摘要
目的探究血清心型脂肪酸结合蛋白(heart type fatty acid binding protein,H-FABP)、心肌肌钙蛋白Ⅰ(cardiac troponin Ⅰ,cTnⅠ)浓度结合全球急性冠状动脉事件注册(global registry of acute coronary events,GRACE)危险评分对急性心肌梗死(acute myocardial infarction,AMI)患者预后评估的价值。方法采用回顾性分析,连续入选2016年10月至2019年2月日照市中医医院收治的AMI患者318例,依据随访12个月患者预后结局分为良好组(n=226)和不良组(n=92)。收集所有受试者性别、年龄、体质量指数(body mass index,BMI)、吸烟史、糖尿病、原发性高血压(高血压)、心率、动脉二氧化碳分压(arterial partial pressure of carbon dioxide,PaCO2)、动脉血氧分压(arterial partial pressure of oxygen,PaO2)、肺动脉收缩压(pulmonary artery systolic pressure,PASP)等一般资料及血清标本。记录患者GRACE评分及血清cTnⅠ浓度,采用酶联免疫吸附试验(ELISA)检测血清H-FABP浓度。采用Spearman法分析血清H-FABP浓度、cTnⅠ浓度与GRACE评分的相关性,采用Logistic回归分析分析影响AMI患者不良预后的危险因素,绘制受试者工作特性(receiver operating characteristic,ROC)曲线分析三者对AMI患者不良预后的预测价值。结果与良好组比较,不良组AMI患者心率、血清H-FABP浓度、cTnⅠ浓度及GRACE评分均显著增加,差异有统计学意义(P<0.05)。Spearman分析结果显示,不良预后AMI患者血清H-FABP浓度、cTnⅠ浓度与GRACE评分均呈正相关(r=0.813、0.787,P<0.05)。血清H-FABP浓度、cTnⅠ浓度与GRACE评分高均是影响患者不良预后的独立危险因素(P<0.05)。ROC曲线分析结果显示,三者单独检测预测AMI患者不良预后的曲线下面积(area under the curve,AUC)分别为0.604、0.724、0.849,截断值分别为123.540 pg/mL、1.628μg/L、143.55分,灵敏度分别为52.60%、47.80%、71.70%,特异度分别为100%、100%、95.60%;三者联合检测的AUC为0.915,灵敏度为87.10%,特异度为94.70%,灵敏度显著提高,优于单独检测。结论血清H-FABP浓度、cTnⅠ浓度及GRACE危险评分是AMI患者预后不良的独立危险因素,联合检测可提高对AMI患者不良预后的预测价值,可能对临床应用有一定参考意义。
Objectives To explore the value of serum heart type fatty acid binding protein(H-FABP),cardiac troponinⅠ(cTnⅠ)and the global registry of acute coronary events(GRACE)risk score in the prognosis of patients with acute myocardial infarction(AMI).Methods By retrospective analysis,318 patients with AMI admitted to Rizhao Hospital of Traditional Chinese Medicine from October 2016 to February 2018 were selected successively,according to the 12 months outcome of follow-up,the patients were divided into good outcome group(n=226)and bad outcome group(n=92).The general data of sex,age,body mass index(BMI),smoking history,diabetes mellitus,hypertension,heart rate,arterial partial pressure of carbon dioxide(PaCO2),arterial partial pressure of oxygen(PaO2),pulmonary artery systolic pressure(PASP)and serum samples were collected.The score of GRACE and the serum concentration of cTnⅠ were recorded.The serum concentration of H-FABP was detected by enzyme-linked immunosorbent assay(ELISA).Spearman method was used to analyze the correlation between the serum concentrations of H-FABP,cTnⅠ and GRACE score.Logistic regression analysis was used to analyze the risk factors of adverse prognosis in patients with AMI.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum concentrations of H-FABP,CTn I and GRACE score for the adverse prognosis of AMI patients.Results Compared with good outcome group,the heart rate,serum concentrations of H-FABP,cTnⅠ and GRACE score of AMI patients in bad outcome group increased significantly(P<0.05).Spearman analysis showed that there was a positive correlation between serum concentrations of H-FABP,cTnⅠ and GRACE score in AMI patients with poor prognosis(r=0.813,0.787;P<0.05).The high serum concentration of H-FABP,cTnⅠ and GRACE score were independent risk factors for poor prognosis(P<0.05).ROC curve showed that the areas under the curve(AUC)of predicting the adverse prognosis of AMI patients were 0.604,0.724 and 0.849,respectively;the cutoff values were 123.540 pg/m L,1.628μg/L,143.55 points,respectively;the sensitivities were 52.60%,47.80%,71.70%,respectively;the specificities were 100%,100%,95.60%,respectively.AUC of the three combined tests was 0.915;the sensitivity was 87.10%and the specificity was 94.70%.The sensitivity was significantly improved,which was better than that of the single detection.Conclusions Serum concentrations of H-FABP,cTnⅠ and GRACE risk score are independent risk factors of poor prognosis in patients with AMI,and combined detection can improve the predictive value of a poor prognosis in patients with AMI,which may have some reference significance for clinical application.
作者
张雪梅
丁文文
聂小妹
ZHANG Xue-mei;DING Wen-wen;NIE Xiao-mei(Department of Cardiovascular,Rizhao Hospital of Traditional Chinese Medicine,Rizhao,Shandong 276800,China;Department of Endocrinology,Rheumatology and Nephrology,Wulian County People′s Hospital,Rizhao,Shandong 276800,China)
出处
《岭南心血管病杂志》
CAS
2021年第2期121-126,共6页
South China Journal of Cardiovascular Diseases
基金
济宁医学院教师科研扶持基金(项目编号:JYFC2019FKJ159)。
