摘要目的:探讨血红蛋白与血肌酐比值（Hb/SCr）联合血尿酸（SUA）对急性心肌梗死（AMI）患者急诊经皮冠脉介入治疗（PCI）术后院内死亡的临床预测价值。方法:回顾性分析2017年1月至2021年12月于南京医科大学康达学院第一附属医院急诊行PCI治疗的AMI患者的临床资料。收集患者一般资料、基础病史、血常规、肝肾功能、血凝常规、SUA等指标。主要复合终点定义为院内死亡，包括PCI期间及术后住院15 d内院内全因死亡。单因素分析AMI患者急诊PCI术后院内死亡相关因素，多变量Logistic回归分析独立相关因素及构建风险预测模型，采用Hosmer-Lemeshow法和受试者工作特征曲线（ROC曲线）分别检验模型及相关因素的拟合优度、预测效果。结果:最终纳入1 976例患者，院内死亡92例，存活1 884例。死亡组SUA高于存活组（μmol/L：476.88±132.04比354.87±105.31， P<0.01），Hb/SCr比值明显低于存活组（13.84±5.48比19.20±5.74， P<0.01）。Pearson相关性分析显示，SUA与Hb/SCr比值呈直线负相关（ r＝-0.502， P<0.01）。Logistic回归风险模型分析最终纳入年龄〔优势比（ OR）＝0.916〕、Hb/SCr比值（ OR＝0.182）、白细胞计数（WBC， OR＝2.733）、C-反应蛋白（CRP， OR＝3.611）、SUA（ OR＝4.667）、血糖（Glu， OR＝2.726）、同型半胱氨酸（Hcy， OR＝2.688）7个因素构建风险预测模型，为AMI患者急诊PCI术后发生院内死亡的独立相关因素（均 P<0.05）。Hosmer-Lemeshow检验模型拟合效果，结果显示 P＝0.447，该模型预测AMI患者急诊PCI术后发生院内死亡的ROC曲线下面积（AUC）为0.764〔95%可信区间（95% CI）为0.712~0.816， P＝0.001〕，当截断值为0.565 8时，敏感度为70.7%，特异度为70.2%，约登指数为0.410。用Hb/SCr比值+ SUA、SUA、Hb/SCr比值、Hb、SCr预测AMI患者急诊PCI术后发生院内死亡时，Hb/SCr比值+ SUA的AUC最大，为0.810；最佳截断值为-0.847时，敏感度为77.7%，特异度为74.5%，约登指数为0.522。 结论:年龄、SUA、Hb/SCr比值、WBC、CRP、Glu、Hcy为AMI患者急诊PCI术后院内死亡的独立相关因素；入院时Hb/SCr比值越低、SUA越高，AMI患者急诊PCI术后院内死亡风险越高；Hb/SCr比值联合SUA较单一指标对AMI患者急诊PCI术后院内死亡的预测价值更高，有助于早期识别高危患者。

abstractsObjective:To investigate the clinical value of hemoglobin to serum creatinine ratio (Hb/SCr) combined with blood uric acid (SUA) in predicting in-hospital mortality after emergency percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI).Methods:The clinical data of AMI patients who underwent emergency PCI in the First Affiliated Hospital of Kangda College of Nanjing Medical University from January 2017 to December 2021 were retrospectively analyzed. The general information, underlying medical history, blood routine, liver and kidney function, blood coagulation routine, SUA and other indicators were collected from patients. The primary composite endpoint was defined as in-hospital death, including in-hospital all-cause death during PCI and 15-day post-procedure hospitalization. Multivariate Logistic regression was used to analyze factors associated with in-hospital death after emergency PCI in patients with AMI. Multivariate Logistic regression was used to analyze the independent related factors and construct a risk prediction model. The Hosmer-Lemeshow method and receiver operator characteristic curve (ROC curve) were used to test the goodness of fit and predictive effect of the model and correlates, respectively.Results:A total of 1 976 patients were enrolled, 92 died in hospital and 1 884 survived. SUA was higher in the death group than that in the survival group (μmol/L: 476.88±132.04 vs. 354.87±105.31, P < 0.01), and the Hb/SCr ratio was significantly lower than that in the survival group (13.84±5.48 vs.19.20±5.74, P < 0.01). Pearson analysis showed a linear negative correlation between SUA and Hb/SCr ratio ( r = -0.502, P < 0.01). Logistic regression risk model analysis finally included age [odds ratio ( OR) = 0.916], Hb/SCr ratio ( OR = 0.182), white blood cell count (WBC, OR = 2.733), C-reactive protein (CRP, OR = 3.611), SUA ( OR = 4.667), blood glucose (Glu, OR = 2.726), homocysteine (Hcy, OR = 2.688) 7 factors to construct a risk prediction model, which were independent correlation factors for in-hospital death in AMI patients after emergency PCI (all P < 0.05). Hosmer-Lemeshow test verified the fitting effect of the model, and the result showed P = 0.447. The area under the ROC curve (AUC) of the model for predicting in-hospital death in AMI patients after emergency PCI was 0.764 [95% confidence interval (95% CI) was 0.712-0.816, P = 0.001].When the cut-off value was 0.565 8, the sensitivity was 70.7%, the specificity was 70.2%, and the Yoden index was 0.410. When Hb/SCr ratio+SUA, SUA, Hb/SCr ratio, Hb and SCr were used to predict in-hospital death in AMI patients after emergency PCI, the AUC of Hb/SCr ratio+SUA was the largest, which was 0.810. When the optimal cut-off value was -0.847, the sensitivity was 77.7%, the specificity was 74.5%, and the Youden index was 0.522. Conclusions:Age, SUA, Hb/SCr ratio, WBC, CRP, Glu, and Hcy are independent risk factors for in-hospital death after emergency PCI in AMI patients. The lower the Hb/SCr ratio and the higher the SUA at admission, the higher the risk of in-hospital death after emergency PCI in AMI patients. Hb/SCr ratio combined with SUA has a higher predictive value for in-hospital death after emergency PCI in AMI patients than single index, which is helpful for early identification of high-risk patients.