血清同型半胱氨酸、胱抑素C、超敏C-反应蛋白水平对急性ST段抬高型心肌梗死患者PCI术后并发心力衰竭的预测价值

doi:10.3969/j.issn.1004-583X.2023.02.004

摘要/Abstract

摘要：

目的探讨血清同型半胱氨酸、胱抑素C、超敏C-反应蛋白水平在预测急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入(PCI)术后心力衰竭(HF)中的应用价值。方法回顾性选取2020年7-12月行PCI术的STEMI患者168例,术后随访1年,依据STEMI患者术后是否发生HF分为两组, HF组92例,非HF组76例, 收集患者临床资料,比较两组各指标的差异,用多因素Logistic回归分析STEMI患者行PCI术后发生HF的危险因素,绘制ROC曲线,分析血清同型半胱氨酸、胱抑素C、超敏C-反应蛋白水平对STEMI患者PCI术后发生HF的预测价值。结果 HF组的年龄、同型半胱氨酸、胱抑素C、超敏C-反应蛋白水平显著高于非HF组,左心室射血分数(LVEF)水平低于非HF组,差异有统计学意义(P<0.05);两组性别、吸烟史、饮酒史、糖尿病史、高血压史、单支血管病变,心率、体质量指数(BMI)、肌钙蛋白T、肌酸激酶同工酶(CK-MB)、甘油三脂、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、尿酸、肌酐差异均无统计学意义(P >0.05)。多因素Logistic回归分析结果显示, 年龄、同型半胱氨酸、胱抑素C、超敏C-反应蛋白是STEMI患者PCI术后发生HF的独立危险因素。ROC曲线分析表明, 血清同型半胱氨酸、胱抑素C、超敏C-反应蛋白预测STEMI患者PCI术后发生HF的AUC分别为0.706、0.698、0.762,特异度分别为0.609、0.641、0.601,敏感度分别为0.724、0.697、0.812, 三者联合预测AUC为0.817, 特异度为0.690, 敏感度为0.868。结论血清同型半胱氨酸、胱抑素C、超敏C-反应蛋白是STEMI患者PCI术后并发HF的危险因素,且三者联合在预测STEMI患者PCI术后并发HF中具有较高的临床价值。

关键词: 急性ST段抬高型心肌梗死, 心力衰竭, 同型半胱氨酸, 胱抑素C, 超敏C-反应蛋白

Abstract:

Objective To investigate the value of serum homocysteine, Cystatin C and high-sensitivity C-reactive protein in predicting heart failure (HF) after percutaneous coronary intervention (PCI) in patients with acute ST-elevation myocardial infarction (STEMI). Methods A total of 168 patients with STEMI who underwent PCI from July 2020 to December 2020 were retrospectively selected as the research objects. They were followed up for 1 year. They were assgined to HF group (n=92) and non-HF group (n=76) according to the presence or absence of HF after PCI. The clinical data of the patients were collected and compared between the two groups were compared. Multivariate logistic regression was used to analyze the risk factors, and ROC curve was drawn to analyze the predictive value of serum homocysteine, Cystatin C and high-sensitivity C-reactive protein for HF after PCI in STEMI patients. Results The age, homocysteine, Cystatin C and high sensitive C-reactive protein levels in HF group were significantly higher than those in non-HF group, while the left ventricular ejection fraction (LVEF)level was significantly lower (P<0.05). There were no significant differences in gender, smoking history, drinking history,diabetes history, hypertension history, single vessel disease, heart rate, body mass index (BMI), troponin T, creatine kinase MB (CK-MB), triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, uric acid and creatinine between the two groups (P >0.05). Multivariate logistic regression analysis showed that age, homocysteine, Cystatin C, and high-sensitivity C-reactive protein were independent risk factors for HF after PCI in STEMI patients. ROC curve analysis showed that the area under the curve (AUC) of serum homocysteine, Cystatin C and hypersensitive C-reactive protein in predicting HF after PCI in STEMI patients was 0.706, 0.698 and 0.762 respectively, with the specificity of 0.609, 0.641 and 0.601 respectively, and the sensitivity of 0.724, 0.697 and 0.812 respectively. AUC of the combined prediction of serum homocysteine, Cystatin C and hypersensitive C-reactive protein was 0.817, with the specificity and sensitivity of 0.690 and 0.868, respectively. Conclusion Serum homocysteine, Cystatin C and high sensitive C-reactive protein are the risk factors of HF after PCI in STEMI patients, and their combination detection has a high clinical value in predicting HF after PCI in STEMI patients.

Key words: ST elevation myocardial infarction, heart failure, homocysteine, cystatin C, high sensitive C-reactive protein

中图分类号:

R542.22

李娜娜, 江珊. 血清同型半胱氨酸、胱抑素C、超敏C-反应蛋白水平对急性ST段抬高型心肌梗死患者PCI术后并发心力衰竭的预测价值[J]. 临床荟萃, 2023, 38(2): 121-125.

