2023 年第 2 期 第 18 卷

全球急性冠状动脉事件注册评分联合血清可溶性白细胞介素6受体水平对急性心肌梗死患者术后主要不良心血管事件发生风险的预测价值

The value of global registry of acute coronary events score combined with serum soluble interleukin-6 receptor level in predicting postoperative major adverse cardiovascular events in patients with acute myocardial infarction

作者：黄舒洁1洪达2林圣美3

英文作者：Huang Shujie1 Hong Da2 Lin Shengmei3

单位：1福建省立医院心血管内科，福州350001；2福建省立医院全科医学科，福州350001；3福建省立医院放射科，福州350001

英文单位：1Department of Cardiovascular Medicine Fujian Provincial Hospital Fuzhou 350001 China; 2Department of General Medicine Fujian Provincial Hospital Fuzhou 350001 China; 3Department of Radiology Fujian Provincial Hospital Fuzhou 350001 China

关键词：急性心肌梗死；全球急性冠状动脉事件注册评分；可溶性白细胞介素6受体；主要不良心血管事件

英文关键词：Acutemyocardialinfarction;Globalregistryofacutecoronaryeventsscore;Solubleinterleukin-6receptor;Majoradversecardiovascularevents

• 摘要：

• 目的 探讨全球急性冠状动脉事件注册（GRACE）评分联合血清可溶性白细胞介素6受体（sIL-6R）水平对急性心肌梗死（AMI）患者术后主要不良心血管事件（MACE）发生风险的预测价值。方法 选取2020年6月至2021年6月福建省立医院收治的116例行经皮冠状动脉介入治疗的AMI患者，根据术后6个月内是否发生MACE分为MACE组和无MACE组。入院后进行GRACE评分，采用酶联免疫吸附试验法检测患者血清sIL-6R水平，比较2个指标和一般资料的组间差异，分析GRACE评分联合sIL-6R水平对AMI患者术后MACE发生风险的预测价值。结果 无MACE组纳入81例患者，MACE组纳入35例患者。MACE组患者心率、心力衰竭病史比例均高于无MACE组，舒张压、收缩压均低于无MACE组（均P＜0.05）。MACE组患者GRACE评分和血清sIL-6R水平均高于无MACE组（均P＜0.001）。多因素Logistic回归分析结果显示，GRACE评分≥138分（比值比=2.843，95%置信区间：1.498～5.397）、血清sIL-6R水平≥439.56 kU/L（比值比=3.121，95%置信区间：1.373～7.094）是AMI患者术后发生MACE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，GRACE评分和血清sIL-6R水平联合预测AMI患者术后MACE发生风险的曲线下面积为0.861（95%置信区间：0.823～0.889），敏感度和特异度分别为83.54%和76.22%。结论 AMI术后发生MACE患者GRACE评分和血清sIL-6R水平升高，二者联合对AMI术后MACE发生风险具有较好预测价值。

• Objective To explore the value of global registry of acute coronary events(GRACE) score combined with soluble interleukin-6 receptor(sIL-6R) level in predicting postoperative major adverse cardiovascular events(MACE) in patients with acute myocardial infarction(AMI). Methods  Totally 116 patients with AMI undergoing percutaneous coronary intervention in Fujian Provincial Hospital from June 2020 to June 2021 were selected. They were divided into MACE group and non-MACE group according to the occurrence of MACE 6 months after treatment. GRACE score was performed after admission, and serum sIL-6R level was detected by enzyme-linked immunosorbent assay. The differences were compared between the two groups in GRACE score, serum sIL-6R level and general data. The predictive value of GRACE score combined with sIL-6R level in the occurrence of MACE in patients with AMI after surgery was analyzed. Results  The non-MACE group had 81 patients and the MACE group had 35 patients. The heart rate and the rate of heart failure history in the MACE group were higher than those in the non-MACE group, and the systolic blood pressure and diastolic blood pressure were lower than those in the non-MACE group(all P<0.05). The GRACE score and serum sIL-6R level in the MACE group were higher than those in the non-MACE group(both P<0.001). Multivariate Logistic regression analysis showed that the GRACE score ≥138(odds ratio=2.843, 95% confidence interval: 1.498-5.397), and the serum sIL-6R level ≥439.56 kU/L(odds ratio=3.121, 95% confidence interval: 1.373-7.094) were independent risk factors for postoperative MACE in patients with AMI(both P<0.05). The receiver operating characteristic curve showed that the area under the curve of the combination of GRACE score and serum sIL-6R level was 0.861(95% confidence interval: 0.823-0.889) in predicting postoperative MACE in patients with AMI, and sensitivity and specificity were 83.54% and 76.22%, respectively. Conclusions  The GRACE score and serum sIL-6R level increase in AMI patients with postoperative MACE. Those have good predictive value in the occurrence of MACE after AMI operation.