血栓弹力图参数联合ApoA1、ApoB水平对冠心病PCI术预后的预测价值  

Prognostic value of thromboelastography combined with serum apolipoprotein A1 and apolipoprotein B levels in patients undergoing elective percutaneous coronary intervention

作　　者：刘鹏 林芳 吴屹 LIU Peng;LIN Fang;WU Yi(Mianyang Central Hospital,School of Medicine,University of Electronic Science and Technology of China,Mianyang Sichuan 621000,China)

机构地区：[1]电子科技大学医学院附属绵阳医院·绵阳市中心医院,四川绵阳621000

出　　处：《中国急救复苏与灾害医学杂志》2024年第5期599-602,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：2020年四川省卫生健康委员会科研课题(编号:20PJ264)。

摘　　要：目的探讨血栓弹力图(TEG)参数联合血清载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)水平对冠心病择期经皮冠状动脉介入(PCI)术预后的预测方法。方法选取2020年1月—2023年6月于绵阳市中心医院接受PCI治疗的共106例患者,根据预后分为两组,其中预后不良组33例,预后良好组73例。回顾性收集分析患者资料,采用受试者工作特征(ROC)曲线评估TEG参数联合血清ApoA1、ApoB水平的预测价值。结果预后不良组凝血反应时间(R)值、凝固时间(K)值较预后良好组短,而Angel角(α)、图中两侧曲线的最宽距离(MA)值、血栓弹力图(ε)值高于预后良好组,最大凝固时间(m)值较预后良好组长(P<0.05);预后不良组ApoA1水平低于预后良好组,ApoB水平高于预后良好组(P<0.05);多因素Logistics回归分析显示,TEG参数中的R值、K值与血清ApoA1、ApoB均是患者PCI术预后的独立影响因素(P<0.05);ROC曲线分析结果显示,R值、K值、血清ApoA1及其ApoB联合预测的曲线下面积(AUC)分别为0.627、0.709、0.755、0.712、0.788,联合预测的AUC优于各单项指标,敏感度、特异度分别为100.00%、84.93%。结论TEG参数R值与K值、血清ApoA1、ApoB均是冠心病者PCI术预后的独立影响因素,其联合预测冠心病患者PCI术后预后不良时有较好的敏感度,在特异度上的优势也值得临床关注。Objective To investigate the prognostic method for patients with coronary heart disease after elective percutaneous coronary intervention(PCI).Methods A total of 106 patients who received PCI in Mianyang Central Hospital from January 2020 to June 2023 were selected.According to the prognosis,they were divided into two groups,with 33 cases in the poor prognosis group and 73 cases in the good prognosis group.Retrospective collection and analysis of patient data were conducted,and the predictive value of TEG combined with serum ApoA1 and ApoB levels was evaluated using ROC curve analysis.Results The coagulation reaction time(R)and coagulation time(K)values of the poor prognosis group were shorter than those of the good prognosis group,while AngelαAngle,the widest distance(MA)value of the curves on both sides of the graph,and the thrombus elasticity graph(ε)The value was higher than that of the group with good prognosis,and the maximum coagulation time(m)value was longer than that of the group with good prognosis(P<0.05).The ApoA1 level in the poor prognosis group was lower than that in the good prognosis group,while the ApoB level was higher than that in the good prognosis group(P<0.05).Multivariate logistic regression analysis indicated that R value,K value,and serum ApoA1 among the TEG parameters were protective factors for post PCI prognosis(P<0.05).The ROC curve analysis results showed that the area under the curve(AUC)of R value,K value,serum ApoA1,and their combined prediction were 0.627、0.709、0.755、0.712、0.788,respectively.The AUC predicted by the combined prediction was superior to all individual indicators,with sensitivity and specificity of 100.00%and 84.93%.Conclusion The TEG parameter R value and K value,as well as serum ApoA1,are protective factors affecting the prognosis of coronary heart disease patients after PCI.The combined prediction of these factors has good sensitivity and clinical importance in identifying adverse prognosis after PCI in coronary heart disease patients.

关 键 词：冠心病 经皮冠状动脉介入 预后 血栓弹力图 载脂蛋白A1 载脂蛋白B 

分 类 号：R541[医药卫生—心血管疾病] R445.9[医药卫生—内科学]