Li Nana, Jiang Shan. Predictive values of serum homocysteine, cystatin C and high sensitive C-reactive protein levels on heart failure after percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction[J]. Clinical Focus, 2023, 38(2): 121-125.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.02.004

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I2/121

图/表 4

表1 两组一般资料比较

Tab. 1 Comparison of general data between the two groups

项目	HF组( $n$ =92)	非HF组( $n$ =76)	统计值	$P$ 值
年龄(岁)	72.52±6.97	65.05±6.25	$t$ =7.229	0.000
男性[例(%)]	43(46.7)	40(52.6)	χ²=0.578	0.447
吸烟史[例(%)]	46(50.0)	35(46.1)	χ²=0.260	0.610
饮酒史[例(%)]	27(29.3)	20(26.3)	χ²=0.190	0.663
糖尿病史[例(%)]	21(22.8)	16(21.1)	χ²=0.076	0.782
高血压史[例(%)]	48(52.2)	30(39.5)	χ²=2.699	0.100
单支血管病变[例(%)]	25(27.2)	18(23.7)	χ²=0.266	0.606
心率(次/min)	83.24±13.48	79.45±13.89	$t$ =1.790	0.075
LVEF(%)	47.34±5.78	51.02±6.03	$t$ =-4.038	0.000
BMI(kg/m²)	23.61±1.05	23.40±1.34	$t$ =1.108	0.270

表1 两组一般资料比较

Tab. 1 Comparison of general data between the two groups

项目	HF组( $n$ =92)	非HF组( $n$ =76)	统计值	$P$ 值
年龄(岁)	72.52±6.97	65.05±6.25	$t$ =7.229	0.000
男性[例(%)]	43(46.7)	40(52.6)	χ²=0.578	0.447
吸烟史[例(%)]	46(50.0)	35(46.1)	χ²=0.260	0.610
饮酒史[例(%)]	27(29.3)	20(26.3)	χ²=0.190	0.663
糖尿病史[例(%)]	21(22.8)	16(21.1)	χ²=0.076	0.782
高血压史[例(%)]	48(52.2)	30(39.5)	χ²=2.699	0.100
单支血管病变[例(%)]	25(27.2)	18(23.7)	χ²=0.266	0.606
心率(次/min)	83.24±13.48	79.45±13.89	$t$ =1.790	0.075
LVEF(%)	47.34±5.78	51.02±6.03	$t$ =-4.038	0.000
BMI(kg/m²)	23.61±1.05	23.40±1.34	$t$ =1.108	0.270

表2 两组生化指标比较($\bar{x}±s$)

Tab. 2 Comparison of biochemical index between the two groups

项目	HF组( $n$ =92)	非HF组( $n$ =76)	$t$ 值	$P$ 值
肌钙蛋白T(mg/ml)	6.53±0.48	6.47±0.43	0.812	0.481
肌酸激酶同工酶(U/L)	73.39±15.02	70.97±13.54	1.082	0.281
甘油三脂(mmol/L)	2.71±0.68	2.66±0.59	0.456	0.649
高密度脂蛋白胆固醇(mmol/L)	2.09±0.50	2.18±0.42	-1.285	0.200
低密度脂蛋白胆固醇(mmol/L)	3.38±0.92	3.33±1.06	0.311	0.756
尿酸(μmol/L)	337.00±84.49	318.34±89.30	1.388	0.167
肌酐(μmol/L)	77.06±15.37	72.85±16.11	1.728	0.086
同型半胱氨酸(mmol/L)	21.02±6.84	16.03±6.15	4.921	0.000
胱抑素C(mg/L)	1.73±0.48	1.39±0.42	4.740	0.000
超敏C-反应蛋白(mg/L)	14.42±3.78	10.61±3.60	6.660	0.000

表2 两组生化指标比较($\bar{x}±s$)

Tab. 2 Comparison of biochemical index between the two groups

项目	HF组( $n$ =92)	非HF组( $n$ =76)	$t$ 值	$P$ 值
肌钙蛋白T(mg/ml)	6.53±0.48	6.47±0.43	0.812	0.481
肌酸激酶同工酶(U/L)	73.39±15.02	70.97±13.54	1.082	0.281
甘油三脂(mmol/L)	2.71±0.68	2.66±0.59	0.456	0.649
高密度脂蛋白胆固醇(mmol/L)	2.09±0.50	2.18±0.42	-1.285	0.200
低密度脂蛋白胆固醇(mmol/L)	3.38±0.92	3.33±1.06	0.311	0.756
尿酸(μmol/L)	337.00±84.49	318.34±89.30	1.388	0.167
肌酐(μmol/L)	77.06±15.37	72.85±16.11	1.728	0.086
同型半胱氨酸(mmol/L)	21.02±6.84	16.03±6.15	4.921	0.000
胱抑素C(mg/L)	1.73±0.48	1.39±0.42	4.740	0.000
超敏C-反应蛋白(mg/L)	14.42±3.78	10.61±3.60	6.660	0.000

表3 STEMI患者PCI术后发生HF危险因素分析

Tab. 3 Analysis of HF risk factors after PCI in STEMI patients

变量	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
变量	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
年龄	0.150	0.034	18.976	0.000	1.161	1.086	1.242
LVEF	-0.099	0.037	7.272	0.007	0.906	0.843	0.973
同型半胱氨酸	0.080	0.033	5.909	0.015	1.083	1.016	1.155
胱抑素C	1.062	0.488	4.726	0.020	2.892	1.110	7.533
超敏C-反应蛋白	0.153	0.058	6.949	0.008	1.165	1.040	1.306

表3 STEMI患者PCI术后发生HF危险因素分析

Tab. 3 Analysis of HF risk factors after PCI in STEMI patients

变量	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
变量	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
年龄	0.150	0.034	18.976	0.000	1.161	1.086	1.242
LVEF	-0.099	0.037	7.272	0.007	0.906	0.843	0.973
同型半胱氨酸	0.080	0.033	5.909	0.015	1.083	1.016	1.155
胱抑素C	1.062	0.488	4.726	0.020	2.892	1.110	7.533
超敏C-反应蛋白	0.153	0.058	6.949	0.008	1.165	1.040	1.306

图1 血清同型半胱氨酸、胱抑素C、超敏C-反应蛋白对STEMI患者PCI术后并发HF的预测价值

Fig.1 Predictive value of serum homocysteine、cystatinC、and hypersensitive C-reactive protein for HF after PCI in STEMI patients

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