血清前白蛋白水平对心脏重症监护病房急性心力衰竭患者长期预后的影响研究

背景　血清前白蛋白是营养和炎性状态的标志物，血清前白蛋白水平低与冠心病预后不良有关。然而，血清前白蛋白水平对急性心力衰竭（AHF）患者的预后价值尚未确定。目的　探讨入院时血清前白蛋白水平与心脏重症监护病房内AHF患者长期预后之间的关联。方法　回顾性纳入2014年1月-2017年2月在海南省人民医院心脏重症监护病房的AHF患者186例，入院后24 h内检测其血清前白蛋白水平，再进行随访，随访截止日期为2019年2月。根据血清前白蛋白参考值，将患者分为血清前白蛋白>14.0 mg/dl组（119例）和血清前白蛋白≤14.0 mg/dl组（67例），比较两组患者一般资料及全因死亡、复合终点（由AHF发作引起的全因死亡或再入院）发生率，比较两组患者全因死亡和复合终点的生存曲线，分析全因死亡和复合终点的影响因素。结果　血清前白蛋白≤14.0 mg/dl组患者全因死亡、复合终点发生率高于血清前白蛋白>14.0 mg/dl组（P<0.05）。两组患者全因死亡和复合终点的生存曲线比较，差异有统计学意义（P<0.05）。多因素Cox回归分析显示：血清前白蛋白≤14.0 mg/dl与全因死亡和复合终点有关（P=0.002、<0.001）。结论　检测入院时的血清前白蛋白水平可能有助于监护环境下AHF患者的风险分层，且较低的血清前白蛋白水平可能与心脏重症监护病房接受治疗的AHF患者的长期不良预后有关。

Association of Serum Prealbumin Level and Long-term Prognosis in Patients with Acute Heart Failure in the Cardiac Intensive Care Unit

Background　Serum prealbumin is a marker of nutritional and inflammatory status.Low serum prealbumin levels are associated with poor prognosis of coronary heart disease.However，the prognostic value of serum prealbumin levels in patients with acute heart failure （AHF） has not been determined.Objective　To explore the association between serum prealbumin levels at admission and long-term prognosis in patients with AHF in the cardiac intensive care unit.Methods　A retrospective analysis was performed on 186 cases of AHF treated in the Cardiac Intensive Care Unit，Hainan General Hospital from January 2014 to February 2017.By the serum prealbumin level within 24 hours of admission，they were stratified into >14.0 mg/dl（n=119） and≤14.0 mg/dl（n=67） groups，and all received post-discharge follow-up services.The deadline for follow-up was February 2019.The general data and incidence rates of all-cause death and composite endpoints were compared between the two groups.The Kaplan-Meier survival curves of all-cause death and composite endpoints were compared between the two groups.Factors associated with all-cause death and composite endpoints were identified.Results　The incidence rates of all-cause death and composite endpoints in patients with serum prealbumin albumin≤14.0 mg/dl were higher （P<0.05）.There were significant differences in Kaplan-Meier survival curves of all-cause death and composite endpoints between the two groups （P<0.05）.Multivariate Cox regression analysis showed that serum prealbumin≤14.0 mg/dl was associated with all-cause death（P=0.002） and composite endpoints （P<0.001）.Conclusion　Measuring serum prealbumin levels at admission may help to stratify the risk of AHF patients in the acute care setting，and lower serum prealbumin levels may be associated with long-term adverse prognosis.