Correlation between serum albumin-globulin ratio and short-term prognosis in patients with chronic heart failure
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摘要: 目的 探索白蛋白及球蛋白比值(AGR)与慢性心力衰竭(心衰)患者近期内发生主要不良心血管事件(MACE)的相关性。方法 选取2021年3月—2022年3月河北省人民医院心血管内科住院的心衰患者362例，随访出院后6个月内是否发生MACE，分为MACE组115例和非MACE组247例。对MACE组与非MACE组临床资料进行统计分析。采用Log Rank检验分析不同AGR分组MACE累积生存率的差异。采用Cox比例风险回归模型分析MACE的风险因素。采用ROC曲线评估AGR对MACE的预测价值。结果 基线资料分析，与非MACE组比较，MACE组AGR水平明显低于非MACE组，差异有统计学意义[1.24(1.09，1.39) vs 1.39(1.23，1.59)，P < 0.001]。AGR与心衰严重程度相关性分析中，整体心衰人群、MACE组及非MACE组分别发现AGR水平随着NHYA心功能分级的增加而降低，差异分别有统计学意义[P < 0.001，P=0.008，P=0.003]。Log Rank检验中，AGR低水平组MACE累积生存率明显低于高水平组(Wald χ2=19.593，PLog Rank < 0.001)。多因素Cox回归分析显示，AGR、尿酸、糖尿病、心房颤动是慢性心力衰竭患者近期MACE的独立预测因素[HR=0.171，95%CI(0.063~0.460)，P < 0.001；HR=1.003，95%CI(1.001~1.004)，P=0.001；HR=1.75，95%CI(1.189~2.575)，P=0.005；HR=1.821，95%CI(1.222~2.715)，P=0.003]。ROC曲线分析中，AGR诊断MACE的ROC曲线下面积为0.681[95%CI(0.623~0.740)，P < 0.001]，灵敏度及特异度分别为60.9%和68.8%。结论 AGR与慢性心衰患者近期预后相关，是慢性心衰近期MACE发生率的独立危险因素，对近期发生MACE有一定的预测价值。Abstract: Objective To investigate the correlation between albumin to globulin ratio(AGR) and recent major adverse cardiovascular events(MACE) in patients with chronic heart failure.Methods A total of 362 patients with heart failure admitted to the Department of Cardiovascular Medicine, Hebei General Hospital from March 2021 to March 2022 were selected to follow up whether they developed MACE within 6 months after discharge. They were divided into two groups, 115 patients in the MACE group and 247 patients in the non-MACE group. The clinical data of MACE group and non-MACE group were analyzed statistically. Log Rank test was used to analyze the difference of MACE cumulative survival in different AGR groups. Cox proportional hazard regression model was used to analyze the risk factors of MACE. The predictive value of AGR to MACE was evaluated by ROC curve.Results Based on baseline data analysis, AGR level in the MACE group was significantly lower than that in the non-MACE group, and the difference was statistically significant[1.24(1.09, 1.39) vs 1.39(1.23, 1.59), P < 0.001]. In the analysis of the correlation between AGR and severity of heart failure, it was found that the level of AGR decreased with the increase of NHYA cardiac function classification in the overall heart failure population, MACE group and non-MACE group, respectively, and the difference was statistically significant(P < 0.001, P=0.008, P=0.003). In Log Rank test, the MACE cumulative survival rate of the low AGR group was significantly lower than that of the high AGR group(Wald χ2=19.593, PLog Rank=P < 0.001). Multi-factor Cox regression analysis showed that AGR, uric acid, Diabetes Mellitus and Atrial Fibrillation were independent predictors of recent MACE in patients with chronic heart failure[HR=0.171, 95%CI(0.063-0.460), P < 0.001; HR=1.003, 95%CI(1.001-1.004), P=0.001; HR=1.75, 95%CI(1.189-2.575), P=0.005; HR=1.821, 95%CI(1.222-2.715), P=0.003]. In ROC curve analysis, the area under ROC curve for AGR diagnosis of MACE was 0.681[95%CI(0.623-0.740), P < 0.001], and the sensitivity and specificity were 60.9% and 68.8%, respectively.Conclusion AGR is associated with the short-term prognosis of patients with chronic heart failure, it is an independent risk factor for the recent incidence of MACE in chronic heart failure and has a certain value in predicting the recent occurrence of MACE.
