范卫泽
傅向华
WANG Yan-bo;GU Xin-shun;HAO Guo-zhen;JIANG Yun-fa;FAN Wei-ze;FU Xiang-hua(Department of Cardiology Ward 5,The Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)
出处
《中国全科医学》
CAS
北大核心
2018年第4期426-430,共5页
Chinese General Practice
基金
河北省2016年度医学科学研究重点课题计划(20160118)
关键词
心肌梗死
心肾综合征
TIMI危险评分
预测
影响因素分析
Myocardial infarction
Cardiorenal syndrome
Thrombolysis in myocardial infarction risk score
Forecasting
Root cause analysis
