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目的:评价高敏C反应蛋白(hs-CRP)及其联合血脂对急性冠脉综合征(ACS)患者长期预后的预测价值。方法:连续入选ACS患者246名,测定其入院时的hs-CRP和肌钙蛋白T(cTnT)水平以及基线的血清总胆固醇、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)等指标。观察住院及随访期间(40±6)个月主要心血管事件的发生情况,据此将患者分为事件组和对照组。根据两组中有显著差异的临床指标,筛选对终点事件有独立预测价值的指标。依据所筛选独立预测指标的不同水平,对患者进行危险分层,观察不同危险组患者的主要心血管事件发生率。所有资料均采用SPSS13.0软件进行分析。结果:完成随访241例,失访率2.0%,其中121例发生心血管事件。事件组和对照组患者的年龄、白细胞计数、hs-CRP、LDL-C/HDL-C和cTnT阳性率均有显著差异(P<0.05),行Logistic回归分析后只有hs-CRP和LDL-C/HDL-C进入回归方程(P<0.01)。分别根据hs-CRP和LDL-C/HDL-C的三分位数对患者进行危险分层,发现随着hs-CRP和LDL-C/HDL-C的升高,患者的心血管事件发生率均呈上升趋势(均P<0.05)。对于LDL-C/HDL-C<2.75的患者,hs-CRP可进一步分层,识别出危险性相对较高者。结论:hs-CRP可以独立预测ACS患者长期再发心血管事件的危险;结合血脂,其危险分层作用更强。
Objective: To evaluate the long-term prognosis of patients with acute coronary syndrome (ACS) with high-sensitivity C-reactive protein (hs-CRP) and its combined lipids. Methods: A total of 246 consecutive patients with ACS were enrolled in this study. The serum levels of hs-CRP and troponin T (cTnT), serum total cholesterol, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol HDL-C) and other indicators. The occurrence of major cardiovascular events during hospitalization and follow-up (40 ± 6 months) were observed. Patients were divided into incident group and control group. Based on the clinically significant differences between the two groups, we screened out the independent predictors of endpoints. Patients were stratified according to the level of independent predictors selected and the prevalence of major cardiovascular events in different risk groups was observed. All data are analyzed using SPSS13.0 software. Results: A total of 241 follow-up visits were completed with a follow-up rate of 2.0%. Among them, 121 had cardiovascular events. There were significant differences in the age, white blood cell count, hs-CRP, LDL-C / HDL-C and cTnT positive rates between the incident group and the control group (P <0.05). Only Logistic regression analysis showed that there were only hs-CRP and LDL-C / HDL-C into the regression equation (P <0.01). Risk stratification of patients based on tertile of hs-CRP and LDL-C / HDL-C, respectively, found that as the hs-CRP and LDL-C / HDL-C increased, the incidence of cardiovascular events All showed an upward trend (all P <0.05). For patients with LDL-C / HDL-C <2.75, hs-CRP may be further stratified to identify those at a higher risk. Conclusion: hs-CRP can independently predict the risk of long-term recurrence of cardiovascular events in patients with ACS. Combined with blood lipids, the role of risk stratification is stronger.