急性心肌梗死患者直接经皮冠状动脉介入治疗围手术期多血清标志物与预后  

Peri-procedural levels of multiple serum biomarkers and prognosis in ST-segment elevation myocardial infarction patients undergoing primary angioplasty

作　　者：赵博[1] 颜红兵[2] 赵汉军[2] 宋莉[2] 周鹏[1] 刘臣 

机构地区：[1]首都医科大学附属北京安贞医院,北京100029 [2]中国医学科学院阜外心血管病医院

出　　处：《中国介入心脏病学杂志》2012年第3期130-136,共7页Chinese Journal of Interventional Cardiology

基　　金：首都医学发展科研基金(2009-2076)

摘　　要：目的单血清标志物缺乏判断预后的特异性与敏感性。本研究评价接受直接经皮冠状动脉介入治疗(primary percutaneous coronary intervention,PPCI)的ST抬高心肌梗死(ST elevation myocardial infarction,STEMI)患者围手术期组合分析多血清标志物水平评估预后的价值。方法梗死相关动脉内灌注血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂改善心肌再灌注和减少出血并发症的研究(NCT01181388)连续入选接受PPCI的203例STEMI患者,本研究纳入其中化验指标完整可供分析的145例患者,按其术前肌钙蛋白I(20ng/ml)、高敏C反应蛋白(10mg/L),术后即刻B型钠尿肽(2000fmol/ml)的水平是否高于研究界定值分为低值组、单项高值组、两项高值组和三项高值组。比较住院期间超声评估的心功能、住院期间、术后30天、180天主要心脏不良事件(major adverse cardiac events,MACE)包括心因性死亡、再发心肌梗死、靶血管再次血运重建)和出血事件等预后指标的差异。结果住院期间共有4例患者发生MACE,其中低值组3例(6%),单项高值组0例,两项高值组0例,三项高值组1例(14%),三项高值组患者住院期间MACE发生率有增加趋势(χ2=7.922,P=0.048)。30天内共有7例患者发生MACE,其中死亡2例(均来自两项高值组),再发心肌梗死3例,靶血管再次血运重建2例,各组患者30天MACE发生率间差异无统计学意义(χ2=5.381,P>0.05),但是两项高值组患者死亡率较高(8%)并且差异具有统计学意义(χ2=9.282,P=0.026)。180天内共有10例患者发生MACE,其中死亡5例,再发心肌梗死3例,靶血管再次血运重建2例,各组患者180天MACE发生率间差异无统计学意义。结论多血清标志物异常可能在一定程度上提示预后不良,组合分析多种血清标志物来评估PPCI患者的预后可能比单独分析一种血清标志物更有意义。Objective No single serum biomarker has the specificity or the sensitivity in predicting the outcome of patients. This study is to evaluate the role of peri-procedural multiple serum biomarkers approach in the assessment of the prognosis in acute ST-segment elevation myocardial infarction （STEMI） patients undergoing primary angioplasty. Methods This study is a sub-study of the SUIT-AMI trial （Impacts of superselective IRA infusion of glucoprotein I1 b/Ill a inhibitor on myocardial reperfusion and bleeding complications in AMI patients, NCT01181388） including 203 consecutive patients with STEMI who underwent primary angioplasty. The complete data of biomarkers was available for analysis in 145 of 203 patients. According to the pre-procedure cardiac troponin I （20 ng/ml） and high sensitive CRP （10 rag/ L） and instantly post-procedure N-terminal probrain natriuretic peptide （2000 fmol/ml）, these patients were divided into four groups （ low value, n = 50 ; single high value, n = 62 ; double high values, n = 26 ; and triple high values, n = 7）. In-hospital ultrasound based cardiac function.30-dav and 180-dav maior adversecardiac events [ MACE, including cardiac death, recurrent myocardial infarction （MI） and target vascular revascularization （TVR）] and bleeding were recorded for analysis. Results In-hospital MACE were recorded in four patients. Of them, three in the low value group （6%） and one in the triple high values group （ 14% ） with a tendency of higher than other three groups （X2 = 7. 922, P = 0. 048）. At 30-day follow- up, there were 7 MACEs including two deaths （all from double high values group）, three recurrent MIs and two TVRs without significant differences between groups （X2 = 5. 381, P 〉 0.05 ）. However, the 30 day mortality of the double high value group was greatly higher than other groups（ 8% vs. 0% ,X2 = 9. 282,P = 0. 026）. At 180-day follow-up, there were 10 MACEs including five deaths, three recurrent MIs and two TVRs without great differen

关 键 词：心肌梗死 血管成形术 经腔 经皮冠状动脉 生物学标记 预后 

分 类 号：R542.22[医药卫生—心血管疾病]