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纤维蛋白原与白蛋白比值对急性ST段抬高型心肌梗死患者梗死相关动脉自发再通的预测价值

[Value of fibrinogen to albumin ratio on predicting spontaneous recanalization of infarct-related artery in patients with acute ST-segment elevation myocardial infarction].

作者信息

Zhao Y P, Ji Y Y, Wang F Y, Wang S L, Lai G K, Wang T, Tang J M

机构信息

Department of Cardiology, Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450014, China.

出版信息

Zhonghua Xin Xue Guan Bing Za Zhi. 2019 Feb 24;47(2):123-128. doi: 10.3760/cma.j.issn.0253-3758.2019.02.009.

Abstract

To investigate the value of fibrinogen to albumin ratio (FAR) at admission on predicting spontaneous recanalization of infarct-related artery (IRA) in patients with acute ST-segment elevation myocardial infarction (STEMI). Clinical data from 255 acute STEMI patients ((61.1±11.2) years old, 189 males) who underwent emergency coronary angiography within 12 hours in our hospital from December 2015 to April 2018 were retrospectively analyzed. The acute STEMI patients were divided into non-spontaneous recanalization group (thrombolysis in myocardial infarction (TIMI) flow grade 0-1, 203 cases) and spontaneous recanalization group (TIMI flow grade 2-3, 52 cases). Multivariate logistic regression analysis was used to evaluate related factors of IRA spontaneous recanalization. The receiver operating characteristic (ROC) curve was used to evaluate the value of FAR in predicting spontaneous coronary recanalization. There was no significant difference in age,gender, hypertension, diabetes, smoking,systolic blood pressure,diastolic blood pressure,heart rate, duration of chest pain, type of infarction, infarct-related artery, door-to-balloon time, and drug used before admission between non-spontaneous recanalization group and spontaneous recanalization group (all 0.05). The FAR and high-sensitivity C-reactive protein levels were significantly lower in the spontaneous recanalization group than in the non-spontaneous recanalization group (8.20±1.85 vs. 11.02±2.75, 0.001; (6.87±3.36) g/L vs. (8.51±3.72) g/L, 0.004). Multivariate logistic regression analysis showed that FAR (0.492, 95 0.354-0.686, 0.001), serum uric acid (0.994, 95 0.989-0.999, 0.018) and high-sensitivity C-reactive protein (0.774, 95 0.614-0.975, 0.030) were independent negative correlation with spontaneous recanalization of infarct-related artery in patients with acute STEMI. The ROC curve showed that the area under the curve of FAR predicting spontaneous recanalization of infarct-related artery in patients with acute STEMI was 0.807 (95 0.630-0.758, 0.001), and the diagnostic threshold was 9.26, the sensitivity was 76.9%, the specificity was 75.9%. The level of admission FAR has certain predictive value for spontaneous recanalization of infarct-related arteries in patients with acute STEMI.

摘要

探讨急性ST段抬高型心肌梗死(STEMI)患者入院时纤维蛋白原与白蛋白比值(FAR)对梗死相关动脉(IRA)自发再通的预测价值。回顾性分析我院2015年12月至2018年4月期间255例急性STEMI患者(年龄(61.1±11.2)岁,男性189例)的临床资料,这些患者均在12小时内接受了急诊冠状动脉造影。将急性STEMI患者分为非自发再通组(心肌梗死溶栓(TIMI)血流分级0 - 1级,203例)和自发再通组(TIMI血流分级2 - 3级,52例)。采用多因素logistic回归分析评估IRA自发再通的相关因素。采用受试者工作特征(ROC)曲线评估FAR对冠状动脉自发再通的预测价值。非自发再通组与自发再通组在年龄、性别、高血压、糖尿病、吸烟、收缩压、舒张压、心率、胸痛持续时间、梗死类型、梗死相关动脉、门球时间及入院前使用药物等方面比较,差异均无统计学意义(均P>0.05)。自发再通组的FAR及高敏C反应蛋白水平显著低于非自发再通组(8.20±1.85 vs. 11.02±2.75,P = 0.001;(6.87±3.36)g/L vs.(8.51±3.72)g/L,P = 0.004)。多因素logistic回归分析显示,FAR(比值比0.492,95%置信区间0.354 - 0.686,P = 0.001)、血清尿酸(比值比0.994,95%置信区间0.989 - 0.999,P = 0.018)和高敏C反应蛋白(比值比0.774,95%置信区间0.614 - 0.975,P = 0.030)与急性STEMI患者梗死相关动脉自发再通呈独立负相关。ROC曲线显示,FAR预测急性STEMI患者梗死相关动脉自发再通的曲线下面积为0.807(95%置信区间0.630 - 0.758,P = 0.001),诊断阈值为9.26,灵敏度为76.9%,特异度为75.9%。入院时FAR水平对急性STEMI患者梗死相关动脉自发再通具有一定的预测价值。

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