内科

目的探讨急性心肌梗死（AMI）患者血清胱抑素C（Cys-C）、缺血修饰白蛋白（IMA）、视黄醇结合蛋白-4（RBP4）水平与冠状动脉病变严重程度的相关性及对预后的预测价值。方法选取2022年2月至2024年2月收治的98例AMI患者（研究组）及同期98例健康体检者（对照组）为研究对象。根据冠状动脉造影Gensini总积分，将AMI患者分为轻、中、重度病变组。对AMI患者进行为期6个月的随访，根据是否发生主要不良心血管事件分为预后良好与预后不良组。比较各组间血清Cys-C、IMA、RBP4水平的差异，采用Pearson相关性分析探讨其与Gensini总积分的相关性，采用受试者工作特征（ROC）曲线分析各指标及三者联合对预后的预测效能。结果研究组入院时血清Cys-C、IMA、RBP4水平均高于对照组（均P<0.05）。在AMI患者中，上述指标水平随冠状动脉病变严重程度加重而升高（轻度<中度<重度，均P<0.05），且均与Gensini总积分呈正相关（r分别为0.643、0.712、0.685，均P<0.05）。预后不良组（n=21）入院时各指标水平均高于预后良好组（n=77）（均P<0.05）。ROC曲线分析显示，入院时血清Cys-C、IMA、RBP4水平预测预后不良的曲线下面积（AUC）分别为0.787、0.825、0.759，三者联合预测的AUC为0.923，高于任一单一指标。结论 AMI患者血清Cys-C、IMA、RBP4水平与冠状动脉病变严重程度密切相关，且对预后不良具有预测价值，联合检测可提升预测效能，为AMI患者临床风险评估提供了潜在的血清学依据。

Objective To explore the correlation of serum cystatin C (Cys-C), ischemia-modified albumin (IMA), and retinol-binding protein-4 (RBP4) levels with the severity of coronary artery lesions in patients with acute myocardial infarction (AMI) and their prognostic predictive value. Methods A total of 98 AMI patients (study group) admitted between February 2022 and February 2024, and 98 healthy controls recruited from physical examinations during the same period, were enrolled. According to the total Gensini score of coronary angiography, AMI patients were divided into mild, moderate, and severe lesion subgroups. All AMI patients were followed up for 6 months and further classified into good prognosis group and poor prognosis group based on the occurrence of major adverse cardiovascular events. Serum levels of Cys-C, IMA, and RBP4 were compared among groups. Pearson correlation analysis was used to explore their correlation with total Gensini score. Receiver operating characteristic (ROC) curve was applied to evaluate the predictive efficacy of single indicators and their combination for prognosis. Results Serum levels of Cys-C, IMA, and RBP4 on admission in the study group were higher than those in the control group (all P<0.05). Among AMI patients, the above indicators increased gradually with the aggravation of coronary lesions (mild < moderate < severe, all P<0.05), and were positively correlated with total Gensini score (r=0.643, 0.712, 0.685, all P<0.05). The levels of the three indicators on admission in the poor prognosis group (n=21) were higher than those in the good prognosis group (n=77) (all P<0.05). ROC curve analysis showed that the areas under the curve (AUC) of serum levels of Cys-C, IMA, and RBP4 for predicting poor prognosis were 0.787, 0.825, and 0.759, respectively; the combined AUC was 0.923, which was superior to any single indicator. Conclusion Serum Cys-C, IMA, and RBP4 levels are closely correlated with the severity of coronary artery lesions in AMI patients, and have predictive value for poor prognosis; combined detection can improve predictive efficacy, providing a potential serological basis for clinical risk assessment of AMI patients.