纤维蛋白原浓度对择期经皮冠状动脉介入术后心肌损伤及临床预后的预测价值  

Predictive value of fibrinogen concentration on post procedural myocardial injury and clinical prognosis following selective percutaneous coronary intervention

作　　者：张伟[1] 崔杏仙 李靖[3] 张彩虹 李海涛 徐占稳[3] 

机构地区：[1]河北大学附属医院泌尿外科,河北保定071000 [2]保定市耳鼻喉专科医院,河北保定071000 [3]河北大学附属医院心脏内二科,河北保定071000 [4]雄县昝岗镇卫生院,河北雄县071800 [5]徐水县华北第一医院内一科,河北徐水072550

出　　处：《医学研究与教育》2015年第1期21-25,共5页Medical Research and Education

摘　　要：目的探讨血浆纤维蛋白原（fibrinogen,FIB）水平是否对于经皮冠脉介入（percutaneous coronary intervention,PCI）后心肌损伤及其临床预后具有预测价值。方法选取拟行择期PCI的患者,术前测定FIB水平,应用ROC曲线分析,选取灵敏度与特异度之和为最大值的点为最佳界值点,分析其对患者术后心肌损伤是否具有预测价值并划定界值水平;依据界值将患者分为2组,比较2组间术后心肌损伤发生率以及心肌肌钙蛋I（cTnI）浓度;随访1年,观察2组间不良心血管事件是否存在差异。结果术前FIB水平对PCI术后心肌损伤具有预测价值（Area Under Curve,AUC=0.782,P〈0.001）。FIB界值划定为3.85g/L,灵敏度为65.53%,特异度为78.54%。FIB〈3.85g/L组与FIB≥3.85g/L组的心肌损伤发生率差异有统计学意义（13.93%vs 52.81%,χ^2=36.959,P〈0.001）;FIB≥3.85 g/L组的术后cTnI水平较高[（0.25±0.67）ng/mL vs（0.55±0.65）ng/mL,t=-3.129,P=0.002]。2组间不良心血管事件差异有统计学意义（Log Rank P=0.025）;FIB≥3.85g/L显著增加不良心血管事件发生（HR=2.069,95%CI：1.056-4.054）。结论术前FIB浓度对于择期PCI术后心肌损伤以及临床预后具有预测价值。Objective To explore whether the fibrinogen（FIB） level can predict post procedural myocardial injury and clinical prognosis after percutaneous coronary intervention（PCI）. Methods FIB level was measured preopratively in patients scheduled to undergo PCI to analyze its predictive value of postoperative myocardial injury. ROC analysis was performed to determine the cutoff point, at which sensitivity and specificity would be maximal. Based on the boundary value, the study subjects were divided into two groups. Compared the incidence of postoperative myocardial injury and c Tn I concentration between two groups, and observed if there any differences. Follow-up of 1 year, surveyed if the adverse cardiovascular events had any differences. Results The preoperative FIB level had predictive value for myocardial injury of post-PCI（Area Under Curve, AUC = 0.782, P〈0.001）. FIB boundary value was 3.85g/L, sensitivity 65.53%, specificity 78.54%. The incidence of myocardial injury had a significant difference between the FIB 〈3.85g/L group and FIB≥3.85 g/L group（ 13. 93 % V S 52. 81 %, χ^2= 36. 959, P 0. 001）. The cTnI levels of postoperative was higher in the FIB≥3.85g/L group[（0.25±0.67） ng/mL vs（0.55±0.65） ng/mL, t=-3.129, P=0.002]. The incidence of adverse cardiovascular events had statistical differences between the two groups（Log Rank P=0.025）. FIB≥3.85 g/L led to a significant increase in adverse cardiovascular events（HR=2.069, 95% CI： 1.056-4.054）. Conclusion The preoperative fibrinogen concentration has predictive values on post procedural myocardial injury and clinical outcomes on patients underwent selective PCI.

关 键 词：纤维蛋白原 经皮冠状动脉介入术 心肌损伤 

分 类 号：R65[医药卫生—外科学]