王辉,刘震宇,张抒扬,沈珠军,范中杰,曾勇,谢洪智,王崇慧,金晓峰,方全,朱文玲

• 1:中国医学科学院 北京协和医学院 北京协和医院心内科

摘要(Abstract)：

目的本研究旨在明确ST段抬高心肌梗死(STEMI)患者成功行直接经皮冠状动脉介入治疗(PCI)后住院期间发生心力衰竭(HF)的预测因素。方法回顾性分析接受直接PCI成功治疗的初发STEMI患者的临床和冠状动脉造影资料,根据住院期间是否发生HF将患者分为HF组和无HF组。确定住院期间HF的发生率、预测因素及其对预后的影响。结果共入选患者834例,男662例(79.4%),年龄(62.9±12.9)岁。其中,HF组94例(11.3%),无HF组740例(88.7%)。HF组的30 d全因死亡率显著高于无HF组(24.5%比1.5%,P<0.001)。Cox回归分析显示,犯罪血管为前降支(HR 2.173,95%CI 1.12~4.212,P=0.022)、ln 24 h N末端B型利钠肽原(NT-proBNP)(HR 1.904,95%CI 1.479~2.452,P<0.001)、24 h超敏C反应蛋白(hsCRP)≥11.0 mg/L(中位数)(HR 2.901,95%CI 1.309~6.430,P=0.009)和基线血糖(HR 1.022,95%CI1.000~1.044,P=0.046)是住院期间发生HF的独立预测因素。受试者工作曲线显示,以24 h NTproBNP≥1171 pg/ml为阈值诊断住院期间HF的敏感性和特异性分别为92.5%和76.8%(c=0.883,P<0.001),以24 h hsCRP≥13.5 mg/L为阈值诊断住院期间HF的敏感性和特异性分别为86.0%和77.0%(c=0.829,P<0.001)。在犯罪血管为前降支的患者中,24 h NT-proBNP<1171 pg/ml且24 h hsCRP<13.5 mg/L的患者住院期间HF的发生率为0.4%,而24 h NT-proBNP≥1171 pg/ml且24 h hsCRP≥13.5 mg/L的患者住院期间HF的发生率为60.9%,两者差异有统计学意义(P<0.001)。结论 STEMI患者即使接受直接PCI成功治疗,其住院期间HF的发生率仍然较高,发生HF者预后差。犯罪血管为前降支、hsCRP、NT-proBNP和基线血糖是住院期间发生HF的独立预测因素。检测并联合应用不同的血清生物标记物是预测STEMI患者直接PCI术后住院期间发生HF的有效方法。

关键词(KeyWords)： 心力衰竭;心肌梗死;血管成形术,经腔,经皮冠状动脉

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 王辉,刘震宇,张抒扬,沈珠军,范中杰,曾勇,谢洪智,王崇慧,金晓峰,方全,朱文玲

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