术前血清超敏C反应蛋白对冠心病患者非心脏手术围术期心脏事件的预测作用  

The role of preoperative high-sensitivity C-reactive protein in the prediction of perioperative cardiac events in patients with CAD undergoing non-cardiac surgery

作　　者：曲歌[1] 许力[1] 于春华[1] 韩伟[2] 黄宇光[1] 

机构地区：[1]中国医学科学院北京协和医院麻醉科,北京100730 [2]中国医学科学院基础医学研究所,北京100730

出　　处：《基础医学与临床》2012年第12期1406-1410,共5页Basic and Clinical Medicine

基　　金：卫生部公益性行业科研专项(200802030)

摘　　要：目的评价对于老年冠心病患者非心脏手术,术前超敏C反应蛋白(hsCRP)水平对于围手术期心脏事件(PCE)的预测能力。方法前瞻性队列研究,连续纳入81例年龄≥60岁择期拟行中高危非心脏手术的冠心病患者,术前检测静脉血中hsCRP浓度(ELISA法),监测术后即刻及3 d内的12导联心电图和肌钙蛋白(cTnI)水平(免疫比浊法),并随访住院期间心脏并发症。结果 PCE发生率为32%。hsCRP与PCE的ROC曲线下面积(AUC)为0.75(95%CI,0.64～0.87;P<0.05),临界值为12 mg/L。应用二元logistic回归进行多变量分析,hsCRP≥12 mg/L是PCE的独立危险因素(RR,26.29;95%CI,2.46～281.42;P<0.01)。用hsCRP≥12 mg/L预测PCE的特意度为94.55%,准确度为74.07%。其预测参数优于RCRI分级,并能在RCRI分级基础上识别高危个体。结论老年冠心病患者非心脏手术,术前hsCRP≥12 mg/L是PCE的独立危险因素,与临床指征相结合能够识别高危患者,具有应用前景。Objective To determine the value of preoperative high-sensitivity C-reactive protein（hsCRP） in predicting perioperative cardiac events（PCE） in elderly patients with coronary artery disease（CAD） undergoing non-cardiac surgery.Methods A prospective cohort study was conducted.Eighty-one patients with the diagnosis of CAD undergoing major non-cardiac surgery were enrolled.hsCRP concentration was measured before surgery.Clinical variables were evaluated.The PCE were followed by the examinations of 12-lead ECG and Troponin I（cTnI） levels.Results PCE occurred in 32% of the patients.Using receiver operating characteristic（ROC） analysis,hsCRP predicted PCE with the area under the curve of 0.75（95% CI,0.64-0.87;P0.05）.The cutoff value was 12 mg/L,showing a sensitivity of 30.77% and specificity of 94.55%.Multivariate analysis revealed that hsCRP≥12 mg/L as independent predictor for PCE（RR,26.29;95% CI,2.46-281.42;P0.01）,and had higher predictive accuracy than Revised cardiac risk index（RCRI）.Conclusions In elderly patients with CAD undergoing non-cardiac surgery,preoperatvie hsCRP is an independent predictor of PCE.hsCRP≥12 mg/L identified patients at higher risk.

关 键 词：冠心病 非心脏手术 超敏C反应蛋白 围手术期心脏事件 

分 类 号：R614[医药卫生—麻醉学]