摘要
目的分析血清胆红素水平对老年急性心肌梗死(AMI)患者经皮冠状动脉介入术(PCI)后发生不良心血管事件的预测效能。方法选取2020年10月-2022年10月辽宁省金秋医院心血管内科收治老年AMI患者425例作为研究对象,PCI术后接受3个月随访,统计随访期间不良心血管事件发生情况,将发生不良心血管事件的患者纳入发生组,未发生不良心血管事件的患者纳入未发生组。PCI前检测血清总胆红素(TBil)、直接胆红素(DBil)、间接胆红素(IBil)水平,分析各指标与老年AMI患者PCI术后发生不良心血管事件的关系,检验血清胆红素水平对老年AMI患者PCI术后发生不良心血管事件的预测价值。结果老年AMI患者425例,PCI术后随访3个月期间不良心血管事件发生率为25.41%(108/425);发生组血清TBil、DBil、IBil水平低于未发生组,差异具有统计学意义(t=4.076、7.498、10.022,P均<0.001)。病变支数多、LDL-C、TBil、DBil、IBil高水平及LVEF低水平为老年AMI患者PCI术后发生不良心血管事件的危险因素[OR(95%CI)=5.188(1.332~20.215)、90.131(10.390~781.871)、1.204(1.070~1.355)、2.422(1.681~3.491)、1.490(1.293~1.716)、1.126(1.068~1.188),HDL-C高及CK-MB、Fib低水平为保护因素[OR(95%CI)=0.003(0.000~0.041)、0.812(0.749~0.879)、0.561(0.403~0.781)];受试者工作特征曲线(ROC)显示,血清TBil、DBil、IBil及三者联合预测老年AMI患者PCI术后不良心血管事件的曲线下面积(AUC)分别为0.601、0.731、0.774、0.796,三项联合的AUC最大(Z=6.451、8.352、11.882,P均<0.001);限制性立方样条分析结果显示,血清TBil、DBil、IBil水平与老年AMI患者PCI术后不良心血管事件的关联强度呈非线性剂量反应关系(r=0.696、0.744、0.837,P均<0.001);决策曲线分析显示,在阈值0.2~0.4范围内,血清TBil、DBil、IBil预测老年AMI患者PCI术后不良心血管事件具有一定价值。结论血清胆红素低表达与老年AMI患者PCI术后发生不良心血管事件有关,且关联强度呈非线性剂量反应关系,检测血清胆红素水平利于预测老年AMI患者PCI术后不良心血管事件发生风险。
Objective To analyze the predictive efficacy of serum bilirubin levels for adverse cardiovascular events after percutaneous coronary intervention(PCI)in elderly patients with acute myocardial infarction(AMI).Methods Four hundred and twenty five elderly AMI patients admitted to the Cardiovascular Department of Jinqiu Hospital in Liaoning Province from October 2020 to October 2022 were selected as the research subjects.All patients received PCI treatment at the hospital and underwent a 3-month follow-up after surgery.The incidence of adverse cardiovascular events during the follow-up period was analyzed,and patients with unconscionable vascular events were included in the occurrence group,while patients without adverse cardiovascular events were included in the nonoccurrence group.Before PCI,serum total bilirubin(TBil),direct bilirubin(DBil),and indirect bilirubin(IBil)levels were measured to analyze the relationship between various indicators and adverse cardiovascular events in elderly AMI patients after PCI.The predictive value of serum bilirubin levels on adverse cardiovascular events in elderly AMI patients after PCI was tested.Results There were 425 elderly AMI patients,and the incidence of adverse cardiovascular events during the 3-month follow-up period after PCI was 25.41%(108/428);The serum TBil,DBil,and IBil levels in the occurrence group were significantly lower than those in the nonoccurrence group(t=4.076,7.498,10.022,P<0.001).High levels of LDL-C,CK-MB,FIB,and low expression of HDL-C,LVEF,TBil,DBil,and IBIl are risk factors for adverse cardiovascular events in elderly AMI patients after PCI[OR(95%CI)=90.131(10.390-781.871),0.003(0.001-0.041),0.812(0.749-0.879),0.561(0.403-0.781),1.126(1.068-1.188),1.204(1.070-1.355),2.422(1.681-3.491),1.490(1.293-1.716)];The receiver operating characteristic curve(ROC)showed that the area under the curve(AUC)of serum TBil,DBil,IBIl,and their combination in predicting adverse cardiovascular events after PCI in elderly AMI patients were 0.601,0.731,0.774,and 0.796,respectively.The AUC of the three combinations was the highest(Z=6.451,8.352,11.882,P<0.001);The results of restricted cubic spline analysis showed that there was a non-linear dose-response relationship between the continuous changes in serum TBil,DBil,and IBil and the adverse cardiovascular events after PCI in elderly AMI patients(r=0.696,0.744,0.837,P<0.001);Decision curve analysis shows that within the threshold range of 0.2 to 0.4,serum TBil,DBil,and IBIl have certain value in predicting adverse cardiovascular events in elderly AMI patients after PCI.Conclusion Low expression of serum bilirubin is associated with adverse cardiovascular events in elderly AMI patients after PCI,and the correlation strength is non-linear dose-response relationship.Detecting serum bilirubin levels is beneficial for predicting the risk of adverse cardiovascular events in elderly AMI patients after PCI.
作者
张家龙
杨杨
盛英杰
Zhang Jialong;Yang Yang;Sheng Yingjie(Liaoning Jinqiu Hospital,Shenyang City,Liaoning Province,Shenyang 110005,China)
出处
《疑难病杂志》
CAS
2023年第8期810-816,共7页
Chinese Journal of Difficult and Complicated Cases
基金
辽宁省青年科学基金资助项目(20210154)。
关键词
心肌梗死
急性
经皮冠状动脉介入术
胆红素
不良心血管事件
决策曲线
老年人
Acute myocardial infarction
Percutaneous coronary intervention
Total bilirubin
Direct bilirubin
Indirect bilirubin
Decision curve
Elderly
