急性心肌梗死介入术后血清TNF-α及hs-CRP对判断预后的意义  

Prognostic Significance of TNF-α and hs-CRP in Acute Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention

作　　者：罗玮[1] 崔博[2] 孙根义[1] 王伟[1] 

机构地区：[1]天津市胸科医院心内科,300051 [2]南开大学医学院医学部

出　　处：《天津医药》2011年第12期1112-1115,共4页Tianjin Medical Journal

摘　　要：目的:探讨经皮冠状动脉介入(PCI)治疗后血清肿瘤坏死因子-α(TNF-α)及超敏C-反应蛋白(hs-CRP)水平与急性心肌梗死(AMI)患者近、远期预后的关系。方法:成功接受PCI的初发AMI患者152例,PCI后12h内取血进行TNF-α及hs-CRP检测。采用Logistic回归评价PCI后血TNF-α及hs-CRP水平与患者30d和1年内发生心脏不良事件(MACE)的关系。采用Kaplan-Meier生存曲线分析不同TNF-α及hs-CRP水平的患者30d和1年的生存率。结果:PCI后MACE组与无MACE组比较,前壁心肌梗死所占比例、肌酸激酶同工酶峰值、左心室射血分数、TNF-α及hs-CRP水平差异均有统计学意义。AMI患者术后随访30d和1年的TNF-α和hs-CRP为MACE的危险因素。PCI后高TNF-α组的患者30d和1年累积生存率明显低于低TNF-α组。高hs-CRP组与低hs-CRP组的患者相比30d累积生存率差异无统计学意义,1年累积生存率明显减低。高TNF-α组1年的再发心肌梗死率、30d和1年的再次血运重建率均高于低TNF-α组。高hs-CRP组PCI术后30d和1年的再发心肌梗死率、再次血运重建率均明显高于低hs-CRP组。结论:TNF-α及hs-CRP升高与初发AMI患者成功PCI后近期和远期MACE事件发生率密切相关。Objective： To evaluate the prognostic value of serum levels of tumor necrosis factor-α （TNF-α） and high sensitivity C-reactive protein （hs-CRP） in patients with acute myocardial infarction （AMI） treated with percutaneous coronary intervention （PCI）. Methods： A total of 152 consecutive AMI patients underwent successful PCI were enrolled in this study. The serum levels of TNF-α and hs-CRP were measured within 12 hours after PCI. All patients were followed up for 1 year. The logistic regression analysis was used to evaluate predictive values of postprocedural TNF-α and hs-CRP for major？adverse cardiac events （MACE） at 30 days and 1 year after PCI. Time-to-event analyses were performed using the Kaplan-Meier survival curves in patients with various ranges of postprocedural TNF-α and hs-CRP. Results： There were significant differences in percentage of anterior myocardial infarction, the peak of creatine kinase MB, left ventricular ejection fraction and TNF-α and hs-CRP levels between MACE group and non-MACE group after PCI. The multivariable logistic analysis showed that TNF-α and hs-CRP were risk factors of MACE after 30 days and 1 year follow-up. There were significantly lower 30-day and 1-year survival rates in patients with higher postprocedural TNF-α level after PCI than those of patients with lower postprocedural TNF-α level. But there was no significant difference in 30-day survival rate between patients with higher postprocedural hs-CRP level and patients with lower hs-CRP level, and 1-year cumulative survival rate was significantly decreased. There were significantly higher recurrent myocardial infarction rate after 1-year, revascularization rates after 30-days and 1-year in patients with higher TNF-α level than those of patients with lower TNF-α level. Compared with those in lower hs-CRP group, there were significantly lower recurrent myocardial infarction rates and revascularization rates after 30-day and 1-year in patients with higher hs-CRP after PCI. Conclusion： I

关 键 词：心肌梗死 血管成形术 经腔 经皮冠状动脉 肿瘤坏死因子α C反应蛋白质 预后 随访研究 

分 类 号：R442.2[医药卫生—诊断学]