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Key words:
- heart failure /
- albumin /
- globulin /
- albumin to globulin ratio /
- prognosis
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图 1 MACE组与非MACE组的AGR与NHYA心功能分级的相关性
Figure 1. Correlation between AGR and NHYA class in patients with chronic heart failure
表 1 MACE组与非MACE组临床资料比较
Table 1. Comparison of clinical data between MACE group and non-MACE group
例(%), X±S, M(P25, P75) 项目 整体人群(362例) 非MACE组(247例) MACE组(115例) t/Z/χ2 P 男性 234(64.6) 166(67.2) 68(59.1) 2.239 0.135 年龄/岁 69.78±11.19 68.28±10.82 73.00±11.31 3.808 < 0.001 BMI/(kg/m2) 25.39(22.89，27.92) 25.61(23.00，28.05) 24.80(22.19，27.68) 0.809 0.418 收缩压/mmHg 131(114，152) 132(116，152) 129(112，145) 1.328 0.184 舒张压/mmHg 78(69，88) 79(70，89) 75(66，85) 2.498 0.012 心率/(次/min) 84(70，98) 84(72，98) 81(69，96) 1.415 0.157 NYHA Ⅲ/Ⅳ级 306(84.5) 207(83.8) 99(86.1) 0.312 0.576 冠心病 232(64.1) 152(61.5) 80(69.6) 2.197 0.138 高血压 228(64.1) 149(60.3) 79(68.7) 2.359 0.125 糖尿病 149(41.2) 88(35.6) 61(53.0) 9.827 0.002 心房颤动 136(37.6) 80(32.4) 56(48.7) 8.896 0.003 吸烟史 79(21.8) 46(18.6) 33(28.7) 4.666 0.031 饮酒史 40(11.0) 24(9.7) 16(13.9) 1.406 0.236 袢利尿剂 284(78.5) 198(80.2) 86(74.8) 1.343 0.246 醛固酮受体拮抗剂 291(80.4) 204(82.6) 87(75.7) 2.396 0.122 ACEI/ARB 44(12.2) 29(11.7) 15(13.0) 0.125 0.724 β-受体阻滞剂 255(70.4) 180(72.9) 75(65.2) 2.21 0.137 ANRI 189(52.2) 135(54.7) 54(47.0) 1.864 0.172 SGLT-2抑制剂 77(21.3) 52(21.1) 25(21.7) 0.022 0.882 LVEF/% 44(34，57) 41(34，56) 47(37，59) 2.172 0.030 NT-proBNP/(ng/L) 2 993(1 094，7 792) 2 704(1 123，7 081) 3 799(1 063，8 835) 1.381 0.167 CRP/(mg/L) 6.32(3.27，14.12) 5.39(2.65，12.01) 9.75(4.34，19.29) 3.378 0.001 WBC/(×109/L) 7.16(5.69，9.05) 7.35(5.82，9.01) 6.80(5.40，9.04) 0.953 0.341 Hb/(g/L) 128(113，139) 130(116，141) 122(104，135) 3.537 < 0.001 淋巴细胞计数/(×109/L) 1.36(0.96，1.86) 1.42(1.01，1.87) 1.20(0.89，1.78) 1.625 0.104 总蛋白/(g/L) 64.28±7.06 64.45±6.64 63.90±7.90 0.692 0.489 白蛋白/(g/L) 36.62±4.74 37.36±4.37 35.04±5.13 4.432 < 0.001 总胆红素/(μmol/L) 16.15(12.58，24.53) 16.00(13.10，24.10) 16.60(11.65，25.80) 0.045 0.964 空腹血糖/(mmol/L) 5.77(5.06，7.83) 5.60(5.03，7.46) 6.25(5.15，8.39) 1.685 0.092 TC/(mmol/L) 3.68(3.10，4.44) 3.73(3.16，4.42) 3.54(3.02，4.61) 1.391 0.164 LDL-C /(mmol/L) 2.28(1.81，2.92) 2.31(1.85，2.91) 2.18(1.68，2.91) 1.371 0.170 肌酐/(μmol/L) 85.80(71.10，112.63) 84.20(71.70，109.85) 93.80(69.80，120.50) 1.045 0.296 尿酸/(μmol/L) 400.35(315.30，481.53) 388.40(311.80，473.95) 421.20(329.25，506.25) 2.172 0.030 eGFR/(mL/min/1.73m2) 71.57(53.81，86.06) 72.90(57.74，87.69) 66.88(47.01，82.76) 2.513 0.012 AGR 1.35(1.17，1.53) 1.39(1.23，1.59) 1.24(1.09，1.39) 5.559 < 0.001 注：1 mmHg=0.133 kPa。 
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表 2 CHF患者近期发生MACE的单因素和多因素Cox比例风险回归分析
Table 2. Univariate and multivariate Cox proportional risk regression analysis of recent MACE in CHF patients
项目 单因素Cox分析 多因素Cox分析 P值 HR 95%CI P值 HR 95%CI 性别 0.141 1.322 0.912~1.918 0.264 0.775 0.495~1.212 年龄 < 0.001 1.033 1.016~1.051 0.178 1.013 0.994~1.033 舒张压 0.007 0.983 0.971~0.995 0.112 0.989 0.975~1.003 吸烟史 0.023 1.600 1.068~2.396 0.224 1.364 0.828~2.247 冠心病 0.115 1.377 0.925~2.048 0.695 1.094 0.698~1.713 高血压 0.111 1.378 0.929~2.043 0.172 1.350 0.877~2.079 糖尿病 0.001 1.854 1.285~2.674 0.005 1.750 1.189~2.575 心房颤动 0.003 1.730 1.200~2.495 0.003 1.821 1.222~2.715 eGFR 0.007 0.987 0.978~0.997 0.790 0.999 0.988~1.009 尿酸 0.016 1.568 1.087~2.261 0.001 1.003 1.001~1.004 NT-proBNP 0.055 1.000 1.000~1.000 0.691 1.000 1.000~1.000 CRP 0.002 1.011 1.004~1.018 0.529 1.002 0.995~1.010 白蛋白 < 0.001 0.907 0.872~0.943 0.083 0.955 0.906~1.006 AGR < 0.001 0.100 0.047~0.213 < 0.001 0.171 0.063~0.460 血红蛋白 < 0.001 0.985 0.977~0.993 0.853 0.999 0.990~1.009 LVEF 0.066 1.013 0.999~1.026 0.373 1.007 0.991~1.023
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