急性ST段抬高型心肌梗死患者入院血清白蛋白水平与梗死相关动脉自发再通的关系
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摘要
目的:探讨急性ST段抬高型心肌梗死(STEMI)患者入院血清白蛋白水平与梗死相关动脉自发再通的关系。方法:选取确诊为STEMI并在12 h内急诊行冠状动脉造影的患者212例。根据梗死相关动脉是否自发再通将患者分为非自发再通组(NSR组,n=153)和自发再通组(SR组,n=59)。采用logistic回归筛选梗死相关动脉自发再通的影响因素,采用ROC曲线评价入院血清白蛋白水平预测梗死相关动脉自发再通的价值。结果:SR组患者入院血清白蛋白水平高于NSR组(P<0.001)。Logistic回归分析结果显示,入院血清白蛋白水平(OR=1.241,95%CI=1.160~1.328)和高敏C反应蛋白(hs-CRP)水平(OR=0.730,95%CI=0.534~0.996)均是STEMI患者梗死相关动脉自发再通的独立影响因素。ROC曲线分析结果显示,入院血清白蛋白水平预测梗死相关动脉自发再通的曲线下面积为0.832(95%CI=0.774~0.879,P<0.001),截断值为40.48 g/L时,敏感度为84.7%,特异度为68.6%。结论:入院血清白蛋白水平是STEMI患者梗死相关动脉自发再通的独立预测因素。
Aim:To investigate the relationship between admission serum albumin level and spontaneous recanalization of infarct-related arteries in patients with acute ST segment elevation myocardial infarction(STEMI).Methods:A total of212 patients who were diagnosed as STEMI and underwent emergent coronary angiography within 12 hours were selected,and allocated into non-spontaneous recanalization group(NSR group,n=153) and spontaneous recanalization group(SR group,n=59) according to spontaneous recanalization of infarct-related arteries.Logistic regression analysis was used to screen the predictors of spontaneous recanalization,and ROC curve was used to evaluate the value of admission serum albumin level for predicting spontaneous coronary recanalization.Results:Admission serum albumin level in the SR group was significantly higher than that in the NSR group(P<0.001).Logistic regression analysis showed that admission serum albumin level(OR=1.241,95% CI=1.160-1.328) and hs-CRP(OR=0.730,95% CI=0.534-0.996) were independent predictors of spontaneous recanalization of infarct-related arteries in STEMI patients.ROC curve results showed that the area under ROC curve of admission serum albumin level predicting spontaneous recanalization of infarct-related arteries was0.832(95% CI=0.774-0.879,P<0.001);when the cut-off value was 40.48 g/L,the sensitivity was 84.7%,and the specificity was 68.6%.Conclusion:Admission serum albumin level is an independent predictor of spontaneous recanalization of infarct-related arteries in patients with STEMI.
Aim:To investigate the relationship between admission serum albumin level and spontaneous recanalization of infarct-related arteries in patients with acute ST segment elevation myocardial infarction(STEMI).Methods:A total of212 patients who were diagnosed as STEMI and underwent emergent coronary angiography within 12 hours were selected,and allocated into non-spontaneous recanalization group(NSR group,n=153) and spontaneous recanalization group(SR group,n=59) according to spontaneous recanalization of infarct-related arteries.Logistic regression analysis was used to screen the predictors of spontaneous recanalization,and ROC curve was used to evaluate the value of admission serum albumin level for predicting spontaneous coronary recanalization.Results:Admission serum albumin level in the SR group was significantly higher than that in the NSR group(P<0.001).Logistic regression analysis showed that admission serum albumin level(OR=1.241,95% CI=1.160-1.328) and hs-CRP(OR=0.730,95% CI=0.534-0.996) were independent predictors of spontaneous recanalization of infarct-related arteries in STEMI patients.ROC curve results showed that the area under ROC curve of admission serum albumin level predicting spontaneous recanalization of infarct-related arteries was0.832(95% CI=0.774-0.879,P<0.001);when the cut-off value was 40.48 g/L,the sensitivity was 84.7%,and the specificity was 68.6%.Conclusion:Admission serum albumin level is an independent predictor of spontaneous recanalization of infarct-related arteries in patients with STEMI.
