【摘要】 目的 探索红细胞分布宽度(RDW)和游离三碘甲状原氨酸(fT3)对女性急性ST段抬高型心肌梗死(STEMI)合并糖尿病患者长期随访主要不良心血管事件(MACE)的预测价值。方法 选取2017年6月至2019年12月于郑州大学附属洛阳中心医院住院的女性初发STEMI合并糖尿病患者259例，并进行(31.81±9.02)月的随访，根据MACE发生情况，分为MACE组(59例)和无MACE组(200例)，采用Cox回归法分析MACE的影响因素，绘制受试者工作特征曲线(ROC)评价RDW和fT3对MACE的预测价值，采用Kaplan-Meier曲线分析无MACE累积生存率。结果 MACE组前壁心肌梗死占比、术后TIMI≤1级占比、RDW高于无MACE组，fT3低于无MACE组(P<0.05)。多因素Cox回归分析显示，高RDW(HR=1.337，95%CI：1.092～1.636，P=0.005)和低fT3(HR=-0.615，95%CI：0.411～0.712，P<0.001)是女性STEMI合并糖尿病发生MACE的独立危险因素(P<0.05)。ROC曲线结果显示，RDW和fT3预测MACE的ROC曲线下面积(AUC)分别为0.693、0.714，RDW联合fT3有更好的预测价值(AUC=0.785，95%CI：0.725～0.844，灵敏度为79.7%，特异度为67.0%)。高RDW且低fT3组患者MACE发生率高于其他三组，Log-Rank检验(χ~2=34.924，P<0.05)。结论 高RDW、低fT3对女性初发STEMI合并糖尿病患者的长期预后具有一定预测价值，高RDW及低fT3患者MACE发生率较高。更多还原

【Abstract】 Objective This study was designed to explore the value of red blood cell distribution width (RDW) and free triiodothyronine (fT3) on predicting long-term major adverse cardiac event (MACE) in female initial acute ST-segment elevation myocardial infarction (STEMI) patients with diabetes mellitus.Methods A total of 259 female patients with initial STEMI combined with diabetes who were hospitalized at the Luoyang Central Hospital affiliated with Zhengzhou University from June 2017 to December 2019 were selected for a follow-up of (31.81±9.02) months.Based on the occurrence of Major Adverse Cardiac Events (MACE),they were divided into the MACE group (59 cases) and the non-MACE group (200 cases).The COX regression method was used to analyze the influencing factors of MACE,and the Receiver Operating Characteristic (ROC) curve was constructed to evaluate the predictive value of RDW and fT3 for MACE.The Kaplan-Meier curve was used to analyze the cumulative survival rate without MACE.Results In the MACE group,the proportion of anterior wall myocardial infarction,the proportion of postoperative TIMI≤1,and higher RDW were higher than in the non-MACE group,while fT3 was lower than in the non-MACE group (P<0.05).Multifactorial Cox regression analysis showed that high RDW (HR=1.337,95%CI:1.092～1.636,P=0.005) and low fT3 (HR=～0.615,95%CI:0.411～0.712,P<0.001) are independent risk factors for MACE in female STEMI patients with diabetes (P<0.05).The ROC curve results showed that the area under the ROC curve (AUC) for predicting MACE was 0.693 for RDW and 0.714 for fT3,with the combination of RDW and fT3 showing better predictive value (AUC=0.785,95%CI:0.725～0.844,sensitivity=79.7%,specificity=67.0%).The incidence of MACE in patients with high RDW and low fT3 was higher than in the other three groups,with the Log-Rank test (χ~2=34.924,P<0.05).Conclusion High RDW and low fT3 have a certain predictive value for the long-term prognosis of female patients with initial STEMI combined with diabetes,with patients having high RDW and low fT3 experiencing a higher incidence of MACE.更多还原