基于血栓弹力图的凝块溶解时间与ACS合并高脂血症患者再发心肌梗死的相关性研究  

Correlation between clot lysis time based on thromboelastogram and recurrent myocardial infarction in patients with acute coronary syndrome and hyperlipidemia

作　　者：曹梦霞 李凤娟 任璐 李琴 王媛[3] 杜杰 CAO Mengxia;LI Fengjuan;REN Lu;LI Qinu;WANG Yuan;DU Jie(Department of Biochemistry and Molecular Biology,Shanxi Medical University,Taiyuan,030001,China;Shanxi Medical University-Collaborative Innovation Center for Molecular Imaging of Precision Medicine;Cardiovascular Biology Laboratory,Beijing Institute of Heart Lung Blood and Vessel Diseases,Beijing Anzhen Hospital,Capital Medical University)

机构地区：[1]山西医科大学基础医学院生物化学与分子生物学教研室,太原030001 [2]山西医科大学分子影像精准诊疗省部共建协同创新中心 [3]首都医科大学附属北京安贞医院北京市心肺血管疾病研究所血管生物研究室

出　　处：《临床心血管病杂志》2022年第5期378-383,共6页Journal of Clinical Cardiology

基　　金：国家自然科学基金项目(No:81790622)。

摘　　要：目的:探讨凝块溶解时间(CLT)与急性冠状动脉综合征(ACS)合并高脂血症患者再发心肌梗死(心梗)事件风险的关系。方法:纳入2019年1月—2020年2月于北京安贞医院住院确诊为ACS且出院前行血栓弹力图检测的患者,共计909例。收集研究对象的人口学特征、临床检测结果并对其进行电话随访,中位随访时间为2年。根据患者出院诊断及既往病史将其分为ACS高脂血症组(685例)和ACS非高脂血症组(224例)。通过多因素logistic回归模型分析CLT与ACS合并高脂血症患者再发心梗事件的关系,并利用受试者工作特征(ROC)曲线评价CLT对患者再发心梗事件的评估效能。使用Kaplan-Meier方法计算生存曲线。结果:ACS高脂血症组患者出院前CLT值高(P=0.007)。多因素logistic回归模型显示,调整病史、合并症及临床检验指标等后,CLT与ACS高脂血症患者再发心梗事件发生风险独立相关(OR=1.45,95%CI:1.06-2.00,P=0.020)。ROC曲线分析得到CLT评估ACS高脂血症患者再发心梗事件风险的最佳截止点为12.7 min, Kaplan-Meier生存曲线分析结果表明CLT≥12.7 min组再发心梗发生率显著高于CLT<12.7 min组(Log rank:P=0.043)。结论:CLT可评估ACS合并高脂血症患者出院后发生再发心梗事件风险。Objective: To investigate the relationship between clot lysis time(CLT) and the risk of recurrence of myocardial infarction events in patients with acute coronary syndrome and hyperlipidemia. Methods: A total of 909 patients who were hospitalized with acute coronary syndrome were included in Beijing Anzhen Hospital from January 2019 to February 2020. And these patients also underwent thromboelastography(TEG) testing before discharge. Their clinical characteristics and serum markers were collected. Patients were followed up by telephone and the median duration of follow-up was 2 years. The patients were divided into ACS hyperlipidemia group(n=685) and ACS non-hyperlipidemia group(n=224) according to their diagnosis at discharge and past medical history. The relationship between CLT and recurrent myocardial infarction event in ACS patients with hyperlipidemia was analyzed by multivariate logistic regression model, and the receiver operating characteristic(ROC) curve was used to evaluate the efficacy of CLT in evaluation of recurrent myocardial infarction. Survival analysis was performed using Kaplan-Meier survival curve. Results: The CLT value before discharge was higher in the ACS hyperlipidemia group(P=0.007). Multivariate logistic regression model showed that after adjusting medical history, comorbidities and clinical test indicators, CLT was independently associated with the risk of recurrent myocardial infarction in patients with ACS hyperlipidemia(OR=1.45, 95%CI: 1.06-2.00, P=0.020). The ROC curve analysis showed that the optimal cutoff point for CLT to assess the risk of recurrent myocardial infarction in patients with ACS hyperlipidemia was 12.7 min. The Kaplan-Meier survival curve analysis showed that the incidence of recurrent myocardial infarction in the CLT ≥ 12.7 min group was significantly higher than that in the CLT group<12.7 min group(Log rank: P=0.043). Conclusion: CLT can assess the risk of recurrent myocardial infarction in patients with ACS complicated with hyperlipidemia after discharge.

关 键 词：急性冠状动脉综合征 高脂血症 血栓弹力图 预后研究 

分 类 号：R541.4[医药卫生—心血管疾病]