摘要
目的探讨急性冠脉综合征(ACS)患者血浆超敏C-反应蛋白与白蛋白比值(HCRP/ALB)对死亡的预测价值。方法回顾性分析2018年1月至2020年8月在首都医科大学附属北京安贞医院住院的ACS患者〔包括不稳定型心绞痛(UA)、急性非ST段抬高心肌梗死(NSTEMI)、急性ST段抬高心肌梗死(STEMI)〕的临床资料。根据入院时HCRP、ALB数值,计算HCRP/ALB比值。根据院内结局将患者分为死亡组与存活组,比较两组间基线资料、生化指标的差异;利用受试者工作特征曲线(ROC曲线)分析各变量对死亡的预测价值;利用Logistic回归分析患者死亡的危险因素。结果最终入组1722例ACS患者,其中院内死亡74例。死亡组与存活组基线资料比较显示,除高脂血症病史外,其余基线资料差异均有统计学意义,其中死亡组心率(HR)更快(次/min:89±19比73±15,P<0.01),HCRP、B型利钠肽(BNP)、HCRP/ALB比值更高〔HCRP(mg/L):23.24(9.79,33.69)比3.57(1.03,14.26),BNP(ng/L):424.0(164.3,1596.1)比79.0(31.0,211.4),HCRP/ALB比值:0.700(0.289,1.017)比0.089(0.026,0.368),均P<0.01〕,ALB水平更低(g/L:35.37±5.16比39.97±6.43,P<0.01)。ROC曲线分析显示,BNP、HCRP、HCRP/ALB比值预测死亡的ROC曲线下面积及95%可信区间〔AUC(95%CI)〕分别为0.781(0.717~0.845)、0.790(0.724~0.856)、0.803(0.738~0.869)。依据最大约登指数(0.559)对应的HCRP/ALB比值0.246,将患者分为低HCRP/ALB组(HCRP/ALB≤0.246,1163例)及高HCRP/ALB组(HCRP/ALB>0.246,559例),两组间除性别及既往吸烟史、高血压史、糖尿病史外,其余基线资料差异均有统计学意义,其中高HCRP/ALB组患者病死率、主动脉内球囊反搏术(IABP)比例更高(10.4%比1.4%,12.7%比2.7%,均P<0.01),BNP、HCRP、HCRP/ALB比值更高〔BNP(ng/L):253.0(82.8,749.0)比60.0(26.0,145.2),HCRP(mg/L):25.42±17.47比2.62±2.43,HCRP/ALB比值:0.700±0.435比0.066±0.062,均P<0.01〕,而ALB更低(g/L:36.89±4.30比41.17±6.83,P<0.01)。Logistic回归分析显示,HR加快〔优势比(OR)
Objective To investigate the predictive value of plasma high-sensitivity C-reactive protein/albumin ratio(HCRP/ALB)for the death in patients with acute coronary syndrome(ACS).Methods The clinical data of patients with ACS[including unstable angina(UA),non-ST segment elevation myocardial infarction(NSTEMI),ST segment elevation myocardial infarction(STEMI)]admitted to Beijing Anzhen Hospital Affiliated to Capital Medical University from January 2018 to August 2020 were retrospectively analyzed.The plasma HCRP and ALB were recorded and the HCRP/ALB ratio was calculated.Patients were divided into death group and survival group according to the hospital outcome.The differences of baseline data and biochemical indexes between the two groups were compared.Receiver operating characteristic curve(ROC curve)was used to analyze the predictive value of each variable to death.Logistic regression was used to analyze the risk factors of death.Results Among the 1722 ACS patients,74 died in hospital.Comparison of baseline data between death group and survival group showed that the other baseline data were statistically different except for the rate of hyperlipidemia.Among them,patients in death group had higher heart rate(HR),HCRP,B-type natriuretic peptide(BNP),HCRP/ALB[HR(bpm):89±19 vs.73±15,HCRP(mg/L):23.24(9.79,33.69)vs.3.57(1.03,14.26),BNP(ng/L):424.0(164.3,1596.1)vs.79.0(31.0,211.4),HCRP/ALB:0.700(0.289,1.017)vs.0.089(0.026,0.368),all P<0.01],while ALB was lower(g/L:35.37±5.16 vs.39.97±6.43,P<0.01).ROC curve analysis showed that area under ROC curve and 95%confidence interval[AUC(95%CI)]of BNP,HCRP and HCRP/ALB for predicting death were 0.781(0.717-0.845),0.790(0.724-0.856)and 0.803(0.738-0.869),respectively.The Youden index of HCRP/ALB was 0.559,and the corresponding HCRP/ALB was 0.246.The patients were divided into low HCRP/ALB group(HCRP/ALB≤0.246,1163 cases)and high HCRP/ALB group(HCRP/ALB>0.246,559 cases).Except for gender,previous smoking,hypertension and diabetes rates,the other baseline data were statistically
作者
张宁
刘文娴
康云鹏
Zhang Ning;Liu Wenxian;Kang Yunpeng(Department of Coronary Care Unit,Beijing Anzhen Hospital Affiliated to Capital Medical University,Beijing 100029,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2021年第5期573-577,共5页
Chinese Critical Care Medicine
基金
北京市医管局市属医院科研培育计划项目(PX2018026)。
