中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2010年
4期
392-396
,共5页
超敏C反应蛋白%ST段抬高心肌梗死%心绞痛%再梗死%心力衰竭%心源性死亡%随访%预测
超敏C反應蛋白%ST段抬高心肌梗死%心絞痛%再梗死%心力衰竭%心源性死亡%隨訪%預測
초민C반응단백%ST단태고심기경사%심교통%재경사%심력쇠갈%심원성사망%수방%예측
High-sensitivity C-reactive protein%ST-segment elevation myocardial infarction%Angina%Rein-farction%Cardia failure%Cardiac death%Follow up%Prognosis
目的 评价入院早期血清超敏C反应蛋白(hs-CRP)水平对急性ST段抬高心肌梗死(STEMI)患者主要不良心脏事件(MAcE)的预测价值.MACE是心绞痛、再梗死、心力衰竭和心源性死亡.方法 哈尔滨医科大学2006年6月至2007年5月收治的急性SrEMI患者189例,于发病24 h内采空腹肘静脉血(行介人治疗者于术前采血),分别测hs-CRP、白细胞(WBC)、肌酸激酶及其同工酶(CK及CK-MB)、血脂及血糖,并做超声心动图.根据hs-CRP水平,将患者分为hs-CRP升高组(hs-CRP＞4 mg/L)和正常组(hs-CRP≤4mg/L).随访入选患者MACE.各种潜在危险因素单独或联合时与MACE和死亡的相关性用COX比例风险回归进行单、多变量分析.生存曲线采用kaplan-Meier法,并用时序检验和Breslow检验比较生存曲线.结果 两组平均随访(271.1±136.7)d.hs-CRP升高组MACE发生率明显高于正常组(75%vs.25%,P＜0.01),血WBC、CK及CK-MB显著高于正常组(P值分别为0.002,0.039和0.049).MACE组hs-CRP水平显著高于无MACE组(P＜0.01),死亡组hs-CRP显著高于MACE组(P＜0.01). hs-CRP升高组和正常组存活和无MACE患者的Kaplan-Meier曲线均有显著分离(时序检验P值分别为0.0042和0.0062).多因素分析显示,hs-CRP水平是MACE(艘=1.919,P＜0.05)和死亡(RR=3.067,P＜0.05)的独立风险预测因子.高hs-CRP的老年患者(年龄≥65岁)发生MACE(RR=2.547,P＜0.01)和死亡(RR=4.140,P＜0.01)的风险较高.结论 入院早期血清hs-CRP升高是急性STEMI患者随访期发生MACE和死亡的独立危险预测因子.对血清hs-CRP水平和年龄联合评价提供了一种筛选高危患者的方法.
目的 評價入院早期血清超敏C反應蛋白(hs-CRP)水平對急性ST段抬高心肌梗死(STEMI)患者主要不良心髒事件(MAcE)的預測價值.MACE是心絞痛、再梗死、心力衰竭和心源性死亡.方法 哈爾濱醫科大學2006年6月至2007年5月收治的急性SrEMI患者189例,于髮病24 h內採空腹肘靜脈血(行介人治療者于術前採血),分彆測hs-CRP、白細胞(WBC)、肌痠激酶及其同工酶(CK及CK-MB)、血脂及血糖,併做超聲心動圖.根據hs-CRP水平,將患者分為hs-CRP升高組(hs-CRP＞4 mg/L)和正常組(hs-CRP≤4mg/L).隨訪入選患者MACE.各種潛在危險因素單獨或聯閤時與MACE和死亡的相關性用COX比例風險迴歸進行單、多變量分析.生存麯線採用kaplan-Meier法,併用時序檢驗和Breslow檢驗比較生存麯線.結果 兩組平均隨訪(271.1±136.7)d.hs-CRP升高組MACE髮生率明顯高于正常組(75%vs.25%,P＜0.01),血WBC、CK及CK-MB顯著高于正常組(P值分彆為0.002,0.039和0.049).MACE組hs-CRP水平顯著高于無MACE組(P＜0.01),死亡組hs-CRP顯著高于MACE組(P＜0.01). hs-CRP升高組和正常組存活和無MACE患者的Kaplan-Meier麯線均有顯著分離(時序檢驗P值分彆為0.0042和0.0062).多因素分析顯示,hs-CRP水平是MACE(艘=1.919,P＜0.05)和死亡(RR=3.067,P＜0.05)的獨立風險預測因子.高hs-CRP的老年患者(年齡≥65歲)髮生MACE(RR=2.547,P＜0.01)和死亡(RR=4.140,P＜0.01)的風險較高.結論 入院早期血清hs-CRP升高是急性STEMI患者隨訪期髮生MACE和死亡的獨立危險預測因子.對血清hs-CRP水平和年齡聯閤評價提供瞭一種篩選高危患者的方法.
