D-二聚体、超敏肌钙蛋白I对急性脑梗死患者心脑血管事件预测价值的研究  

Study of predictive value of D-dimer and hypersensitive troponin I of cardiovascular and cerebrovascular events in patients with acute cerebral infarction

作　　者：王佳玉[1,2] 张佳 申园[2] 李晶津 魏欣[3] Wang Jiayu;Zhang Jia;Shen Yuan;Li Jingjin;Wei Xin(Neuro-cardiology Center,Tiantan Hospital Affiliated to Capital Medical University,Beijing 100050,China;Neurology Center,Tiantan Hospital Affiliated to Capital Medical University,Beijing 100050,China;Heart and Large Vessel Disease Center,Tiantan Hospital Affiliated to Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京天坛医院神经心脏中心,北京100050 [2]首都医科大学附属北京天坛医院神经病学中心,北京100050 [3]首都医科大学附属北京天坛医院心脏及大血管病中心,北京100050

出　　处：《心脑血管病防治》2023年第5期8-11,38,共5页CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT

摘　　要：目的探讨D-二聚体、超敏肌钙蛋白I对急性脑梗死患者缺血性心脑血管事件的预测价值。方法采用前瞻性研究,选取2014年11月至2015年5月于首都医科大学附属北京天坛医院因急性脑梗死就诊,病因急性脑卒中Org10172治疗试验分型为大动脉粥样硬化性脑卒中的患者。本研究共纳入急性脑梗死患者464例,平均随访(46.44±13.35)个月。根据是否发生主要终点事件进行分组,有事件组患者124例,无事件组患者340例。收集患者临床资料并进行随访,主要终点事件为再发脑梗死及急性缺血性心血管事件。结果有事件组男性、年龄、吸烟、美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin评分、血肌酐、估计肾小球滤过率、脑钠肽(BNP)、超敏肌钙蛋白I、D-二聚体与无事件组比较差异有统计学意义(t/z/χ^(2)=9.415、6.086、20.672、5.550、3.293、2.210、-5.365、-9.739、-14.399、-12.639,P<0.05)。进行多因素Cox回归分析发现,D-二聚体升高是再发脑梗死的预测因素(HR=4.318,95%CI=1.807~10.320,P<0.01),超敏肌钙蛋白I升高是急性缺血性心血管事件的预测因素(HR=3.924,95%CI=1.649~9.339,P<0.01)。男性、年龄、吸烟、BNP水平和NIHSS评分不是主要终点事件的预测因素。多因素Cox回归交互作用分析发现,D-二聚体升高及超敏肌钙蛋白I升高对主要终点事件的预测作用同其他因素不存在交互作用(P>0.05)。结论D-二聚体升高使急性脑梗死患者再发脑梗死风险增加4.3倍,超敏肌钙蛋白I升高使急性脑梗死患者发生急性缺血性心血管事件风险增加3.9倍。Objective To investigate the predictive value of D-dimer and hypersensitive troponin I in ischemic cardiac and cerebrovascular events in patients with acute cerebral infarction.Methods The prospective cohort study enrolled patients with acute cerebral infarction and classified by the Trial of Org 10172 in Acute Stroke Treatment as atherosclerotic stroke in Tiantan Hospital Affiliated to Capital Medical University from November 2014 to May 2015.A total of 464 patients with acute cerebral infarction were included,with a mean follow-up of(46.44±13.35)months.There were 124 patients in the event group and 340 patients in the no-event group according to whether the primary endpoint events occurred.Results Male,age,smoking,National Institutes of Health Stroke Scale(NIHSS)score,modified Rankin Scale(mRS)score,the levels of serum creatinine,estimated glomerular filtration rate(eGFR),brain natriuretic peptide(BNP),hypersensitivity troponin I(hs-cTnI)and D-dimer in the event group were statistically significant different from those in the no-event group(t/z/χ^(2)=9.415,6.086,20.672,5.550,3.293,2.210,-5.365,-9.739,-14.399,-12.639;P<0.05).Multivariate Cox regression analysis showed that the elevation of level of D-dimer was a predictor of recurrent cerebral infarction(HR=4.318,95%CI=1.807-10.320,P<0.01),and the elevation of level of hs-cTnI was a predictor of acute ischemic cardiovascular events(HR=3.924,95%CI=1.649-9.339,P<0.01).Male,age,smoking,BNP level and NIHSS score were not predictors of the primary endpoints.Multi-factor Cox regression interaction analysis found that,there was no interaction between the predictive effect of D-dimer or hs-cTnI and other factors on the primary end point events(P>0.05).Conclusion The elevation of level of D-dimer increases the risk of recurrent cerebral infarction in acute cerebral infarction patients by 4.3-fold,and the elevation of level of hs-cTnI increases the risk of acute ischemic cardiovascular events in acute cerebral infarction patients by 3.9-fold.

关 键 词：D-二聚体 超敏肌钙蛋白I 急性脑梗死 急性心血管事件 

分 类 号：R743.33[医药卫生—神经病学与精神病学]