急性心肌梗死患者D二聚体质量浓度与远期预后的关系  

Effect of D-dimer on long-term prognosis in patients with acute myocardial infarction

作　　者：苏文[1] 李虹伟[1,2] 陈晖 李卫萍[1,2] Su Wen;Li Hongwei;Chen Hui;Li Weiping(Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China;Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease, Beijing 100050, China)

机构地区：[1]首都医科大学附属北京友谊医院心血管中心,北京100050 [2]代谢紊乱相关心血管疾病北京市重点实验室,北京100050

出　　处：《首都医科大学学报》2022年第2期173-177,共5页Journal of Capital Medical University

基　　金：国家自然科学基金青年项目(81900304);北京市优秀人才培养资助青年骨干个人项目(2018000021469G199)。

摘　　要：目的探讨急性心肌梗死(acute myocardial infarction,AMI)患者D二聚体(D-dimer)质量浓度与病情严重程度和远期心源性死亡的关系。方法选取2013年1月至2020年1月收入首都医科大学附属北京友谊医院的AMI患者3990例,根据D-dimer质量浓度分为3组:≤0.50 mg/L、0.51~0.80 mg/L、≥0.81 mg/L,平均随访时间为2.1(1.0~4.0)年。应用Cox比例风险回归模型评估D-dimer对心源性死亡的影响。结果D-dimer≥0.81 mg/L组患者年龄较大、女性居多、体质量指数较低,既往合并高血压、糖尿病者较多,3支病变较为多见,住院期间肾小球滤过率较低,N末端B型利钠肽原峰值明显升高,左室射血分数<50%患者比例明显升高。D-dimer≥0.81 mg/L组患者在随访期间累计心源性病死率(18.7%)高于D-dimer≤0.50 mg/L组(2.3%)和D-dimer 0.51~0.80 mg/L组(6.1%),且校正其他危险因素后,D-dimer能独立预测AMI患者的心源性死亡(HR=1.71,95%CI:1.34~2.18,P<0.001)。结论D-dimer能反映AMI患者病情的严重程度,且D-dimer升高可在一定程度上预测AMI患者远期心源性死亡事件发生率升高。Objective To investigate the relationship between D-dimer and the risk of cardiac death in patients with acute myocardial infarction(AMI).Methods From January 2013 to January 2020,3990 patients admitted in Beijing Friendship Hospital with AMI were included in the present study.Patients were divided into 3 groups according to D-dimer:≤0.50 mg/L,0.51-0.80 mg/L,≥0.81 mg/L.We used Cox proportional hazard regression to evaluate the influence of D-dimer on cardiac death.Results The patients in D-dimer≥0.81 mg/L group were older,thinner,more likely to be female,had higher prevalence of hypertension,diabetes,and multivessel disease,lower estimated glomerular filtration rate,higher levels of N-terminal pro-brain natriuretic peptide,and more likely to have left ventricular ejection fraction<50%.The cardiac mortality rate was highest in D-dimer≥0.81 mg/L group.After adjusting for other risk factors,D-dimer remained an independent risk factor of cardiac death in patients of AMI(HR=1.71,95%CI:1.34-2.18,P<0.001).Conclusion Higher level of D-dimer reflected the severity of disease in patients with AMI.In addition,D-dimer was an independent risk factor of cardiac death in patients with AMI.

关 键 词：急性心肌梗死 D二聚体 心源性死亡 

分 类 号：R541.4[医药卫生—心血管疾病]