Abstract: Background　Multiple studies reported that there is spontaneous recanalization of infarct-related arteries（IRA） in some STEMI patients before emergency PCI，which may be associated with a better outcome.So it is very important to find a simple and effective predicative index for spontaneous recanalization of IRA.At present，there are few studies on the relationship between C-reactive protein/albumin ratio （CAR） and spontaneous recanalization of IRA in patients with acute STEMI at home and abroad.Objective　To investigate the predictive value of CAR for spontaneous recanalization of IRA in patients with acute STEMI.Methods　A retrospective study was conducted.271 acute STEMI patients who underwent emergency PCI in the Second Affiliated Hospital of Zhengzhou University from May 2016 to February 2019 were enrolled，and divided into spontaneous recanalization group （n=56） and non-spontaneous recanalization group（n=215） by the prevalence of spontaneous recanalization of IRA found in the surgery.Clinical baseline data and laboratory results of two groups were compared.Multivariate logistic regression analysis was applied to screen the influential factors of spontaneous recanalization of IRA.The receiver operating characteristic （ROC） curve was used to evaluate the value of CAR in predicting spontaneous recanalization of IRA.Results　The leucocyte count，platelet/lymphocyte ratio （PLR），neutrophil/lymphocyte ratio （NLR），monocyte/high-density lipoprotein cholesterol ratio （MHR），and CAR in the spontaneous recanalization group were all lower than those in the non-spontaneous recanalization group （P<0.05）.Multivariate Logistic regression analysis showed that leucocyte count〔OR=0.856，95%CI（0.753，0.973）〕，NLR〔OR=0.368，95%CI（0.187，0.724）〕，MHR〔OR=0.947，95%CI（0.897，0.999）〕，and CAR〔OR=0.794，95% CI（0.732，0.862）〕 were influencing factors of spontaneous recanalization of IRA.ROC curve analysis showed that the AUC of CAR for predicting spontaneous recanalization of IRA was 0.768〔95%CI（0.705，0.832）〕when the cut-off point was determined as 11.99，with 67.9% sensitivity and 79.1% specificity，respectively.Conclusion　The leucocyte count，NLR，MHR and CAR may independently influence spontaneous recanalization of IRA in patients with acute STEMI，and CAR had certain value in influencing spontaneous recanalization of IRA.

Key words: Myocardial infarction, Spontaneous recanalization, C-reactive protein, Albumin, Root cause analysis, Forecasting

摘要： 背景　研究发现部分ST段抬高型心肌梗死（STEMI）患者急诊经皮冠状动脉介入治疗（PCI）术前存在梗死相关动脉（IRA）自发再通现象。非自发再通的STEMI患者较自发再通患者有不良预后，因此积极寻找简便、有效的指标预测IRA自发再通患者十分重要。目前，国内外关于C反应蛋白/白蛋白比值（CAR）与急性STEMI患者IRA自发再通的相关性研究尚少。目的　探讨CAR对急性STEMI患者IRA自发再通的预测价值。方法　回顾性分析2016年5月—2019年2月在郑州大学第二附属医院因急性STEMI行PCI的患者271例，根据PCI术中IRA是否自发再通将患者分为非自发再通组（n=215）和自发再通组（n=56）。比较两组患者基线资料以及实验室检查结果，采用多因素Logistic回归分析探究IRA自发再通的影响因素，采用受试者工作特征（ROC）曲线评价CAR对IRA自发再通的预测价值。结果　自发再通组白细胞计数、血小板/淋巴细胞比值（PLR）、中性粒细胞/淋巴细胞比值（NLR）、单核细胞/高密度脂蛋白胆固醇比值（MHR）、CAR均低于非自发再通组（P<0.05）。多因素Logistic回归分析结果显示，白细胞计数〔OR=0.856，95%CI（0.753，0.973）〕、NLR〔OR=0.368，95%CI（0.187，0.724）〕、MHR〔OR=0.947，95%CI（0.897，0.999）〕、CAR〔OR=0.794，95%CI（0.732，0.862）〕是急性STEMI患者IRA自发再通的影响因素（P<0.05）。ROC曲线分析结果显示，CAR预测IRA自发再通的ROC曲线下面积为0.768〔95%CI（0.705，0.832）〕，预测临界值为11.99，预测临界值对应的灵敏度为67.9%，特异度为79.1%。结论　白细胞计数、NLR、MHR、CAR是急性STEMI患者IRA自发再通的独立影响因素，且CAR对预测IRA自发再通具有一定价值。

关键词: 心肌梗死, 自发再通, C反应蛋白质, 白蛋白, 影响因素分析, 预测