高敏C反应蛋白对急性ST段抬高型心肌梗死患者近期预后的预测价值被引量：70

The Predictive Value of High Sensitivity C-Reactive Protein for Short Term Prognosis in Patients With Acute Myocardial Infarction

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摘要目的：评价高敏C反应蛋白（hsCRP）对急性ST段抬高型心肌梗死患者近期预后的预测价值。方法：自2005-10至2007-04连续人选我院冠心病监护病房的204例急性ST段抬高型心肌梗死患者，入院后1～3天测定其hsCRP水平，并记录患者资料、心肌酶学和心肌损伤标志物、心功能指标，绘制受试者工作特性曲线（ROC曲线），确定预测心血管事件发生的最佳阈值。计算阈值的敏感性、特异性、阳性预测值、阴性预测值和准确性。记录住院期间心血管事件发生情况。根据住院期间有无心血管事件（包括心原性死亡、心原性休克、充血性心力衰竭）分为事件组54例，非事件组150例。结果：事件组与非事件组比较，事件组hsCRP、平均年龄、糖尿病比例显著增加（P均〈0．05），左心室射血分数（LVEF）、男性比例、吸烟比例显著降低（P均〈0．05）。在预测心脏事件的指标中hsCRP、肌酸激酶MB同工酶（CK—MB）、肌钙蛋白T、LVEF、左心室舒张末内径（LVEDD）的ROC曲线下面积分别为0．638，0．525，0．536，0．694，0．519，只有hsCRP及LVEF有预测价值。将hsCRP阈值点定为12mg／L时对心脏事件的阳性预测价值为54．3％，阴性预测价值为72．2％，敏感性为46．3％，特异性为86．7％，准确性为75．5％。hsCRP〉12mg／L的患者总心血管事件发生率显著高于hsCRP≤12mg／L的患者（44．4％比18．4％，P〈0．05），差异有统计学意义，而死亡两者则差异无统计学意义。单因素分析可见性别、年龄、糖尿病、吸烟、hsCRP、LVEF与预后相关（P均〈0．05）。多元同归结果显示只有hsCRP、LVEF及年龄、糖尿病是发生心血管事件的独立预测因子（P均〈0．05）。结论：hsCRP可以预测急性ST段抬高型心肌梗死患者的近期预后，特别是心力衰竭和心原性休克的发生。 Objective： To evaluate the predictive value of high sensitivity C-reactive protein （HsCRP） for short term prognosis in patients with acute ST elevation myocardial infarction （STEMI）. Methods ： We summarized 204 consecutive patients with STEMI from October 2005 to April 2007 in our hospital and divided them into two groups according to the occurrence of cardiac events as cardiac death, cardiac shock and heart failure. Event group, n = 54, and Non-event group, n--150. We examined hsCRP 1 N 3 days after the admission in all patients, recorded the cardiac function and other clinical condition, calculated the receiver operative characteristic （ROC） curve, all those informations were studied and compared between two groups. Results： In Event group, the patients＇ hsCRP, mean age and the history of diabetes were higher than those in Non-event group, P 〈 0. 05 respectively. The left ventricular ejection fraction （LVEF）, male gender and smoking ratio were lower in Eventgroup, P 〈 0. 05 respectively. The area under ROC curve of hsCRP and LVEF were 0. 638 and O. 694, which presented the predictive value for cardiac events. The optimal cutoff value of hsCRP was 12mg/L, at that point, the positive predictive rate for cardiac events was 54. 3%, negative rate was 72. 2%, sensitivity was 46. 3%, specificity was 86. 7% and accuracy was 75.5%. The patients with hsCRP 〉 12mg/L had more chance to suffer from cardiac events, P 〈 0. 05. Multi regression logistic analysis in- dicated that hsCRP, age, LVEF, diabetes were the indeoendent risk factors of cardiac events. P 〈 0. 05 resoectivelv. Conclusion： hsCRP could predict the short term prognosis in patients with STEMI, especially for heart failure and cardiac shock.

作者刘蓉杨跃进乔树宾陈纪林陈在嘉高润霖吴元杨伟宪赵冬云

机构地区中国医学科学院北京协和医学院心血管病研究所阜外心血管病医院冠心病诊治中心

出处《中国循环杂志》 CSCD 北大核心 2011年第1期19-22,共4页 Chinese Circulation Journal

关键词急性心肌梗死高敏C反应蛋白预后 Acute myocardial infarction High sensitivity C-reactive protein Prognosis

分类号 R541 [医药卫生—心血管疾病]

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