血管性血友病因子预测非体外循环冠状动脉旁路移植术后缺血事件风险的研究  

Study on plasma von Willebrand factor in the prediction of risk of ischemic events in patients undergoing off-pump coronary artery bypass graft

作　　者：门剑龙[1] 任静[1] 张伯玮[1] 马睿[1] 王赞新[2] 

机构地区：[1]天津医科大学总医院医学检验科,300052 [2]天津医科大学总医院心血管外科,300052

出　　处：《中华老年医学杂志》2014年第11期1171-1175,共5页Chinese Journal of Geriatrics

摘　　要：目的 研究血浆血管性血友病因子抗原（vWF Ag）在非体外循环冠状动脉旁路移植（OPCAB）手术后的变化特点以及对患者心血管缺血风险的评估价值. 方法 对我院2010年至2012年间收治的非ST段抬高型心肌梗死患者338例进行回顾性队列分析,男249例,女89例,平均（69.2±4.5）岁.采用IL ACL-TOP 700型血液凝固仪测定vWF Ag水平.采用ROC曲线评价vWFAg的诊断性能.利用x2检验和Logistic回归分析评估vWF Ag与临床病理因素的关联性.用Cox回归分析模型评价预后影响因素. 结果 病情稳定组和恢复不良组中各时间点的vWF Ag水平间存在显著差异（x^2＝129.53和101.48,均P＜0.01）,恢复不良组患者在OPCAB术后第14、30、60和90 d的vWF Ag水平均高于病情稳定组患者的同期水平（均P＜0.05）.ROC结果显示,OPCAB术后第30天血浆vWF Ag临界值为251％时,其诊断患者在术后31～90 d内心血管缺血事件的曲线下面积为0.839（95％ CI：0.776～～0.902）.Logistic回归分析显示,术后第30天血浆vWF Ag水平受年龄、左室射血分数、左主干病变、血肌酐、旁路移植血管数量、心肌梗死病史和高血压等因素的影响（均P＜0.01）.Cox分析显示OPCAB术后第30天的血浆vWF Ag临界值可作为OPCAB患者术后1年内心血管缺血事件风险的独立预后评价指标. 结论 OPCAB术后患者血浆vWF Ag水平变化能敏感反映多种风险因素对于血管内皮功能的整体影响,可以作为评价术后90 d内病情发展趋势和预测患者远期预后的有效指标.Objective To study the variation characteristics of plasma von Willebrand factor antigen （vWF Ag） after the off-pump coronary artery bypass graft （OPCAB） and its predictive value on the assessment of cardiovascular ischemia events in the postoperative patients.Methods A total of 338 patients with non-ST-segment elevation myocardial infarction were selected from 2010 to 2012 in this retrospective cohort study,with 249 males and 89 females and a mean age of （69.2 ± 4.5） years.The level of vWF Ag was assayed by the IL ACL-TOP 700 blood coagulation instrument.Receiver-operator curve （ROC） analysis of vWF Ag levels in the prediction of risk of ischemic events was performed.x2 test and Logistic regression were conducted to analyze the relevance between vWF Ag and clinical pathological factors.Cox regression analysis model were used to evaluate the effect on prognosis.Results There was significant difference in vWF Ag level at different time point between the poor recovery group and the stable disease group （x^2 =129.53 and 101.48 respectively,both P〈0.01）.And the vWF Ag level was higher in the poor recovery group on the 14th,30th,60th,90th day after OPCAB than in the stable disease group at the same time points respectively （all P〈0.05）.The optimum cut-off point of vWF Ag （the 30th day after OPCAB） for prediction of ischemic events was 251 % within the 31-90th day after OPCAB,the area under ROC curve was 0.839 （95% confidence interval：0.776-0.902）.The Logistic regression analysis showed that the vWF Ag level on 30th day after OPCAB was affected by age,left ventricular ejection fraction,left main artery disease,serum creatinine level,vascular number of bypass grafts,history of myocardial infarction and hypertension （all P〈0.01）.The Cox analysis showed that the cut-off value of vWF Ag （on the 30th day after OPCAB） was the independent prognostic assessment parameter for ischemic events in patients with cardiovascular diseases within one year.Conclusions The variation of ser

关 键 词：心肌梗死 冠状动脉旁路移植术 非体外循环 血管性血友病因子抗原 

分 类 号：R654.3[医药卫生—外科学]