中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2014年
1期
75-78
,共4页
陈都%徐峰%陆士奇%陈文静
陳都%徐峰%陸士奇%陳文靜
진도%서봉%륙사기%진문정
心肌梗死%急性心力衰竭%超敏C反应蛋白%前白蛋白%Killip分级%ROC曲线%Logistic回归分析%危险因素
心肌梗死%急性心力衰竭%超敏C反應蛋白%前白蛋白%Killip分級%ROC麯線%Logistic迴歸分析%危險因素
심기경사%급성심력쇠갈%초민C반응단백%전백단백%Killip분급%ROC곡선%Logistic회귀분석%위험인소
Myocardial infarction%Acute heart failure%High sensitive C-reactive protein%Prealbumin%Killip classification%ROC curve%Logistic regression analysis%Risk factor
目的 研究急性心肌梗死患者发病早期血清超敏C反应蛋白(hs-CRP)和前白蛋白(PAB)水平与急性心力衰竭发生及其严重程度的关系.方法 回顾性收集2010年9月至2012年9月间在苏州大学附属第一医院住院并确诊的181例急性心肌梗死患者病历资料,其中114例(63.0％)并发急性心力衰竭归为心力衰竭组并记录其Killip分级,另外67例(37.0％)未并发急性心力衰竭作为对照组.血清hs-CRP (mg/L)和PAB (mg/L)数值为人院次日早晨空腹静脉血样本测得.对血清hs-CRP和PAB等相关临床数据行Logistic回归分析、Spearman相关分析、ROC曲线分析.结果 单因素Logistic回归分析显示心力衰竭组血清hs-CRP水平高于对照组(P=0.000),而PAB水平低于对照组(p=0.000);Spearman相关分析显示心力衰竭组血清hs-CRP、PAB水平和Killip分级之间具有相关性(rhs-CRP=0.234,Phs-CRP=0.003;rPAB=-0.321,PPAB=0.000);多因素Logistic回归分析提示血清hs-CRP(OR 1.086,95％ CI 1.012 ～1.167,P=0.023)、PAB(OR 0.991,95％ CI0.983～0.999,P=0.038)为急性心肌梗死并发急性心力衰竭的独立危险因素;ROC曲线分析得到两者曲线下面积(AUC)分别为:AUChs-CRP=0.722,95％ CI0.651～0.786,AUCpAB=0.723,95％ CI0.652 ～0.787.结论 发病早期血清hs-CRP高或PAB低的急性心肌梗死患者更容易并发急性心力衰竭,两者均为并发急性心力衰竭的独立危险因素,且和心力衰竭的严重程度存在相关性.
目的 研究急性心肌梗死患者髮病早期血清超敏C反應蛋白(hs-CRP)和前白蛋白(PAB)水平與急性心力衰竭髮生及其嚴重程度的關繫.方法 迴顧性收集2010年9月至2012年9月間在囌州大學附屬第一醫院住院併確診的181例急性心肌梗死患者病歷資料,其中114例(63.0％)併髮急性心力衰竭歸為心力衰竭組併記錄其Killip分級,另外67例(37.0％)未併髮急性心力衰竭作為對照組.血清hs-CRP (mg/L)和PAB (mg/L)數值為人院次日早晨空腹靜脈血樣本測得.對血清hs-CRP和PAB等相關臨床數據行Logistic迴歸分析、Spearman相關分析、ROC麯線分析.結果 單因素Logistic迴歸分析顯示心力衰竭組血清hs-CRP水平高于對照組(P=0.000),而PAB水平低于對照組(p=0.000);Spearman相關分析顯示心力衰竭組血清hs-CRP、PAB水平和Killip分級之間具有相關性(rhs-CRP=0.234,Phs-CRP=0.003;rPAB=-0.321,PPAB=0.000);多因素Logistic迴歸分析提示血清hs-CRP(OR 1.086,95％ CI 1.012 ～1.167,P=0.023)、PAB(OR 0.991,95％ CI0.983～0.999,P=0.038)為急性心肌梗死併髮急性心力衰竭的獨立危險因素;ROC麯線分析得到兩者麯線下麵積(AUC)分彆為:AUChs-CRP=0.722,95％ CI0.651～0.786,AUCpAB=0.723,95％ CI0.652 ～0.787.結論 髮病早期血清hs-CRP高或PAB低的急性心肌梗死患者更容易併髮急性心力衰竭,兩者均為併髮急性心力衰竭的獨立危險因素,且和心力衰竭的嚴重程度存在相關性.
