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目的:探讨低蛋白血症对急性ST段抬高型心肌梗死患者冠脉病变严重程度以及近远期预后的影响。方法:回顾分析我院2014年收治入院的所有急性ST段抬高型心肌梗死(acute ST-segment elevation myocardial infarction,STEMI)患者临床资料,根据纳入与排除标准分为低蛋白血症组(n=64)和正常蛋白组(n=203),分析2组患者的冠脉病变情况,并随访心肌梗死后1年内的死亡率及主要不良心血管事件(major adverse cardiovascular events,MACE)发生率。结果:与正常蛋白组相比,低蛋白血症组患者的年龄偏大,体质指数较低,入院时血压水平偏低,KILLIP心功能分级较高(均P<0.05),冠脉三支血管病变人数比例更高(P=0.010);低蛋白血症组在心肌梗死后1年内全因死亡率及7 d内的MACE发生率明显高于正常蛋白组(P=0.004;P=0.021);2组住院期间出血事件发生率无显著差异(P=0.552);多变量Cox比例风险模型分析结果显示,校正多种混杂因素后,低蛋白血症是STEMI患者1年内全因死亡的独立危险因素(HR=2.610,95%CI=1.165~5.848,P<0.05)。结论:血浆白蛋白水平与STEMI患者的冠脉病变及近远期预后密切相关,低蛋白血症是评估STEMI患者预后的独立危险因素。
Objective: To investigate the effect of hypoproteinemia on the severity of coronary artery disease and its prognosis in patients with acute ST-segment elevation myocardial infarction. Methods: The clinical data of all acute ST-segment elevation myocardial infarction (STEMI) patients admitted to our hospital in 2014 were retrospectively analyzed. According to inclusion and exclusion criteria, they were divided into hypoproteinemia group (n = 64) and normal protein group (n = 203). The coronary lesions were analyzed in two groups. The incidence of major adverse cardiovascular events (MACE) within one year after myocardial infarction was followed up. Results: Compared with normal protein group, patients with hypoalbuminemia were older, lower body mass index, lower blood pressure at admission, higher KILLIP cardiac function (all P <0.05), coronary artery (P = 0.010). The incidence of all-cause mortality within 1 year after myocardial infarction and the MACE within 7 days in hypoproteinemia group were significantly higher than those in normal group (P = 0.004; P = 0.021). There was no significant difference in the incidence of bleeding between the two groups (P = 0.552). Multivariate Cox proportional hazards model analysis showed that hypoalbuminemia was an independent risk factor for all-cause mortality within 1 year in STEMI patients after various confounding factors were corrected (HR = 2.610, 95% CI = 1.165-5.848, P <0.05). Conclusions: Plasma albumin level is closely related to coronary artery disease and short-term and long-term prognosis in STEMI patients. Hypoproteinemia is an independent risk factor for evaluating the prognosis of patients with STEMI.