稳定型冠心病患者血清白蛋白浓度降低与不良心血管事件的关联

Association of low serum albumin concentration and adverse cardiovascular events in stable coronary heart disease.

作者信息

Chien Shih-Chieh, Chen Chun-Yen, Leu Hsin-Bang, Su Cheng-Huang, Yin Wei-Hsian, Tseng Wei-Kung, Wu Yen-Wen, Lin Tsung-Hsien, Chang Kuan-Cheng, Wang Ji-Hung, Wu Chau-Chung, Yeh Hung-I, Chen Jaw-Wen

机构信息

Department of Critical Care Medicine, MacKay Memorial Hospital, Taipei, Taiwan.

Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Mackay Medical College, New Taipei City, Taiwan.

出版信息

Int J Cardiol. 2017 Aug 15;241:1-5. doi: 10.1016/j.ijcard.2017.04.003. Epub 2017 Apr 7.

DOI:10.1016/j.ijcard.2017.04.003

PMID:28413113

Abstract

OBJECTIVE

Coronary heart disease (CHD) is a leading cause of death in developed countries. Exploration of indicators to identify high risk individuals who develop adverse outcomes despite stable baseline condition is important. This study is to evaluate the association between serum albumin concentration and cardiovascular (CV) outcomes in individuals of stable CHD.

METHODS

Seven-hundred-thirty-four participants from Biosignature study, a nationwide prospective cohort study aimed to identity risk factors among patients with stable CHD, were enrolled for analysis. They were divided into low serum albumin group (baseline albumin concentration <3.5g/dL, n=98) and normal albumin group (baseline albumin concentration ≥3.5g/dL, n=636). The relations between baseline albumin and adverse CV outcomes within 18months of follow-up were analyzed.

RESULTS

Compared baseline characteristics with normal albumin group, subjects in low albumin group are older, having more diabetic patients, lower hemoglobin level, lower estimated glomerular filtration rate, lower total cholesterol level, lower left ventricular ejection fraction, and higher blood glucose. While there is no significant difference of total CV events between two groups, low serum albumin concentration is associated with an increased risk of all-cause mortality (10.2% vs. 0.5%, p<0.001) and hard CV events (7.1% vs. 1.4%, p<0.001). The association remains significant after adjustments for confounders (all-cause mortality, HR: 6.81, 95% CI: 1.01-45.62; hard CV events, HR: 3.68, 95% CI: 1.03-13.19).

CONCLUSIONS

Low serum albumin concentration (<3.5g/dL) worsens prognosis of patients with stable CHD.

摘要

目的

冠心病（CHD）是发达国家主要的死亡原因。探索能够识别尽管基线状况稳定但仍会出现不良后果的高危个体的指标非常重要。本研究旨在评估稳定型冠心病患者血清白蛋白浓度与心血管（CV）结局之间的关联。

方法

从生物标志物研究中纳入734名参与者进行分析，该研究是一项全国性的前瞻性队列研究，旨在确定稳定型冠心病患者的危险因素。他们被分为低血清白蛋白组（基线白蛋白浓度<3.5g/dL，n = 98）和正常白蛋白组（基线白蛋白浓度≥3.5g/dL，n = 636）。分析了基线白蛋白与随访18个月内不良CV结局之间的关系。

结果

与正常白蛋白组相比，低白蛋白组的受试者年龄更大，糖尿病患者更多，血红蛋白水平更低，估计肾小球滤过率更低，总胆固醇水平更低，左心室射血分数更低，血糖更高。虽然两组之间的总CV事件无显著差异，但低血清白蛋白浓度与全因死亡率增加（10.2%对0.5%，p<0.001）和严重CV事件增加（7.1%对1.4%，p<0.001）相关。在对混杂因素进行调整后，这种关联仍然显著（全因死亡率，HR：6.81，95%CI：1.01 - 45.62；严重CV事件，HR：3.68，95%CI：1.03 - 13.19）。