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目的:评价第二代急性生理学及慢性健康状况(APACHE II)评分、全球急性冠状动脉事件注册(GRACE)风险评分、游离三碘甲状腺原氨酸(FT3)水平和反T3水平对急性心肌梗死(AMI)患者短期内死亡风险的预测价值。方法:入选240例AMI患者,对其进行APACHE II评分、GRACE风险评分,检测其FT3水平和反T3水平。统计患者住院期间病死率,患者出院1个月后电话随访其生存情况。结果:死亡患者的APACHE II评分、GRACE风险评分均高于存活患者(19.7±2.9 vs.14.4±3.0,P<0.01;260±51 vs.209±34,P<0.01),死亡患者与存活患者间的FT3水平、反T3水平差异有统计学意义[(3.6±1.2)pmol/L vs.(4.9±1.5)pmol/L,P<0.01;(1.4±0.3)nmol/L vs.(1.2±0.4)nmol/L,P<0.05]。Cox回归风险比例模型分析:APACHE II评分、GRACE风险评分和FT3水平是AMI患者短期内死亡的影响因素(HR=1.459,95%CI:1.227-1.734,P<0.01;HR=0.997,95%CI:0.987-1.008,P<0.01;HR=0.6,95%CI:0.418-0.862,P<0.01)。APACHE II评分标准偏回归系数大于GRACE评分和FT3水平的标准偏回归系数(1.321,0.611,-0.573)。受试者工作特征曲线(ROC)下面积(AUC)分析:APACHE II评分的AUC大于GRACE风险评分和反T3水平的AUC(0.893,95%CI:0.834-0.952;0.822,95%CI:0.757-0.866;0.681,95%CI:0.590-0.771,P<0.01)。结论:APACHE II评分对AMI患者短期内死亡风险的预测价值高于GRACE风险评分、FT3水平和反T3水平。
PURPOSE: To evaluate the effects of second-generation acute physiology and chronic health status (APACHE II) scores, global acute coronary event registration (GRACE) risk score, free triiodothyronine (FT3) level and anti-T3 level on acute myocardial infarction AMI) predict the short-term risk of death. Methods: A total of 240 patients with AMI were enrolled. APACHE II score and GRACE risk score were scored. The levels of FT3 and anti-T3 were also measured. Statistical patient mortality during hospitalization, patients were discharged from the hospital after a month of follow-up of their survival. Results: APACHE II scores and GRACE risk scores of death patients were significantly higher than those of survivors (19.7 ± 2.9 vs.14.4 ± 3.0, P <0.01; 260 ± 51 vs. 209 ± 34, P <0.01) There were significant differences between the levels of FT3 and anti-T3 [(3.6 ± 1.2) pmol / L vs. (4.9 ± 1.5) pmol / L, P < 0.4) nmol / L, P <0.05]. Cox proportional hazards model analysis: The APACHE II score, the GRACE risk score, and the FT3 level were the risk factors for short-term mortality in AMI patients (HR = 1.459, 95% CI: 1.227-1.734, P <0.01; HR = 0.997, 95% CI : 0.987-1.008, P <0.01; HR = 0.6, 95% CI: 0.418-0.862, P <0.01). APACHE II score standard partial regression coefficient was greater than the standard partial regression coefficients (1.321, 0.611, -0.573) of GRACE score and FT3 level. The area under the receiver operating characteristic curve (ROC) analysis showed that the AUC of the APACHE II score was greater than the GRACE risk score and the AUC of anti-T3 level (0.893, 95% CI: 0.834-0.952; 0.822, 95% CI: 0.757- 0.866; 0.681, 95% CI: 0.590-0.771, P <0.01). CONCLUSIONS: The APACHE II score predicts the short-term mortality risk of AMI patients to be higher than the GRACE risk score, FT3 level and anti-T3 level.