西藏地区不同血红蛋白水平与院内急性ST段抬高型心肌梗死患者转归分析

Correlation analysis of different hemoglobin levels and outcomes of patients with acute ST-segment elevation myocardial infarction during hospitalization in Tibet

摘要:

目的 探讨西藏高原地区不同血红蛋白（Hb）水平对急性ST段抬高型心肌梗死（STEMI）近期院内主要心脏不良事件（MACE）的影响。方法 回顾性分析2013年10月—2018年10月西藏自治区人民医院高原病心血管内科收治的STEMI患者的临床资料，根据Hb水平分为正常组110例（男性：120 g/L≤Hb≤160 g/L，女性：110 g/L≤Hb≤150 g/L）、较高组69例（男性：160 g/L<Hb<180 g/L，女性：150 g/L<Hb<180 g/L）、极高组121例（Hb≥180 g/L）。对3组近期MACE的发生率进行分析。结果 极高组患者较其他两组年龄偏小，吸烟及饮酒史情况发生率较高（P <0.05），白细胞、尿酸、白蛋白水平较高（P <0.05），低密度脂蛋白、D-二聚体较低（P <0.05）。正常组患者Killip分级中Ⅲ、Ⅳ级发生率较高（P <0.05）。3组患者住院时间及院内MACE发生率差异无统计学意义（P >0.05）。多因素Cox回归显示，中国心肌梗死注册登记研究-ST段抬高型心肌梗死（CAMI-STEMI）评分［R=1.165（95% CI：1.007，1.347），P =0.040］、心肌梗死溶栓治疗临床试验（TIMI）评分［R=0.861（95% CI：0.755，0.980），P =0.024］是患者院内MACE发生率的独立预测因子。结论 高血红蛋白水平与近期院内心血管不良事件无关，其远期心血管风险是否具有相关性需要进一步探讨。CAMI-STEMI评分、TIMI评分是西藏高原地区STEMI患者院内MACE发生率的独立预测因子。

Abstract:

Objective To explore the correlation analysis of different Hb levels in Tibetan plateau region on recent (in-hospital) major adverse cardiovascular events (MACE) of acute ST-segment elevation myocardial infarction (STEMI).Methods Clinical data of STEMI patients admitted to the department of cardiovascular internal medicine of Tibet autonomous region people's hospital from October 2013 to October 2018 were retrospectively analyzed. According to Hb level, they were divided into normal group (110 cases in total, male 120 ≤ Hb ≤160 g/L, female 110 ≤ Hb ≤150 g/L), higher group (69 cases in total, male 160 < HB < 180 g/L, female 150 < HB < 180 g/L), and extremely high group (121 cases in total, male/female Hb ≥180 g/L,). The incidence and correlation of recent MACE in the 3 groups were analyzed.Results Compared with the other two groups, the extremely high group had a higher incidence rate of younger age, smoking, and drinking history (P < 0.05), The levels of leukocyte, uric acid, and albumin were higher (P < 0.05), and the values of low density lipoprotein and D- dimer were lower than those of the other two groups (P < 0.05) and the normal group had a higher incidence rate of grade Ⅲ-Ⅳ in Killip classification (P < 0.05). There was no significant difference in hospital stay and MACEs incidence among the three groups (P > 0.05). Multivariate Cox stepwise regression showed that after adjusting for other factors, CAMI-STEMI score [R = 1.165, (95% CI: 1.007, 1.347), P = 0.040], and TIMI score [R = 0.861, (95% CI: 0.755, 0.980), P = 0.024] were independent predictors of MACE incidence in hospital.Conclusion High hemoglobin level has no correlation with recent (in-hospital) adverse cardiovascular events, and whether long-term cardiovascular risks have correlation needs further discussion. CAMI-STEMI score and TIMI score are independent predictors of MACE incidence in STEMI patients in Tibet plateau.