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目的 分析血清残余胆固醇（RC）、超敏C反应蛋白（hs-CRP）水平与急性心肌梗死（AMI）患者经皮冠状动脉介入（PCI）治疗后发生心力衰竭的关系；评价RC联合hs-CRP对AMI患者PCI后发生心力衰竭的预测价值。方法 选择接受PCI治疗的AMI患者201例，根据是否并发心力衰竭，分为心力衰竭组（75例）和非心力衰竭组（126例）。收集患者一般资料，包括性别、年龄、病史、冠状动脉多支病变情况、TIMI分级、血压、左心室射血分数（LVEF）、左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）；收集实验室检查结果，包括入院24 h白细胞计数、红细胞计数、血红蛋白浓度、血小板计数、红细胞压积、hs-CRP、N末端脑钠肽前体（NT-proBNP）、空腹血糖、糖化血红蛋白、血尿素氮、血肌酐、肾小球滤过率、胱抑素C、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、载脂蛋白A1、载脂蛋白B、脂蛋白a，并计算RC。分别采用单因素分析和多因素Logistic回归分析RC、hs-CRP与AMI患者PCI后发生心力衰竭的关系。采用受试者工作特征（ROC）曲线分析RC联合hs-CRP对AMI患者PCI后发生心力衰竭的预测效能。结果 与非心力衰竭组相比，心力衰竭组年龄偏大，男性、有糖尿病史者、有饮酒史者及TIMI分级0级者占比较高，LVEDD、LVESD、RC、hs-CRP、NT-proBNP、血尿素氮、胱抑素C、脂蛋白a水平较高，LVEF、红细胞计数、血红蛋白、红细胞压积较低（P均<0.05）；多因素Logistic回归分析显示，LVEF、甘油三酯、hs-CRP、RC是AMI患者PCI后发生心力衰竭的独立影响因素（P均<0.05）。ROC曲线分析显示，RC联合hs-CRP对AMI患者PCI后发生心力衰竭有一定预测价值（ROC曲线下面积为0.718，灵敏度为0.592，特异度为0.613,P<0.05）。结论 高水平的RC、hs-CRP与AMI患者PCI后发生心力衰竭有关，两指标联合检测对AMI患者PCI后发生心力衰竭有一定预测价值。
Abstract：Objective To investigate the associations between serum residual cholesterol(RC) and high-sensitivity C-reactive protein(hs-CRP) levels and the incidence of heart failure in patients with acute myocardial infarction(AMI) following percutaneous coronary intervention(PCI), and to evaluate the predictive value of RC combined with hs-CRP for heart failure in AMI patients after PCI. Methods Totally 201 AMI patients who underwent PCI were enrolled and categorized into the heart failure group(n = 75) and the non-heart failure group(n = 126) based on the presence of concurrent heart failure. General information of patients was collected, including gender, age, medical history, multi-vessel coronary artery disease, TIMI grade, blood pressure, left ventricular ejection fraction(LVEF), left ventricular end-diastolic diameter(LVEDD), and left ventricular end-systolic diameter(LVESD). Laboratory test results were also collected, including white blood cell count, red blood cell count, hemoglobin concentration, platelet count, hematocrit, hs-CRP, N-terminal pro-brain natriuretic peptide(NT-proBNP), fasting blood glucose, glycated hemoglobin, blood urea nitrogen, serum creatinine, glomerular filtration rate, cystatin C, total cholesterol, triglycerides, high-density lipoprotein cholesterol, lowdensity lipoprotein cholesterol, apolipoprotein A1, apolipoprotein B, and lipoprotein a; RC was calculated accordingly.Univariate analysis and multivariate Logistic regression analysis were conducted to explore the relationships between RC, hs-CRP, and the occurrence of heart failure in AMI patients after PCI. The receiver operating characteristic(ROC) curve was utilized to assess the predictive efficacy of RC combined with hs-CRP for heart failure in AMI patients after PCI. Results Compared with the non-heart failure group, the heart failure group was older and exhibited higher proportions of males, individuals with a history of diabetes, alcohol consumption, and TIMI grade 0, and elevated levels of LVEDD, LVESD, RC, hs-CRP, NT-proBNP, blood urea nitrogen, cystatin C, and lipoprotein a, while had lower levels of LVEF, red blood cell count, hemoglobin, and hematocrit(all P<0. 05). Multivariate Logistic regression analysis showed that LVEF, triglycerides, hs-CRP, and RC were independent influencing factors for heart failure in AMI patients after PCI(all P<0. 05). ROC curve analysis demonstrated that RC combined with hs-CRP had a certain predictive value for the occurrence of heart failure in AMI patients after PCI(area under the ROC curve = 0. 718, sensitivity = 0. 592, specificity = 0. 613, P<0. 05). Conclusions Elevated levels of RC and hs-CRP are associated with the incidence of heart failure in AMI patients after PCI. Combined detection of these two indicators holds potential predictive value for heart failure occurrence in this population.
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基本信息:
中图分类号:R542.22;R541.6
引用信息:
[1]李丹妮,郭晨,孙玉宇,等.血清残余胆固醇、超敏C反应蛋白水平与急性心肌梗死患者PCI后心力衰竭的关系[J].山东医药,2025,65(06):1-6.
基金信息:
陕西省自然科学基础研究计划项目（2024JC-YBQN-0791）; 陕西省重点研发计划项目（2024SF2-GJHX-12）