血浆可溶性肿瘤坏死因子受体1联合GRACE评分对急性冠脉综合征患者主要不良心血管事件的预测价值  

Predictive value of plasma soluble tumor necrosis factor receptor 1 combining GRACE scores to major adverse cardiovascular events(MACE) in patients with acute coronary syndrome

作　　者：钟健[1] 付强[1] 孙凯[2] 朱可[1] 张倩[1] 魏鹏[1] 

机构地区：[1]徐州市中心医院心内科,徐州221009 [2]潍坊医学院,潍坊261053

出　　处：《中国循证心血管医学杂志》2016年第5期556-559,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的 探讨血浆可溶性肿瘤坏死因子受体1（sTNFR1）联合全球急性冠脉综合征（ACS）注册（GRACE）评分是否可以进一步提高其评估ACS患者预后的能力.方法 连续入选2013年10月-2014年10月于徐州市中心医院心内科诊断为ACS的住院患者101例.依据随访是否发生主要不良心血管事件（MACE）分为MACE组（n=10）和非MACE组（n=91）.患者入院24 h内测定血浆sTNFR1水平,同时进行入院GRACE评分.出院后对患者进行1个月,3个月和6个月的随访,随访终点事件是MACE.结果 平均随访（183±15）d,共发生MACE 10例,发生率为9.9%.MACE组患者的血浆sTNFR1水平明显高于非MACE组的患者（P〈0.001）.多因素Logistic回归分析表明血浆sTNFR1水平和GRACE评分是ACS患者1～6个月MACE发生的独立预测因素.在预测ACS患者1-6个月MACE发生的受试者工作特征（ROC）曲线中,血浆sTNFR1水平的曲线下面积为0.898（95%CI：0.821～0.950,P〈0.01）,GRACE评分的曲线下面积为0.691（95%CI：0.590～0.780,P〈0.05）,联合预测因子的曲线下面积为0.909（95%CI：0.834～0.958,P〈0.01）.当血浆sTNFR1水平、GRACE评分和联合预测因子取得最佳界值点时,对ACS患者1-6个月 MACE发生风险的预测价值达到最大（灵敏度分别为100%、100%和94.5%,特异度分别为67%,40.3%和80%）. 结论 血浆sTNFR1水平是影响ACS患者预后的独立危险因素之一;血浆sTNFR1水平联合GRACE评分进一步提高其评估ACS患者预后的能力.Objective To discuss whether the predictive value of plasma soluble tumor necrosis factor receptor1 （sTNFR1） combining GRACE scores can be improved further in reviewing prognosis in patients with acute coronarysyndrome （ACS）. Methods ACS patients （n=101） were chosen from Oct. 2013 to Oct. 2014, and divided into groupof major adverse cardiovascular events （MACE group, n=10） and non-MACE group （n=91）. The level of sTNFR1was detected within 24 h after hospitalization, and at the same time GRACE scores were reviewed in all patients. Thepatients were followed up for 1 m, 3 m and 6 m after discharged from hospital, and the end-point events of follow-upwere MACE. Results The average follow-up day was （183±15） d, and there were totally 10 cases of MACE （9.9%）.The level of plasma of sTNFR1 was significantly higher in MACE group than that in non-MACE group （P〈0.001）.The multi-factor Logistic regression analysis indicated that the level of plasma of sTNFR1 and GRACE scores wereindependent predictive factors of MACE in ACS patients after 1 m to 6 m. The prediction of receiver operatingcharacteristic curve （ROC） showed that the area under curve （AUC） of sTNFR1 was 0.898（95%CI0.821～0.950,P〈0.01）, AUC of GRACE scores was 0.691（95%CI：0.590～0.780,P〈0.05）, and AUC of joint predictors was0.909（95%CI：0.834～0.958,P〈0.01）. When the level of plasma sTNFR1, GRACE scores and joint predictorsreached the optimal cutoff point, their predictive values achieved the maximum for MACE risk after 1 m, 3 m and6 m （sensitivity was respectively 100%, 100% and 94.5%, and specificity was respectively 67%, 40.3% and 80%）.Conclusion The level of plasma sTNFR1 is one of independent risk factors influencing the prognosis in ACS patients,and when it is combined with GRACE scores, its value of reviewing the prognosis will be further improved.

关 键 词：急性冠脉综合征 血浆可溶性肿瘤坏死因子受体1 GRACE评分 主要不良心脏事件 

分 类 号：R541.4[医药卫生—心血管疾病]