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目的探讨血清总胆红素(serum total bilirubin,STB)及直接胆红素(serum direct bilirubin,SDB)浓度与急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)术后住院病死率的关系。方法收集南京鼓楼医院427例因急性STEMI入院患者的临床资料,分析STB、SDB与其住院病死率的关系。研究分为死亡组和存活组2组,使用SPSS 20.0统计学软件进行差异性检验、ROC曲线分析、COX比例风险回归分析。结果 PCI术后较高的STB(STB≥19.85μmol/L)、较高的SDB(SDB≥4.65μmol/L)均会增加急性STEMI患者住院期间病死率(分别为:HR=2.38,95%CI:1.05~5.40;HR=3.91,95%CI:1.66~9.17)。校正其他混杂因素(性别、吸烟、饮酒、高血压、糖尿病、卒中、心梗部位等)后,较高的STB及较高的SDB仍然是急性STEMI患者住院期间高病死率的独立危险因素(分别为:HR=2.71,95%CI:1.19~6.16;HR=4.49,95%CI:1.90~10.59)。结论急性STEMI患者PCI术后较高的STB及较高的SDB浓度可显著增加患者的住院病死率。
Objective To investigate the clinical significance of serum total bilirubin (STB) and serum direct bilirubin (SDB) in patients with acute ST-segment elevation myocardial infarction (STEMI) In-hospital mortality after percutaneous coronary intervention (PCI). Methods The clinical data of 427 hospitalized patients with acute STEMI in Nanjing Drum Tower Hospital were collected to analyze the relationship between STB and SDB and their in-hospital mortality. The study was divided into two groups: death group and survival group. SPSS 20.0 statistical software was used to test the difference, ROC curve analysis and COX proportional hazard regression analysis. Results High postoperative STB (STB≥19.85μmol / L) and higher SDB (SDB≥4.65μmol / L) all increased the mortality rate during hospitalization in STEMI patients (HR = 2.38,95% CI : 1.05 ~ 5.40; HR = 3.91, 95% CI: 1.66 ~ 9.17). After adjusting for other confounding factors (gender, smoking, alcohol consumption, hypertension, diabetes, stroke, myocardial infarction, etc.), higher STB and higher SDB were still independent risk factors for high mortality during hospitalization in acute STEMI patients As follows: HR = 2.71, 95% CI: 1.19 ~ 6.16; HR = 4.49, 95% CI: 1.90 ~ 10.59). Conclusion The higher STB and higher SDB concentrations in patients with acute STEMI can significantly increase the in-hospital mortality.