摘要
目的探讨C反应蛋白与血浆前白蛋白比值(CP比值)预测肾功能不全合并急性心肌梗死预后价值。本研究是一项单中心、观察性、回顾性队列研究,研究对象为2020年1月~2023年3月在聊城市人民医院心内科接受冠状动脉血管造影术的中重度慢性肾脏疾病(CKD)ST段抬高型心肌梗死(STEMI)患者,估计肾小球滤过率(eGFR)在(15~60)ml/(min·1.73 m^(2))之间。通过将血清CRP除以血清前白蛋白水平获得CP比值。研究的主要结局为急性肾损伤(AKI)。结果与未发生AKI组相比,AKI组患者的年龄较大(P<0.01),白细胞计数较高(P<0.05),肌钙蛋白水平较高(P<0.01),肌酸激酶同工酶(CK-MB)水平较高(P<0.01),AKI组的基线eGFR较低(P<0.05),CRP较高(P<0.01),CP比值较高(P<0.01),多支血管疾病比例高(P<0.05),使用的造影剂总量更大(P<0.01),PCI手术比例高(P<0.01),冠状动脉旁路移植术比例低(P<0.01)。多变量Logistic回归分析显示:年龄(OR=1.04;95%CI=1.02~1.08;P=0.006),eGFR(OR=0.97;95%CI=0.95~0.99;P=0.03),造影剂体积(OR=1.01;95%CI=1.00~1.01;P=0.01)和CP比值(OR=1.36;95%CI=1.17~1.57;P=0.004)是AKI的重要预测因素。在ROC曲线分析中,CP比值预测AKI的曲线下面积为0.732,最佳分界点为0.46(灵敏度:69.1%;特异度:78.2%;P<0.01)。结论术前CP比值升高与接受PCI的中重度CKD患者发生AKI相关。
AIM To explore the prognostic value of C-reactive protein/plasma prealbumin ratio(CP ratio)in predicting renal insufficiency complicated with acute myocardial infarction.METHODS This study was a single-center,observational and retrospective cohort study.The subjects of the study were moderate and severe chronic kidney disease(CKD,the estimated glomerular filtration rate[eGFR]was between(15~60)ml/(min/1.73 m^(2))patients with ST-segment elevation myocardial infarction(STEMI)who underwent coronary angiography in the Department of Cardiology of our hospital from January 2020 to March 2023.The CP ratio was obtained by dividing serum CRP by serum prealbumin level and the main outcome of the study was acute renal injury(AKI).RESULTS Compared with the group without AKI,patients in the AKI group had older age(P<0.01),higher white blood cell counts(P<0.05),higher levels of troponin(P<0.01),higher levels of creatine kinase isoenzymes(CK-MB)(P<0.01),lower baseline eGFR(P<0.05),higher CRP(P<0.01),higher CP ratio(P<0.01),higher proportion of multi vessel diseases(P<0.05),and a larger total amount of contrast agent used(P<0.01),The proportion of PCI surgery is high(P<0.01),and the proportion of coronary artery bypass grafting is low(P<0.01).Multivariate logistic regression analysis showed that age(OR=1.04;95%CI=1.02~1.08;P=0.006),eGFR(OR=0.97;95%CI=0.95~0.99;P=0.03),contrast agent volume(OR=1.01;95%CI=1.00~1.01;P=0.01),and CP ratio(OR=1.36;95%CI=1.17~1.57;P=0.004)were important predictors of AKI.In ROC curve analysis,the area under the curve predicted by CP ratio for AKI is 0.732,and the optimal cutoff point is 0.46(sensitivity:69.1%;specificity:78.2%;P<0.01).CONCLUSION The increase of CP ratio before operation is related to AKI in patients with moderate and severe CKD undergoing PCI.
作者
姜跃华
王发龙
王博
JIANG Yue-hua;WANG Fa-long;WANG Bo(Department of Laboratory,Liaocheng People’s Hospital,Liaocheng 252000,Shandong,China;Department of Laboratory,Liaocheng Fifth People’s Hospital,Liaocheng 252000,Shandong,China)
出处
《心脏杂志》
CAS
2024年第5期546-550,共5页
Chinese Heart Journal
基金
山东省卫生健康委员会科研项目(20220107)。
关键词
C反应蛋白
前白蛋白
肾功能不全
ST段抬高型心肌梗死
急性肾损伤
C-reactive protein
realbumin
renal insufficiency
ST-segment elevation myocardial infarction
acute renal injury
