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血红蛋白水平及CAMI-STEMI评分对急性ST段抬高型心肌梗死患者PCI术后预后的预测价值
作者:罗二飞1  鄢高亮2  钱昊1  秦雨涵1  刘钜川1  马长乐1  彭中兴1  汤成春2 
单位:1. 东南大学 医学院, 江苏 南京 210009;
2. 东南大学附属中大医院 心内科, 江苏 南京 210009
关键词:心肌梗死 血红蛋白 CAMI-STEMI评分 预后 
分类号:R541.4
出版年·卷·期(页码):2018·37·第三期(471-476)
摘要:

目的:评价血红蛋白(Hb)水平及中国心肌梗死注册登记研究-ST段抬高型心肌梗死(CAMI-STEMI)评分对STEMI患者经皮冠状动脉介入治疗(PCI)术后预后的预测价值。方法:纳入接受PCI的STEMI患者360例,记录患者的临床特点并计算CAMI-STEMI评分、记录Hb值及其他生化指标、冠脉病变程度、随访期间(30 d、6个月)主要不良心脑血管事件(MACCE)发生情况,根据患者入院第1次Hb值分为3组。结果:3组PCI术后30 d、6个月MACCE发生率均随Hb水平的降低而增高。多因素Cox逐步回归显示,在校正其他因素后,CAMI-STEMI评分是患者术后30 d MACCE发生率的独立预测因子(OR为1.225,95% CI为1.067~1.406,P=0.004);贫血是患者术后6个月MACCE发生率的独立预测因子(OR为2.071,95% CI为1.178~3.461,P=0.011),无糖尿病的患者术后6个月MACCE发生率较低(OR为0.585,95% CI为0.363~0.944,P=0.028)。结论:CAMI-STEMI评分是患者术后30 d MACCE发生率的独立预测因子;贫血是STEMI患者PCI术后6个月MACCE的独立预测因子,且贫血的STEMI患者发生MACCE的风险明显高于正常Hb水平患者;糖尿病是STEMI患者PCI术后6个月MACCE发生率的独立预测因子。

Objective: To evaluate the prognostic value of hemoglobin(Hb) level and the China Acute Myocardial Infarction registry-ST segment elevation myocardial infarction(CAMI-STEMI) score in the prognosis of patients with STEMI after percutaneous coronary intervention(PCI).Methods: This study included 360 patients with STEMI who received PCI. The clinical characteristics of the patients, the CAMI-STEMI score, Hb and other biochemical indicators, severity of coronary artery disease and the incidence of major adverse cardiovascular and cerebral events(MACCE) during the follow-up period(30 days, 6 months) were recorded. The patients were divided into 3 groups according to the first Hb value after hospitalization.Results: The incidence of MACCE in the 3 groups at 30 days and 6 months after PCI increased with the decrease of Hb levels. Multivariate regression analysis showed that the CAMI-STEMI score was an independent predictor of MACCE incidence at 30 days after PCI(OR 1.225,95%CI 1.067-1.406,P=0.004). Anemia was an independent predictor of MACCE incidence at 6 months after PCI(OR 2.071,95%CI 1.178-3.461,P=0.011). The incidence of MACCE in patients without diabetes at 6 months after PCI was lower(OR 0.585,95%CI 0.363-0.944,P=0.028).Conclusion: The CAMI-STEMI score was an independent predictor of MACCE incidence at 30 days after PCI. Anemia was an independent predictor of MACCE in STEMI patients at 6 months after PCI, and the risk of MACCE in STEMI patients with anemia is significantly higher than that in STEMI patients with normal Hb levels. Diabetes is an independent predictor of MACCE in STEMI patients at 6 months after PCI.

参考文献:

[1] 国家卫生计生委合理用药专家委员会,中国药师协会.冠心病合理用药指南[J].中国医学前沿杂志:电子版,2016,8(6):19-108.
[2] 中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2015,43(5):380-393.
[3] 韩雅玲.中国经皮冠状动脉介入治疗指南(2016)解读[J].中国循环杂志,2016,31(z2):5-8.
[4] BOLINSKA S,SOBKOWICZ B,ZANIEWSKA J,et al.The significance of anaemia in patients with acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention[J].Kardiol Pol,2011,69(1),33-39.
[5] al FALLUJI N,LAWRENCE-NELSON J,KOSTIS J B,et al.Effect of anemia on 1-year mortality in patients with acute myocardial infarction[J].Am Heart J,2002,144:636-641.
[6] 孙钊,杨树森,樊瑛,等.贫血对急性心肌梗死患者预后独立预测的价值[J].国际心血管病杂志,2012,39(1):41-43.
[7] SABATINE M S,MORROW D A,GIUGLIANO R P,et al.Association of hemoglobin levels with clinical outcomes in acute coronary syndromes[J].Circulation,2005,111:2042-2049.
[8] YANG J G,LIU H F,XU H Y,et al.Simple risk prediction model to assess hospital mortality in chinese patients with st elevation myocardial infarction based on a machine learning approach:from china acute myocardial infarction (CAMI)[J].Eur Heart J,2017,38(Suppl):1199.
[9] 方唯一,施鸿毓.急性冠状动脉综合征与贫血[J].心肺血管病杂志,2007,26(3):182-184.
[10] LIU Y,YANG Y M,ZHU J,et al.Anaemia and prognosis in acute coronary syndromes:a systematic review and meta-analysis[J].J Int Med Res,2012,40(1):43-55.
[11] YOUNGE J O,NAUTA S T,AKKERHUIS K M,et al.Effect of anemia on short-and long-term outcome in patients hospitalized for acute coronary syndromes[J].Am J Cardiol,2012,109(4):506-510.
[12] LIU C W,LIAO P C,CHEN K C,et al.Baseline hemoglobin levels associated with one-year mortality in ST-segment elevation myocardial infarction patients[J].Acta Cardiol Sin,2016,32(6):656-666.
[13] 王崇慧,金晓峰,方全,等.血红蛋白水平对冠状动脉介入治疗急性ST段抬高心肌梗死患者远期预后的影响[J].中华医学杂志,2011,91(42):3003-3006.
[14] ZHANG E,LI Z,CHE J,et al.Anemia and inflammation in ST-segment elevation myocardial infarction[J].Am J Med Sci,2015,349(6):493-498.
[15] REINECKE H,TREY T,WELLMANN J,et al.Haemoglobin-related mortality in patients undergoing percutaneous coronary interventions[J].Eur Heart J,2003,24:2142-250.
[16] 李全,高阅春,何继强,等.高血红蛋白水平与冠心病患者的不良预后相关分析[J].心肺血管病杂志,2013,32(1):49-52.

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