PLT/TBIL对冠心病患者PCI术后临床结局的预测价值  

Predictive value of PLT/TBIL on clinical outcome after PCI in patients with coronary heart disease

作　　者：王玎羽 谢翔[2] 赵东英[3] 肖雅文 薛晓燕 WANG Dingyu;XIE Xiang;ZHAO Dongying;XIAO Yawen;XUE Xiaoyan(Department of Education,Space Central Hospital,Beijing 100049,China;Heart Center,First Affiliated Hospital of Xinjiang Medical University,Urumchi,Xinjiang 830011;National Tax Administration Outpatients Department,Second Affiliated Hospital of Tsinghua University,Beijing 100040,China;Department of Anesthesiology,Affiliated Beijing Jintan Hospital,Capital Medical University,Beijing 100038,China;Department of Intensive Care Medicine,Space Central Hospital,Beijing 100049,China)

机构地区：[1]航天中心医院教育处,北京100049 [2]新疆医科大学第一附属医院心脏中心,乌鲁木齐830011 [3]清华大学第二附属医院国税总局门诊部,北京100040 [4]首都医科大学附属北京世纪坛医院麻醉科,北京100038 [5]航天中心医院重症医学科,北京100049

出　　处：《重庆医学》2022年第14期2432-2436,2440,共6页Chongqing medicine

基　　金：新疆维吾尔自治区科技支疆项目(2019E0278)。

摘　　要：目的探讨血小板(PLT)/总胆红素(TBIL)对经皮冠状动脉介入(PCI)术后患者临床结局的预测价值。方法回顾性分析2008-2017年在新疆医科大学第一附属医院心脏中心就诊,经冠状动脉造影确诊为冠心病(CHD)并行PCI的患者共6050例,因失访等原因,最终纳入5825例。依据主要不良心脑血管事件(MACCE)、不良心血管事件(MACE)的发生率计算并确定PLT/TBIL临界值(cut-off值)为19.625,根据该临界值将患者分为PLT/TBIL<19.625组和≥19.625组,并进行长时间的随访,观察CHD患者PCI术后的临床结局。分析比较随访期间两组MACCE、MACE、心源性死亡(CM)及全因性死亡(ACM)发生率,COX比例风险模型分析发生MACCE、MACE、ACM、CM的独立危险因素。结果该研究的随访时间为(28.47±7.45)个月,在此期间共发生MACCE 824例,其中PLT/TBIL<19.625组396例,PLT/TBIL≥19.625组428例。Kaplan-Meier分析显示PLT/TBIL≥19.625组患者MACCE发生率明显高于PLT/TBIL<19.625组(P<0.05)。COX多因素分析显示,PLT/TBIL(OR=1.404,95%CI:1.221~1.614)、性别(OR=0.819,95%CI:0.684~1.980)、糖尿病(OR=1.200,95%CI:1.014~1.421)、高血压(OR=1.378,95%CI:1.193~1.591)是影响CHD患者PCI术后临床结局的影响因素(P<0.05)。PLT/TBIL预测的ROC曲线下面积(AUC)为0.532(95%CI:0.514~0.557,P<0.05),cut-off值为19.625,灵敏度为52.90%,特异度为54.55%。结论PLT/TBIL能预测CHD患者PCI术后的临床结局。Objective To evaluate the predictive value of platelet(PLT)/total bilirubin(TBIL)in the clinical outcome of the patients after percutaneous coronary intervention(PCI).Methods The retrospective analysis was performed on 6050 patients with coronary heart disease(CHD)diagnosed by coronary angiography and undergoing PCI in the Heart Center of First Affiliated Hospital of Xinjiang Medical University during 2008-2017,and 5825 cases were finally included due to loss to follow-up and other reasons.The critical value(cut-off value)of PLT/TBIL was calculated according to the occurrence rates of the major adverse cardiovascular and cerebrovascular events(MACCE)and major adverse cadiovascular events(MACE),which was determined as 19.625.According to this critical value,the patients were divided into the PLT/TBIL<19.625 group and PLT/TBIL≥19.625 group.The long time follow up was performed to observe the clinical outcome after PCI in the patients with CHD.The incidence rates of MACCE,MACE,cardiac mortality(CM)and all-cause mortality(ACD)during the follow-up period were analyzed and comapred between the two groups,and the Cox proportional hazard model was used to analyze the independent risk factors for MACCE,MACE,ACM,and CM.Results The follow-up time in this study was(28.47±7.45)months,and 824 cases of MACCE occurred during this period,including 396 cases(6.80%)in the PLT/TBIL<16.625 group,and 428 cases in the PLT/TBIL≥16.625 group.The Kaplan-Meier analysis showed that the incidence rate of MACCE in the PLT/TBIL≥19.625 group was significantly higher than that in the PLT/TBIL<19.625 group(P<0.05).The Cox multivariate analysis showed that PLT/TBIL(OR=1.404,95%CI:1.221-1.614),gender(OR=0.819,95%CI:0.684-1.980),diabetes(OR=1.200,95%CI:1.014-1.421)and hypertension(OR=1.378,95%CI:1.198-1.591)were the independent risk factors affecting the clinical outcome after PCI in the patients with CHD(P<0.05).The area under the ROC curve(AUC)of PLT/TBIL prediction was 0.532(95%CI:0.514-0.557,P<0.05)and the cut-off value was 19.625,the sen

关 键 词：冠状动脉疾病 经皮冠状动脉介入 血小板/总胆红素 主要不良心脑血管事件 

分 类 号：R541.4[医药卫生—心血管疾病]