血清D-二聚体、纤维蛋白原检测联合血栓弹力图对急性心肌梗死预后的评估价值  

Prognostic value of serum D-dimer and fib combined with thromboelastography in acute myocardial infarction

作　　者：邓容 李广权 苟甜甜 张林 陈欢 DENG Rong;LI Guangquan;GOU Tiantian;ZHANG Lin;CHEN Huan(Department of Laboratory Medicine,363 Hospital, Chengdu 610000, China)

机构地区：[1]三六三医院检验科,四川成都610000

出　　处：《西部医学》2022年第7期1056-1060,共5页Medical Journal of West China

基　　金：四川省卫生和计划生育委员会科研课题(17PJ528)。

摘　　要：目的 探讨血清D-二聚体(D-D)、纤维蛋白原(Fib)检测联合血栓弹力图(TEG)对急性心肌梗死(AMI)预后的评估价值。方法 选取2018年8月~2021年2月我院收治的AMI患者126例,所有患者均接受经皮冠状动脉介入(PCI)治疗,根据患者随访期间是否发生主要心血管不良事件(MACE)将患者分为预后不良组(n=41)和预后良好组(n=85)。比较两组患者的一般临床资料、血清D-D、Fib和TEG指标,分析D-D、Fib和TEG指标的相关性,采用受试者工作特征曲线(ROC)分析D-D、Fib和TEG指标对AMI患者预后的评估价值。结果 预后不良组患者的收缩压(SBP)、舒张压(DBP)水平明显小于预后良好组,心率(HR)明显高于预后良好组(均P<0.05);预后不良组患者的血清D-D、Fib水平高于预后良好组,两组患者的TEG指标凝血反应时间(R)、凝血形成速率(Angle角)、血栓最大振幅值(MA)和凝血综合指数(CI)比较,差异有统计学意义(均P<0.05)。Logistic回归分析结果显示,血清D-D、Fib、R、Angle角、MA和CI是影响患者预后的独立危险因素(P<0.05);相关性分析结果显示,D-D与R呈负相关,与Angle角、MA值和CI均呈正相关(P<0.05);Fib与MA值、CI呈正相关(P<0.05)。ROC曲线分析结果显示,D-D、Fib、R、Angle角、MA值和CI评估AMI患者预后的AUC值分别为0.838、0.824、0.791、0.780、0.808、0.677,联合检测的AUC值为0.863,对AMI患者预后的评估有统计学意义(均P<0.05)。结论 血清D-D、Fib和TEG指标的变化与AMI患者PCI术后MACE发生存在相关性,对AMI患者预后不良的评估具有一定临床价值。Objective To explore the prognostic value of serum D-dimer(D-D)and fibrinogen(Fib)combined with thromboelastography(TEG)in acute myocardial infarction(AMI).Methods A total of 126 patients with AMI treated by percutaneous coronary intervention(PCI)in the hospital from August 2018 to February 2021 were selected.According to the presence or absence of major adverse cardiovascular events(MACE),the patients were divided into poor prognosis group(with MACE during follow-up,n=41)and good prognosis group(without MACE during follow-up,n=85).The general clinical data,serum D-D,Fib and TEG indicators of the two groups were compared.The correlation of D-D,Fib and TEG indicators was analyzed.The receiver operating characteristic(ROC)curve was used to analyze the prognostic value of D-D,Fib and TEG indicators in patients with AMI.Results The systolic blood pressure(SBP)and diastolic blood pressure(DBP)of the poor prognosis group were significantly lower than those of the good prognosis group,while heart rate(HR)were significantly higher than those of the good prognosis group(P<0.05).Serum D-D and Fib levels in the poor prognosis group were higher than those in the good prognosis group.The TEG indicators coagulation reaction time(R),coagulation formation rate(Angle angle),maximum amplitude of thrombus(MA)and coagulation index(CI)showed statistically significant differences between the two groups(P<0.05).Logistic regression analysis showed that serum D-D,FIB,R,angle,Ma and CI were independent risk factors for prognosis(P<0.05).Correlation analysis results showed that D-D was negatively correlated with R,and was positively correlated with Angle angle,MA value and CI(P<0.05).Fib was positively correlated with MA value and CI(P<0.05).ROC curve analysis showed that the AUC values of D-D,Fib,R,Angle angle,MA value and CI for prognosis of patients with AMI were 0.838,0.824,0.791,0.780,0.808,and 0.677,respectively.The AUC value of combined detection was 0.863(P<0.05).Conclusion The changes of serum D-D,Fib and TEG indicators are correl

关 键 词：急性心肌梗死 D-二聚体 纤维蛋白原 血栓弹力图 预后 

分 类 号：R542.2+2[医药卫生—心血管疾病]