摘要
目的 探讨急性心肌梗死合并急性左心衰竭(简称急性左心衰)患者血清铁调素/铁蛋白比值与临床救治效果的关系。方法 将绵阳市中心医院2020年1月至2023年5月收治的303例急性心肌梗死合并急性左心衰患者作为研究对象,根据其治疗1周的临床救治效果分为有效组与无效组,观察两组入院时、治疗1周时血清铁调素、铁蛋白及其比值变化情况,统计并比较两组一般资料及其他实验室指标包括血红蛋白、高敏肌钙蛋白、N端脑利钠肽前体等,通过点二列相关性分析入院时血清铁调素、铁蛋白及其比值与患者临床救治效果的关系,并通过受试者工作特征(ROC)曲线评价入院时血清铁调素、铁蛋白及其比值预测患者救治效果的价值;同时选取2023年5月至2023年10月医院收治的另外68例急性心肌梗死合并急性左心衰患者作为验证对象,通过ROC曲线进一步验证血清铁调素/铁蛋白比值对患者救治效果的预测价值。结果 本研究根据纳入、排除标准共选取308例患者为研究对象,最终303例患者完成救治效果评价,其中有效257例(84.82%)。与有效组比较,无效组入院时、治疗1周时血清铁调素及其与铁蛋白比值均较高,血清铁蛋白水平较低(P<0.05)。与入院时比较,有效组治疗1周时血清铁调素及其与铁蛋白比值均降低,血清铁蛋白水平均升高(P<0.05),但无效组入院时、治疗1周时血清铁调素、铁蛋白及其比值差异无统计学意义(P>0.05)。两组入院时高敏肌钙蛋白、N端脑利钠肽前体、血红蛋白水平比较差异有统计学意义(P<0.05)。点二列相关性发现,患者临床救治效果与入院时血清铁调素水平及其与铁蛋白比值呈正相关(r>0,P<0.05),与入院时血清铁蛋白水平呈负相关(r<0,P<0.05)。ROC曲线发现,入院时血清铁调素、铁蛋白及其比值对患者救治效果均有一定预测价值,且二者比值预测价值更高。加以验证的ROC曲线结果显示,入院时血清铁调素/铁蛋白比值对患者救治效果仍有良好的预测价值。结论 急性心肌梗死合并急性左心衰患者入院时血清铁调素/铁蛋白比值与临床救治效果有关,可辅助临床早期预测患者救治效果,指导救治方案的及时调整。
Objective To explore the relationship between serum hepcidin/ferritin ratio and clinical treatment efficacy in the patients with acute myocardial infarction and acute left heart failure.Methods A total of patients with acute myocardial infarction complicated with acute left heart failure admitted to the Mianyang Central Hospital from January 2020 to May 2023 were divided into effective group and ineffective group according to the clinical treatment efficacy after one-week treatment.The changes of serum hepcidin,ferritin and hepcidin/ferritin ratio of the two groups were observed at admission and after one-week treatment,and the general data and other laboratory indicators including hemoglobin,high-sensitivity troponin,N-terminal pro-brain natriuretic peptide of the two groups were compared statistically.The relationship of serum hepcidin,ferritin and hepcidin/ferritin ratio at admission with the clinical treatment efficacy of patients was analyzed by point-biserial correlation analysis,and the value of serum hepcidin,ferritin and hepcidin/ferritin ratio at admission in predicting the treatment effect of patients was evaluated by receiver operating characteristic(ROC) curves.At the same time,another 68 patients with acute myocardial infarction complicated with acute left heart failure admitted to the hospital from May 2023 to October 2023 were selected as the validation objects.The predictive value of serum hepcidin/ferritin ratio in the treatment effect of patients was further verified through ROC curves.Results According to the inclusion and exclusion criteria,a total of 308 patients were selected as the study subjects in this study.Ultimately,303 patients completed the evaluation of treatment effectiveness,of which 257 patients(84.82%) were effective.The serum hepcidin and hepcidin/ferritin ratio in the ineffective group were higher than those in the effective group at admission and after one-week treatment,and the serum ferritin was lower(P<0.05).Compared with at admission,serum hepcidin and hepcidin/ferritin ratio decreased and serum ferritin level increased in the effective group after one-week treatment(P<0.05).However,there was no statistical significant difference in serum hepcidin,ferritin and hepcidin/ferritin ratio between at admission and after one-week treatment in the ineffective group(P>0.05).There was a statistical significant difference in the levels of high-sensitivity troponin,N-terminal pro-brain natriuretic peptide,and hemoglobin between the two groups at admission(P<0.05).The point-biserial correlation analysis found that the clinical treatment efficacy of patients was positively correlated with the serum hepcidin and hepcidin/ferritin ratio at admission(r>0,P<0.05),and was negatively correlated with the serum ferritin level at admission(r<0,P<0.05).The ROC curve found that serum hepcidin,ferritin,and hepcidin/ferritin ratio at admission had certain predictive value for the treatment effectiveness of patients,and the hepcidin/ferritin ratio had higher predictive value.The validated ROC curve results showed that the serum hepcidin/ferritin ratio at admission still had good predictive value for treatment effectiveness of the patients.Conclusions The serum hepcidin/ferritin ratio at admission in the patients with acute myocardial infarction and acute left heart failure is related to clinical treatment efficacy,which can assist in early prediction of treatment effectiveness and guide timely adjustment of treatment plans.
作者
黄彬
徐秋萍
Huang Bin;Xu Qiuping(Medical Department of Mianyang Central Hospital,Mianyang 621000,China)
出处
《中国急救医学》
CAS
CSCD
2024年第3期200-205,共6页
Chinese Journal of Critical Care Medicine
基金
四川省医院协会医院管理科研专项资金项目(YG2346)。
关键词
铁调素
铁蛋白
急性心肌梗死
急性左心衰竭
相关性
血红蛋白
高敏肌钙蛋白
N端脑利钠肽前体
Hepcidin
Ferritin
Acute myocardial infarction
Acute left heart failure
Correlation
Hemoglobin
High-sensitivity troponin
N-terminal probrain natriuretic peptide
