CAJ | 학술논문

目的：探讨血清铁水平降低对急性ST段抬高心肌梗死患者发生院内急性心力衰竭的预测价值。方法对287名急性ST段抬高心肌梗死（STEMI）患者资料进行回顾性分析，按整个队列血清铁水平的四分位数将患者分为4组，比较不同血清铁水平组的院内急性心衰发病率；分析血清铁水平与Hb、BNP、cTnI、hsCRP水平等参数间的关系；比较血清铁水平、BNP、cTnI和hsCRP等生物标志物与住院期间急性心衰、心源性休克发病率和死亡率等不良后果的关系。结果全部287名STEMI患者的入院平均血清铁水平是10.20μmol/L（6.90，14.40μmol/L），血清铁水平的四分位数：Q1≤6.90μmol/L，Q26.91~10.19μmol/L，Q310.20~14.39μmol/L，Q4≥14.40μmol/L。从Q1到Q4组，院内急性心力衰竭发病率分别是Q179.5%，Q264.3%，Q350.0%和Q445.9%（P<0.001）；单变量Logistic回归分析结果显示血清铁水平低于8.95μmol/L组患者发生院内急性心衰的危险度（OR）是血清铁高于8.95μmol/L组的近3倍（OR 3.358，95%CI 1.791-6.294，P<0.001），多变量Logistic回归分析结果显示OR 2.316（95%CI 1.205-4.453，P=0.012）。结论血清铁水平降低是STEMI患者院内急性心力衰竭的独立危险因素。
목적：탐토혈청철수평강저대급성ST단태고심기경사환자발생원내급성심력쇠갈적예측개치。방법대287명급성ST단태고심기경사（STEMI）환자자료진행회고성분석，안정개대렬혈청철수평적사분위수장환자분위4조，비교불동혈청철수평조적원내급성심쇠발병솔；분석혈청철수평여Hb、BNP、cTnI、hsCRP수평등삼수간적관계；비교혈청철수평、BNP、cTnI화hsCRP등생물표지물여주원기간급성심쇠、심원성휴극발병솔화사망솔등불량후과적관계。결과전부287명STEMI환자적입원평균혈청철수평시10.20μmol/L（6.90，14.40μmol/L），혈청철수평적사분위수：Q1≤6.90μmol/L，Q26.91~10.19μmol/L，Q310.20~14.39μmol/L，Q4≥14.40μmol/L。종Q1도Q4조，원내급성심력쇠갈발병솔분별시Q179.5%，Q264.3%，Q350.0%화Q445.9%（P<0.001）；단변량Logistic회귀분석결과현시혈청철수평저우8.95μmol/L조환자발생원내급성심쇠적위험도（OR）시혈청철고우8.95μmol/L조적근3배（OR 3.358，95%CI 1.791-6.294，P<0.001），다변량Logistic회귀분석결과현시OR 2.316（95%CI 1.205-4.453，P=0.012）。결론혈청철수평강저시STEMI환자원내급성심력쇠갈적독립위험인소。
Objective To evaluate the predictive value of serum iron level for in-hospital acute heart failure (AHF) after acute ST-elevated myocardial infarction (STEMI). Methods This retrospective study involved 287 patients with STEMI stratified by quartiles of admission serum iron concentration. The incidence of AHF was assessed by serum iron quartiles. We evaluated the association of serum iron levels with B-type natriuretic peptide (BNP), cardiac troponin I (cTnI), and high-sensitivity C-reactive protein (hs-CRP) levels on admission, and analyzed the correlation of serum iron levels with in-hospital AHF, death, and duration of hospital stay. Results The average serum iron level on admission of the 287 STEMI patients was 10.20μmol/L (6.90-14.40μmol/L), and the quartiles (Q) of serum iron levels were≤6.90μmol/L (Q1), 6.91-10.19μmol/L (Q2), 10.20-14.39μmol/L (Q3), and ≥14.40 μmol/L (Q4). The incidences of in-hospital AHF from Q1 to Q4 were 79.5%, 64.3%, 50.0% and 45.9%, respectively (P<0.001). Univariate logistic regression analysis showed that low admission serum iron level (Q1) was an independent predictor for in-hospital AHF (OR=3.358, 95%CI 1.791- 6.294, P<0.001), and multivariate logistic regression analysis showed a similar result (OR=2.316, 95%CI 1.205-4.453, P=0.012). Conclusion A lower admission serum iron level is an independent predictor of AHF in STEMI patients during hospitalization.