2023 年第 12 期 第 18 卷

胱抑素C和同型半胱氨酸及载脂蛋白A-1水平与急性心肌梗死患者合并心力衰竭的相关性研究

Correlation of cystatin C, homocysteine and apolipoprotein A-1 levels with heart failure in patients with acute myocardial infarction

作者：田雪邢欣悦李红

英文作者：Tian Xue Xing Xinyue Li Hong

单位：首都医科大学附属北京安贞医院急诊危重症中心，北京100029

英文单位：Emergency and Critical Care Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：急性心肌梗死；胱抑素C；同型半胱氨酸；载脂蛋白A-1；心力衰竭

英文关键词：Acutemyocardialinfarction;CystatinC;Homocysteine;ApolipoproteinA-1;Heartfailure

• 摘要：

• 目的  分析胱抑素C、同型半胱氨酸、载脂蛋白A-1与急性心肌梗死（AMI）患者合并心力衰竭的相关性。方法  选取2020年1月至2021年12月于首都医科大学附属北京安贞医院住院诊治的507例AMI患者的临床资料进行回顾性分析。根据是否合并心力衰竭将患者分为心力衰竭组（285例）及非心力衰竭组（222例）。比较2组患者的临床资料，分析AMI患者合并心力衰竭的危险因素。分析胱抑素C、同型半胱氨酸、载脂蛋白A-1对AMI合并心力衰竭的预测效能。结果  心力衰竭组男性比例、年龄、血肌酐、肌钙蛋白I、N末端B型脑钠肽前体（NT-proBNP）、胱抑素C、同型半胱氨酸水平均高于对照组，急诊经皮冠状动脉介入（PCI）治疗比例、白蛋白、载脂蛋白A-1水平、左心室射血分数（LVEF）均低于对照组，差异均有统计学意义（均P＜0.05）。多因素Logistic回归分析结果显示，年龄增加（比值比=6.524）、未行急诊PCI治疗（比值比=2.473）、LVEF降低（比值比=6.561）、NT-proBNP增高（比值比=1.385）、胱抑素C增高（比值比=3.057）、同型半胱氨酸增高（比值比=1.147）及载脂蛋白A-1降低（比值比=1.142）均为AMI患者合并心力衰竭的独立危险因素（均P＜0.05）。受试者工作特征曲线分析结果显示，胱抑素C、同型半胱氨酸、载脂蛋白A-1联合预测AMI患者合并心力衰竭的曲线下面积为0.819，敏感度为72.4%，特异度为80.5%。结论  胱抑素C、同型半胱氨酸、载脂蛋白A-1是AMI患者合并心力衰竭的独立危险因素，三者联合对预测AMI患者合并心力衰竭具有较好的临床价值。

• Objective To analyze the correlation of cystatin C, homocysteine and apolipoprotein A-1 with heart failure in patients with acute myocardial infarction (AMI). Methods Data of 507 patients with AMI admitted to Beijing Anzhen Hospital, Capital Medical University from January 2020 to December 2021 were retrospectively analyzed. According to the presence or absence of heart failure, the patients were divided into heart failure group (285 cases) and non-heart failure group (222 cases). The clinical data of the two groups were compared, and the risk factors of heart failure in patients with AMI were analyzed. The predictive value of cystatin C, homocysteine and apolipoprotein A-1 in AMI complicated with heart failure was analyzed.Results  The male ratio, age and the levels of serum creatinine, troponin I, N-terminal pro-brain natriuretic peptide (NT-proBNP), cystatin C, homocysteine in the heart failure group were higher than those in the control group; and the proportion of emergency percutaneous coronary intervention (PCI) treatment, the levels of albumin, apolipoprotein A-1 and left ventricular ejection fraction (LVEF) were lower than those in the control group(all P<0.05). Multivariate Logistic regression analysis showed that increase of age ［odds ratio(OR)=6.524］, no emergency PCI (OR=2.473), decrease of LVEF (OR=6.561), increase of NT-proBNP (OR=1.385), increase of cystatin C (OR=3.057), increase of homocysteine (OR=1.147) and decrease of apolipoprotein A-1 (OR=1.142) were independent risk factors for heart failure in patients with AMI (all P<0.05). Receiver operating characteristic curve analysis results showed that the area under the curve of cystatin C, homocysteine and apolipoprotein A-1 combined in predicting heart failure in patients with AMI was 0.819, and the sensitivity and the specificity were 72.4% and 80.5%, respectively. Conclusions  Cystatin C, homocysteine and apolipoprotein A-1 are independent risk factors for heart failure in patients with AMI. The combination of the three has a good clinical value in predicting heart failure in patients with AMI.