河北医科大学学报

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GRACE评分对非ST段抬高急性冠状动脉综合征患者院内1型心肾综合征的预测价值

  

  1. 1.河北医科大学第二医院心血管内五科，河北 石家庄 050000；2.河北省保定市第一中心医院心血管内科，河北 保定 071000
  • 出版日期:2017-03-25 发布日期:2017-03-29
  • 作者简介:汪雁博（1983-），女，河北唐山人，河北医科大学第二医院主治医师，医学博士，从事心血管内科疾病诊治研究。
  • 基金资助:
    河北省医学科学研究重点课题（20160118）

The predictive value of GRACE score on type 1 cardiorenal syndrome in patients with nonST segment elevation acute coronary syndrome

  1. 1.The 5th Department of Cardiology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China;
    2.Department of Cardiology, the First Central Hospital of Baoding City, Hebei Province, Baoding 071000, China
  • Online:2017-03-25 Published:2017-03-29

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摘要： ［摘要］〓
〖HTH〗目的〖HTSS〗〖KG*2〗评价全球急性冠状动脉事件注册（the global registry of acute coronary events，GRACE）风险评分对非ST段抬高急性冠状动脉综合征（nonST segment elevation acute coronary syndrome，nonST ACS）患者院内1型心肾综合征（cardiorenal syndrome，CRS）的预测价值。
〖HTH〗方法〖HTSS〗〖KG*2〗最终入选nonST ACS患者151例，根据患者是否发生1型CRS分为CRS组12例和非CRS组139例，根据患者入院辅助检查结果进行GRACE和CRUSADE风险评分。多因素Logistics回归分析1型CRA发生的危险因素。受试者工作特征（receiver operaling characleristics，ROC）曲线评价GRACE风险评分对ACS患者院内1型CRA发生的预测价值。
〖HTH〗结果〖HTSS〗〖KG*2〗CRS组心源性猝死率、急性非ST段抬高性心肌梗死和主要不良心血管事件发生率高于非心源性猝死组，差异有统计学意义（P＜005）。CRS组肌酸激酶、肌酸激酶同工酶、肌钙蛋白I高于非CRS组，差异有统计学意义（P＜005），CRS组GRACE评分、CRUSADE评分、血肌酐、E/e′、 E/A高于非CRS组，CRS组红细胞压积、血红蛋白、左心室射血分数低于非CRS组，差异有统计学意义（P＜005）。多因素Logistic回归分析结果显示，入院时GRACE评分和CRUSADE评分是nonST ACS患者院内发生1型CRS的独立危险因素（P＜005）。ROC 曲线下面积0.906 （95% CI 0.853~0.960，P＜0001）。取最佳截点值为128时，诊断敏感度和特异度分别为91.7%和80.6%。Youden指数为0.744。
〖HTH〗结论〖HTSS〗〖KG*2〗GRACE风险评分是预测nonST ACS患者院内1型CRS的良好指标，具有较高的敏感度和特异度。

关键词: 冠心病, 心肾综合征, 预测

Abstract: ［Abstract］ Objective〖HTSS〗〓To evaluate the predictive effect of the global registry of acute coronary events(GRACE) score on type 1 cardiorenal syndrome(CRS) in patients with nonST segment elevation acute coronary syndrome(nonST ACS).
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓One hundred and fiftyone cases patients were divided to CRS group 12 cases and nonCRS group according to the incidence of type 1 CRS. The baseline clinical characteristics and the procedure of coronary interventions were recorded and compared. The incidence of major adverse events was followed up. Receiver operaling characleristics(ROC) curve was used to identify predict effect of GRACE score on type 1 CRS in patients with nonST ACS.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓More patients with nonST segment elevation myocardial infarction were in the CRS group, and both GRACE and CRUSADE scores were higher in the CRS group(P＜005). The incidence of sudden death before admission was higher(P＜005) and the level of hematokrit was lower(P＜005) in CRS group compared to the nonCRS group. The peak levels of creatine kinase and troponin I were higher in CRS group than those in the nonCRS group, while the levels of left ventricular ejection fraction and E/e′ were lower(P＜005). The level of diastolic blood pressure in CRS group was lower(P＜0.05). Logistic regression analysis showed that the GRACE and CRUSADE scores were indepandent risk factors of type 1 CRS in patients with ACS during the hospitalization(P＜005). The area under the ROC curve for ratio was 0.906(95% CI  0.853-0.960，P＜0001).  At a cutoff point of 128, the value of GRACE score exhibited 91.7% sensitivity and 80.6% specificity for detecting type 1 CRS in patients with nonST ACS.
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓The value of GRACE score could predict type 1 cardiorenal syndrome in nonST ACS patients，with high sensitivity and specificity.

Key words: coronary disease, cardiorenal syndrome, forecasting

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