动脉血乳酸水平在心血管急症患者风险评估及预后判断中的价值

目的探讨动脉血乳酸水平在心血管急症(急性心肌梗死、急性主动脉夹层A型、急性肺栓塞)患者风险评估及预后判断中的价值。方法回顾性分析上海交通大学附属第六人民医院109例住院期间确诊的心血管急症患者的相关临床资料。根据入院时动脉血乳酸水平分为升高组和正常组,分析两组患者临床特征、生化及血气分析参数、住院期间病死率及随访1年生存情况。结果两组患者性别、年龄、高血压、2型糖尿病和吸烟者比例、肌酐、肌钙蛋白-I、白细胞计数差异无统计学意义(P>0.05)。与正常组比较,升高组心率增快、收缩压降低,血糖水平、B型钠尿肽、C反应蛋白水平升高,HCO3-水平降低(P<0.05),住院期间病死率及随访1年病死率升高(P<0.05)。多因素Logistic回归分析显示,入院后24 h内动脉血乳酸水平升高是心血管急症患者随访1年后死亡的独立危险因素(OR=1.451,95%CI:1.086~1.939,P=0.012)。受试者工作特征曲线分析结果显示,动脉血乳酸水平预测住院期间死亡的曲线下面积(AUC)为0.829(95%CI:0.714~0.944,P<0.001),最佳截断值为6.5 mmol/L,灵敏度为80.0%,特异度为96.0%;预测随访1年后死亡的AUC为0.759(95%CI:0.662~0.856,P<0.001),最佳截断值为3.2 mmol/L,灵敏度为56.0%,特异度为89.0%。结论动脉血乳酸水平可作为心血管急症患者风险评估及预后判断的重要指标。

Value of lactate in assessment of risk and prognosis in patients with acute cardiovascular disease

Objective To explore the value of lactate in assessment of risk and prognosis in patients with acute cardiovascular disease(acute myocardial infarction,acute aortic dissection-type A,acute pulmonary embolism).Methods A retrospective analysis was made on 109 patients with acute cardiovascular disease.All subjects were divided into increased group and normal group according to the level of lactate.Both baseline clinical characteristics,biochemical indexes,main artery blood-gas analysis and the mortality rate during hospitalization and one-year follow-up were analyzed.Results There were no significant differences in ratio of gender,hypertension,type 2 diabetes and smoking,average age,creatinine,troponin-I and leukocyte between the two groups(P>0.05).Compared with the normal group,patients in the increased group had higher average heart rate,lower systolic pressure,higher blood glucose,B-type natriuretic peptide and C-reactive protein levels,lower HCO3-values(P<0.05),as well as higher mortality during both hospitalization and one-year follow-up(P<0.05).Multivariate Logistic analysis showed that the higher lactate value within 24 hours after admission was an independent risk factor for the death after one-year follow-up(OR=1.451,95%CI:1.086-1.939,P=0.012).The results showed that the area under the receiver operating characteristic curve(AUC)was 0.829(95%CI:0.714-0.944,P<0.001),for predicting the in-hospital mortality,the optimal cut-off value was 6.5 mmol/L,the sensitivity was 80.0%,and the specificity was 96.0%.AUC of lactate for predicting the death after one-year follow-up was 0.759(95%CI:0.662-0.856,P<0.001),the optimal cut-off value was 3.2 mmol/L,the sensitivity was 56.0%,and the specificity was 89.0%.Conclusion The level of lactate could be used as an important index of risk assessment and prognosis evaluation in patients with acute cardiovascular disease.