引文
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[11]KURTUL A,MURAT SN,YARLIOGLUES M,et al.Usefulness of serum albumin concentration to predict high coronary SYNTAX score and in-hospital mortality in patients with acute coronary syndrome[J].Angiology,2016,67(1):34
[12]王瑞钰,张清,沈健,等.低蛋白血症与急性ST段抬高型心肌梗死患者冠脉病变及预后的相关性研究[J].重庆医科大学学报,2017(2):225
[13]GARCIA-MARTINEZ R,CARACENI P,BERNARDI M,et al.Albumin:pathophysiologic basis of its role in the treatment of cirrhosis and its complications[J].Hepatology,2013,58(5):1836
[14]NALDI M,BALDASSARRE M,DOMENICALI MA,et al.Structural and functional integrity of human serum albumin:analytical approaches and clinical relevance in patients with liver cirrhosis[J].J Pharm Biomed Anal,2017,144(SI):138
[15]FOERSTERMANN U,XIA N,LI HG.Roles of vascular oxidative stress and nitric oxide in the pathogenesis of atherosclerosis[J].Circ Res,2017,120(4):713
[16]DE SAIN-VAN DER VELDEN MGM,SMOLDERS HC,VAN RIJN HJM,et al.Does albumin play a role in fibrinolysis by its inhibition of plasminogen activation?[J].Fibrinol Proteol,2000,14(4):242
[17]SANKARANARAYANAN S,DE LA LLERA-MOYA MA,PHILLIPS MC,et al.Serum albumin acts as a shuttle to enhance cholesterol efflux from cells[J].J Lipid Res,2013,54(3):671
[18]NICHOLSON JP,WOLMARANS MR,PARK GR.The role of albumin in critical illness[J].Br J Anaesth,2000,85(4):599
[19]BRENER SJ,MEHRAN R,BRODIE BR,et al.Predictors and implications of coronary infarct artery patency at initial angiography in patients with acute myocardial infarction(from the CADILLAC and HORIZONS-AMI Trials)[J].Am J Cardiol,2011,108(7):918
[2]LI XM,LI BY,GAO J,et al.Influence of angiographic spontaneous coronary reperfusion on long-term prognosis in patients with ST-segment elevation myocardial infarction[J].Oncotarget,2017,8(45):79767
[3]PLAKHT Y,GILUTZ H,SHIYOVICH A.Decreased admission serum albumin level is an independent predictor of long-term mortality in hospital survivors of acute myocardial infarction.Soroka Acute Myocardial InfarctionⅡ(SAMI-Ⅱ)project[J].Int J Cardiol,2016,219:20
[4]WADA H,DOHI T,MIYAUCHI K,et al.Impact of serum albumin levels on long-term outcomes in patients undergoing percutaneous coronary intervention[J].Heart Vessels,2017,32(9):1085
[5]CELIK IE,YARLIOGLUES M,KURTUL A,et al.Preprocedural albumin levels and risk of in-stent restenosis after coronary stenting with bare-metal stent[J].Angiology,2016,67(5):478
[6]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
[7]宋雅信,赵晓燕,王小芳,等.中性粒细胞-淋巴细胞比值及D-二聚体与急性冠脉综合征冠脉狭窄程度的关系[J].郑州大学学报(医学版),2016,51(6):780
[8]LEE CW,HONG MK,LEE JH,et al.Determinants and prognostic significance of spontaneous coronary recanalization in acute myocardial infarction[J].Am J Cardiol,2001,87(8):951
[9]QUINLAN GJ,MARTIN GS,EVANS TW.Albumin:biochemical properties and therapeutic potential[J].Hepatology,2005,41(6):1211
[10]GONZLEZ-PACHECO H,AMEZCUA-GUERRA LM,SANDOVAL J,et al.Prognostic implications of serum albumin levels in patients with acute coronary syndromes[J].Am J Cardiol,2017,119(7):951
[11]KURTUL A,MURAT SN,YARLIOGLUES M,et al.Usefulness of serum albumin concentration to predict high coronary SYNTAX score and in-hospital mortality in patients with acute coronary syndrome[J].Angiology,2016,67(1):34
[12]王瑞钰,张清,沈健,等.低蛋白血症与急性ST段抬高型心肌梗死患者冠脉病变及预后的相关性研究[J].重庆医科大学学报,2017(2):225
[13]GARCIA-MARTINEZ R,CARACENI P,BERNARDI M,et al.Albumin:pathophysiologic basis of its role in the treatment of cirrhosis and its complications[J].Hepatology,2013,58(5):1836
[14]NALDI M,BALDASSARRE M,DOMENICALI MA,et al.Structural and functional integrity of human serum albumin:analytical approaches and clinical relevance in patients with liver cirrhosis[J].J Pharm Biomed Anal,2017,144(SI):138
[15]FOERSTERMANN U,XIA N,LI HG.Roles of vascular oxidative stress and nitric oxide in the pathogenesis of atherosclerosis[J].Circ Res,2017,120(4):713
[16]DE SAIN-VAN DER VELDEN MGM,SMOLDERS HC,VAN RIJN HJM,et al.Does albumin play a role in fibrinolysis by its inhibition of plasminogen activation?[J].Fibrinol Proteol,2000,14(4):242
[17]SANKARANARAYANAN S,DE LA LLERA-MOYA MA,PHILLIPS MC,et al.Serum albumin acts as a shuttle to enhance cholesterol efflux from cells[J].J Lipid Res,2013,54(3):671
[18]NICHOLSON JP,WOLMARANS MR,PARK GR.The role of albumin in critical illness[J].Br J Anaesth,2000,85(4):599
[19]BRENER SJ,MEHRAN R,BRODIE BR,et al.Predictors and implications of coronary infarct artery patency at initial angiography in patients with acute myocardial infarction(from the CADILLAC and HORIZONS-AMI Trials)[J].Am J Cardiol,2011,108(7):918