목적 평개입원조기혈청초민C반응단백(hs-CRP)수평대급성ST단태고심기경사(STEMI)환자주요불양심장사건(MAcE)적예측개치.MACE시심교통、재경사、심력쇠갈화심원성사망.방법 합이빈의과대학2006년6월지2007년5월수치적급성SrEMI환자189례,우발병24 h내채공복주정맥혈(행개인치료자우술전채혈),분별측hs-CRP、백세포(WBC)、기산격매급기동공매(CK급CK-MB)、혈지급혈당,병주초성심동도.근거hs-CRP수평,장환자분위hs-CRP승고조(hs-CRP＞4 mg/L)화정상조(hs-CRP≤4mg/L).수방입선환자MACE.각충잠재위험인소단독혹연합시여MACE화사망적상관성용COX비례풍험회귀진행단、다변량분석.생존곡선채용kaplan-Meier법,병용시서검험화Breslow검험비교생존곡선.결과 량조평균수방(271.1±136.7)d.hs-CRP승고조MACE발생솔명현고우정상조(75%vs.25%,P＜0.01),혈WBC、CK급CK-MB현저고우정상조(P치분별위0.002,0.039화0.049).MACE조hs-CRP수평현저고우무MACE조(P＜0.01),사망조hs-CRP현저고우MACE조(P＜0.01). hs-CRP승고조화정상조존활화무MACE환자적Kaplan-Meier곡선균유현저분리(시서검험P치분별위0.0042화0.0062).다인소분석현시,hs-CRP수평시MACE(소=1.919,P＜0.05)화사망(RR=3.067,P＜0.05)적독립풍험예측인자.고hs-CRP적노년환자(년령≥65세)발생MACE(RR=2.547,P＜0.01)화사망(RR=4.140,P＜0.01)적풍험교고.결론 입원조기혈청hs-CRP승고시급성STEMI환자수방기발생MACE화사망적독립위험예측인자.대혈청hs-CRP수평화년령연합평개제공료일충사선고위환자적방법.
Objective To assess the predictive value of early determination of high-sensitivity C-reactive protein (hs-CRP) levels at admission in patients with acute ST-elevated myocardial infarction (STEM1). Major ad-verse cardiovascular events (MACE) were angina,re-infarction, cardiac failure and cardiac arrest. Method One hundred and eighty-nine patients with acute STEMI were enrolled in this study. Before intetventional therapy, a peripheral blood sample was collected from the fasting patients within 24 hours after the onset of symptoms for the measurement of serum hs-CRP, white blood cell count (WBCs), creatine kinase (CK), MB iso-enzyme of creatine kinase (CK-MB), blood lipid and blood glucose separately. Meanwhile, color echocardiogram was performed. Pa-tients were divided into two groups according to the serum level of hs-CRP, hs-CRP ＞ 4 mg/L group and hs-CRP= 4 mg/L group. And patients were monitored for the occurrence of MACE. Univariate and multivariate Cox's pro-portional hazard regression analyses were performed to determine the relationship between various potential risk factors alone or in combination and MACE as well as death. Survival curves were plotted by using the Kaplan-Meier method, and the log-rank test and Breslow test were used to compare the survival curves. Results The pa-tients with acute STEM1 were followed-up for a mean of (271.1= 136.7) days doe MACE. The difference in inci-dence of MACE between high and low hs-CRP level groups was obvious (75% vs. 25%, P ＜ 0.01). The meanserum levels of WBCs, CK, and CK-MB in the high hs-CRP level group were higher than those of the low hs-CRPlevel group(P= 0.002,0.039 and 0.049, respectively). The highest serum level of hs-CRP was found in de-ceased patient cohort. The serum level of hs-CRP was higher in patients with MACE compared with those withoutMACE (P ＜ 0.01). Kaplan-Meier plots for overall survivals and MACE-free survivals showed a significant distinctbetween high and low hs-CRP level groups (P= 0.0042 and 0.0062 by log-rank test, respectively). The hs-CRPserum levels were independent risk predictors of MACE (RR= 1.919, P ＜0.05) and death (RR= 3.067, P ＜ 0.05). Patients with high hs-CRP levels and age P 65 years were at higher risk of MACE occurrence (RR=2.547, P ＜ 0.01) and death (RR= 4.140, P ＜ 0.01). Conclusions The serum levels of hs-CRP at admis-sion were independent risk predictors of MACE and death in patients with acute STEMI during the period of follow-up. The evaluation of hs-CRP and age may provide an approach to screening the high-risk patients.
