GRACE评分联合血栓弹力图对急性冠脉综合征患者主要心血管不良事件的早期预测价值  

The early predictive value of GRACE score combined with thromboelastography for major adverse cardiovascular events in patients with acute coronary syndrome

作　　者：王凯阳[1] 闵轩 宁怡 马依彤[1] 谢翔[1] WANG Kaiyang;MIN Xuan;NING Yi;MA Yitong;XIE Xiang(Department of Cardiology,First Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang 830011,China)

机构地区：[1]新疆医科大学第一附属医院心脏中心,新疆乌鲁木齐830011

出　　处：《石河子大学学报（自然科学版）》2022年第3期383-389,共7页Journal of Shihezi University(Natural Science)

基　　金：国家自然科学基金项目(81770235)。

摘　　要：目的 探讨GRACE评分联合血栓弹力图(TEG)对急性冠脉综合征(ACS)患者主要心血管不良事件(MACEs)的早期预测价值。方法 选取新疆医科大学第一附属医院自2018年1月至2018年12月期间收治的632例ACS患者作为研究对象,收集临床资料及TEG相关指标,并逐一进行GRACE评分。所有研究对象接受定期随访,最终有590名ACS患者纳入本次研究。根据是否发生MACEs,分为事件组和非事件组。分析比较两组间基线资料、TEG指标及GRACE评分的差异;应用二元Logistics回归分析确定早期MACEs的独立危险因素;绘制受试者工作特征(ROC)曲线评估GRACE评分联合TEG相关指标对早期MACEs的预测价值。结果 事件组年龄、K时间、MA值、GRACE评分、Gensini评分较非事件组显著升高,差异具有统计学意义(P<0.05);二分类Logistic单因素回归分析显示:性别、K时间、MA值、GRACE评分以及Gensini评分是ACS患者早期MACEs的危险因素(P<0.05)。筛选P<0.1的变量以及年龄、吸烟史等可能对结局产生偏倚的因素进行Logistic多因素回归分析,结果显示:K时间(OR=8.434, 95%CI:3.968-17.928,P<0.001)、MA值(OR=1.450, 95%CI:1.278-1.644,P<0.001)、GRACE评分(OR=1.135, 95%CI:1.079-1.194,P<0.001)以及Gensini评分(OR=1.027, 95%CI:1.010-1.044,P=0.002)是ACS患者早期MACEs发生的独立危险因素;GRACE评分、K时间、MA值的ROC曲线下面积分别为0.928、0.910、0.911,阈值分别为122.50分、3.55 min、58.15 mm;敏感度分别为85.60%、74.40%、91.20%;特异度分别为88.10%、90.70%、82.10%;K时间+MA值、K时间+GRACE评分、MA值+GRACE评分ROC曲线下面积AUC分别为0.983、0.973、0.978,阈值分别为0.497、0.365、0.175;灵感度分别为90.00%、89.40%、95.60%;特异度分别为96.50%、95.10%、88.80%;三项指标联合预测模型的ROC曲线下面积AUC为0.995(95%CI=0.991-0.998)、阈值为0.499、灵感度为95.00%、特异度为98.40%。结论 TEG中K时间和MA值是ACS患者早期MACEs的独立危险因素Objective To explore the early predictive value of GRACE score combined with thromboelastography(TEG) for the major adverse cardiovascular events(MACEs) in patients with acute coronary syndrome(ACS). Methods A total of 632 ACS patients admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2018 to December 2018 were selected as subjects, clinical data and TEG-related indicators were collected, and GRACE scores were performed one by one. All subjects were followed up regularly, and 590 ACS patients were finally included in this study. According to the occurrence of MACEs, it is divided into event group and non-event group. The differences in baseline data, TEG indicators and GRACE scores between the two groups were compared;Logistic regression analysis was used to determine independent risk factors for MACEs;receiver operating characteristic(ROC) curves were used to evaluate the predictive value of GRACE score combined with TEG related indicators on MACEs. Results In the event group, age, K time, MA value, GRACE score, and Gensini score were significantly higher than those in the non-event group, and the difference was statistically significant(P<0.05);Univariate Logistic regression analysis showed that gender, K time, MA value, GRACE score and Gensini score were risk factors for early MACEs in ACS patients(P<0.05). Factors with P<0.1 and factors that may bias the outcome, such as age and smoking, were included in the multivariate Logistic regression analysis. The results showed: K time(OR=8.434, 95%CI: 3.968-17.928, P<0.001), MA value(OR=1.450, 95%CI: 1.278-1.644, P<0.001), GRACE score(OR=1.135, 95%CI: 1.079-1.194, P<0.001) and Gensini score(OR=1.027, 95%CI: 1.010-1.044, P=0.002) were independent risk factors for early MACEs in ACS patients;The areas under ROC curve of GRACE score, K time and MA value were 0.928, 0.910 and 0.911, the thresholds were 122.50 points, 3.55 min and 58.15 mm, and the sensitivity were 85.60%, 74.40% and 91.20%, respectively, the specificity were 88.10%, 90

关 键 词：GRACE评分 血栓弹力图 急性冠脉综合征 主要心血管不良事件 

分 类 号：R541[医药卫生—心血管疾病]