| Acute myocardial infarction(AMI)with Acute heart failure(AHF)is a critical clinical condition,with high death risk and low clinical cure rate.It is very important for medical workers to accurately judge the clinical status of such patients and predict the level of prognosis of patients.As an important marker of tissue perfusion,the ability of arterial Lactic acid(LA)to evaluate the severity and prognosis of patients with AMI complicated with AHF needs to be verified by clinical studies.ObjectiveTo explore the clinical value of detecting blood LA concentration in evaluating the severity and prognosis of AMI patients complicated with AHF.MethodsA total of 101 patients with AMI complicated with AHF were diagnosed and treated in the Second Affiliated Hospital of Shenyang Medical College from September 2018 to September 2020.The arterial blood LA at admission was collected from each patient,and the patients were divided into two groups according to the blood LA concentration: the elevated LA group(≥2mmol/L)and the normal LA group(<2mmol/L).Among these patients,57 cases were enrolled in the LA elevated group and 44 cases in the normal LA group.General baseline data such as age,sex,smoking,hypertension,diabetes,atrial fibrillation,and pulmonary infections were compared between the two groups.Other clinical data of the two groups were collected,such as: systolic pressure,diastolic blood pressure,heart rate,RBC,hemoglobin,white blood cells,platelets,c-reactive protein,potassium,blood sugar,triglyceride,total cholesterol,low-density lipoprotein cholesterol(LDL),p H,CO2 partial pressure,blood oxygen partial pressure,the actual bicarbonate,bicarbonate,standard residual alkali,anion gap,Killip classification,the types of AMI,coronary vascular lesions counts,troponin T and b-type brain natriuretic peptide(BNP),aspartate aminotransferase(AST),alanine aminotransferase(ALT),γ-glutamyltransferase,serum albumin,total bilirubin,urea,creatinine,glomerular filtration rate,left ventricular eetion fraction(LVEF),left atrial diameter(LAD),left ventricular end-diastolic diameter(LVEDd)and the length of hospital stay,etc.All data collected were analyzed with SPSS 23 software package.Kolmogorov-Smirnov test was first used to test the normality of continuous data.If the measurement data were normally distributed,the mean ± standard deviation(?X±S)was used to represent the data.The t-test was used to compare the mean values of the two groups for those with homogeneous variances,while the t’-test was used to compare the mean values of the two groups for those with uneven variances.For measurement data with non-normal distribution,median value(M)and interquartile range(IQR)were used to represent,and the comparison between the two groups was conducted by rank sum test.The rate of enumeration data n(x%)was denoted,and ?2test was used to compare the rate of the two groups.Logistic regression was performed to analyze the influencing factors of arterial blood LA concentration in AMI patients complicated with AHF.Receiver operating characteristic curve(ROC curve)was used to evaluate the efficacy of the logistic regression model.Kaplan-Meier survival curves were drawn for survival analysis of the two groups..P<0.05 was considered statistically significant.Results1.There were no statistically significant differences between the two groups in gender composition,age,hypertension,diabetes,smoking,pulmonary infection,atrial fibrillation and Killip grade.2.Compared with the normal LA group,the heart rate,red blood cell,white blood cell,serum potassium concentration,anion gap,aspartate aminotransferase,alanine aminotransferase,and the incidence of nosocomial death were all higher in the elevated LA group.Blood p H value,arterial partial pressure of carbon dioxide,actual bicarbonate,standard bicarbonate and standard residual alkali were all lower.P<0.05,the difference was statistically significant.3.After univariate analysis of the related factors that may affect the blood LA concentration of AMI patients with AHF,multivariate Logistic regression analysis was performed on the 13 variables with statistical differences.The test level of the introduced variable α=0.05 showed that there were three factors in the selected model,which were erythrocyte(OR=0.397,95%CI: 0.166-0.946,P=0.037),alanine aminotransferase(OR=0.992,95%CI: 0.978-1.006,P=0.000),and anion gap(OR=0.556,95%CI: 0.428-0.722,P=0.000).4.Draw ROC curves,the analysis showd that the area under the curve of red blood cell related to LA concentration was 0.637(95% CI:0.527~0.746,P=0.019),the area under the curve of alanine aminotransferase related to LA concentration was0.743(95% CI:0.647~0.839,P<0.001),the area under the curve of anion gap related to LA concentration was 0.893(95%CI:0.834~0.953,P<0.001).All had statistical significance.The optimal cut-off value of red blood cell related to LA concentration was 3.85×1012/ L,of which the sensitivity was 0.684,the specificity was 0.614 and the Jordan index was 0.298.The optimum cut-off value of alanine aminotransferase related to LA concentration was 26.85U/L,of which the sensitivity was 0.702,the specificity was 0.705 and the Jordan index was 0.407.The optimum cut-off value of anion gap related to LA concentration was 16.05mmol/L,of which the sensitivity was0.807,the specificity was 0.864 and the Jordan index was 0.671.5.The Kaplan-Meier survival curve was drawn to show that the average survival analysis time of LA elevated group was 19 days(95%CI:14.757~23.459),and that of normal group was 35 days(95%CI:28.488~41.640).The survival analysis function curve was drawn,and the results showed that the survival time of LA elevated group was significantly lower than that of LA normal group.Conclusions1.Heart rate,red blood cell,white blood cell,potassium concentration,anion gap,aspartate aminotransferase and alanine aminotransferase were higher in patients with AMI complicated with AHF,and the incidence of nosocomial death was higher.The p H value,arterial partial pressure of carbon dioxide,actual bicarbonate,standard bicarbonate and standard residual alkali were all lower.2.Red blood cell,alanine aminotransferase and anion gap are independent protective factors of blood LA concentration in patients with AMI complicated with AHF.3.RBC,alanine aminotransferase and anion gap all have predictive value for the blood LA concentration of AMI patients complicated with AHF.The sensitivity and specificity of the anion gap are high,which has a high predictive value.4.Compared with the normal LA concentration group,the survival time of patients with AMI complicated with AHF in elevated LA concentration group was shorter and the risk of death was higher. |
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