血流储备分数和静息全周期比值在急性冠脉综合征患者血运重建后远期预后风险中的评估效能  

Study on the evaluation efficacy of FFR and RFR in long-term prognostic risk of acute coronary syndrome patients after revascularization

作　　者：吕峰峰[1] 赵磊[1] 吕元杰 张亚男 滕震 Lyu Fengfeng;Zhao Lei;Lyu Yuanjie;Zhang Yanan;Teng Zhen(Department of Cardiology,Cangzhou Central Hospital,Cangzhou 061000,China)

机构地区：[1]沧州市中心医院心内一科,河北沧州061000

出　　处：《中国急救医学》2025年第2期134-140,共7页Chinese Journal of Critical Care Medicine

基　　金：沧州市科技计划(222106008)。

摘　　要：目的研究血流储备分数(FFR)和静息全周期比值(RFR)在急性冠脉综合征(ACS)患者血运重建后远期预后风险中的评估效能。方法选取2022年1月至2023年10月于沧州市中心医院就诊且行血运重建治疗的389例ACS患者,治疗前均测定FFR和RFR值,治疗结束随访12~36个月,根据ACS患者血运重建后远期预后是否发生主要心血管不良事件(MACE)分为预后不良组(发生MACE,n=165)和预后良好组(未发生MACE,n=224)。比较两组临床资料及血运重建前后FFR和RFR值差异,利用Cox回归分析影响患者远期预后MACE发生的危险因素,使用受试者工作特征(ROC)曲线和Kaplan-Meier曲线分析FFR和RFR对ACS患者血运重建后远期预后MACE发生风险的评估价值。结果389例ACS患者均完成整个随访,165例患者发生MACE,发生率为42.42%,预后不良组血运重建前后FFR和RFR均低于预后良好组(P<0.05)。Cox回归分析发现,年龄、冠心病家族史、糖尿病、心功能Killip分级、淋巴细胞(LY)、Gensini评分、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、脑钠肽(BNP)、FFR及RFR均是导致患者ACS患者血运重建后远期预后发生MACE的危险因素(P均<0.05)。血运重建前FFR、血运重建后FFR、血运重建前RFR和血运重建后RFR单独预测患者远期预后的曲线下面积(AUC)分别为0.835、0.886、0.859和0.901,当截断值分别取0.69、0.75、0.78和0.84时获得最佳预测效能,进一步分析两项联合预测效能显示,血运重建前后FFR和RFR联合预测患者远期预后的AUC为0.925,预测效能显著提高,即敏感度和特异度分别为0.901和0.855。低FFR1组、低FFR2组、低RFR1组、低RFR2组患者MACE发生风险更高(P<0.05)。结论FFR和RFR与ACS患者血运重建后远期预后有关,可用于预后MACE风险的评估。Objective To study the evaluation efficacy of fractional flow reserve(FFR)and resting full-cycle ratio(RFR)in long-term prognostic risk of the patients with acute coronary syndrome(ACS)after revascularization.Methods A total of 389 ACS patients who received revascularization treatment in Cangzhou Central Hospital from January 2022 to October 2023 were selected.FFR and RFR were measured before treatment,and follow-up was conducted for 12 to 36 months after treatment.Based on whether major adverse cardiovascular events(MACE)occurred in the long-term prognosis of ACS patients after revascularization,they were divided into a poor prognosis group(with MACE occurrence,n=165)and a good prognosis group(without MACE occurrence,n=224).The differences in FFR and RFR before and after revascularization and clinical data between two groups were compared,and Cox regression analysis was used to identify the risk factors affecting MACE occurrence in ACS patients.Receiver operating characteristic(ROC)curve and Kaplan-Meier curve were used to analyze the value of FFR and RFR in evaluating the risk of MACE occurrence for long-term prognosis of ACS patients after revascularization.Results All 389 ACS patients included in the study completed the entire follow-up,and 165 patients had MACE with an incidence rate of 42.42%.The FFR and RFR of the poor prognosis group before and after revascularization were lower than those of the good prognosis group(P<0.05).Cox regression analysis found that age,family history of coronary heart disease,diabetes,Killip grade of cardiac function,lymphocyte(LY),Gensini score,interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),brain natriuretic peptide(BNP),FFR,RFR were all risk factors for MACE in the long-term prognosis of ACS patients after revascularization(P<0.05).The area under curve(AUC)of FFR before revascularization,FFR after revascularization,RFR before revascularization and RFR after revascularization for predicting the long-term prognosis of patients was 0.835,0.886,0.859 and 0.901,respectively.

关 键 词：急性冠脉综合征 血运重建 远期预后风险 血流储备分数 静息全周期比值 

分 类 号：R54[医药卫生—心血管疾病]