목적 연구급성심기경사환자발병조기혈청초민C반응단백(hs-CRP)화전백단백(PAB)수평여급성심력쇠갈발생급기엄중정도적관계.방법 회고성수집2010년9월지2012년9월간재소주대학부속제일의원주원병학진적181례급성심기경사환자병력자료,기중114례(63.0％)병발급성심력쇠갈귀위심력쇠갈조병기록기Killip분급,령외67례(37.0％)미병발급성심력쇠갈작위대조조.혈청hs-CRP (mg/L)화PAB (mg/L)수치위인원차일조신공복정맥혈양본측득.대혈청hs-CRP화PAB등상관림상수거행Logistic회귀분석、Spearman상관분석、ROC곡선분석.결과 단인소Logistic회귀분석현시심력쇠갈조혈청hs-CRP수평고우대조조(P=0.000),이PAB수평저우대조조(p=0.000);Spearman상관분석현시심력쇠갈조혈청hs-CRP、PAB수평화Killip분급지간구유상관성(rhs-CRP=0.234,Phs-CRP=0.003;rPAB=-0.321,PPAB=0.000);다인소Logistic회귀분석제시혈청hs-CRP(OR 1.086,95％ CI 1.012 ～1.167,P=0.023)、PAB(OR 0.991,95％ CI0.983～0.999,P=0.038)위급성심기경사병발급성심력쇠갈적독립위험인소;ROC곡선분석득도량자곡선하면적(AUC)분별위:AUChs-CRP=0.722,95％ CI0.651～0.786,AUCpAB=0.723,95％ CI0.652 ～0.787.결론 발병조기혈청hs-CRP고혹PAB저적급성심기경사환자경용역병발급성심력쇠갈,량자균위병발급성심력쇠갈적독립위험인소,차화심력쇠갈적엄중정도존재상관성.
Objective To investigate the relationship between the serum high sensitive c-reactive protein (hs-CRP) and prealbumin (PAB) and the acute heart failure during the early stage of acute myocardial infarction (MI) patients.Methods A total of 181 MI patients (male:n =154,85.1％ vs.female:n =27,14.9％),admitted between Seppember 2010 and September 2012,were enrolled.They were divided into heart failure group (n =114,63.0％) with Killip classification recorded and control group (n =67,37.0％) without heart failure.The levels of serum hs-CRP and PAB were determined from the venous blood in the followed morning after admission.The clinical data were analyzed by logistic regression,Spearman correlation,and ROC curve.Results The serum level of hs-CRP (mg/L) in the heart failure group was significantly higher than that in the control group (P =0.000),while the serum level of PAB (mg/L) in the heart failure group was significantly lower than that in the control group (P =0.000).High level of hs-CRP and low level of PAB were significantly correlated with Killip classification (rhs-CRP =0.234,Phs-CRP =0.003 ; rPAB =-0.321,PPAB =0.000).Serum hs-CRP (P =0.023,OR 1.086,95％ Cl 1.012-1.167) and PAB (P =0.038,OR O.991,95％ CI O.983-0.999) were the independent risk biomarkers of acute heart failure subsequent to myocardial infarction determined by multivariate logistic regression analysis.The area under the ROC curve:AUChs-CRP =0.722,95％ CI 0.651-0.786; AUCPAB =0.723,95％ CI 0.652-0.787.Conclusions With high level of serum hs-CRP or low level of serum PAB during the early stage of acute myocardial infarction,patients were predisposed to the development of acute heart failure consequently.Both of them are the independent risk biomarkers of acute heart failure subsequent to myocardial infarction.Furthermore,they were significantly correlated with severity of the heart failure in terms of Killip classification.
