D-二聚体预测ST段抬高型心肌梗死患者PCI术后的院内不良结局  

Prediction of D-dimer on the Adverse Outcomes in Hospital After Coronary Intervention for ST-segment Elevation Myocardial Infarction

作　　者：李恒立 周丽娜[2] 卢银苹 马艳伟 王路[1] 杨亚攀 Li Hengli;Zhou Lina;Lu Yinping(Department of Cardiology,Nanyang First People’s Hospital,Nanyang,Henan,473000,China)

机构地区：[1]南阳市第一人民医院心内科,河南南阳473000 [2]南阳市第一人民医院科教科,河南南阳473000 [3]阜外华中心血管病医院心内科,河南郑州450000

出　　处：《黑龙江医学》2025年第2期181-183,共3页Heilongjiang Medical Journal

基　　金：河南省医学科技攻关计划(联合共建)项目(LH⁃GJ20210098);南阳市科技计划项目(KJGG123)。

摘　　要：目的:根据D-二聚体(D-D)水平变化,了解D-D预测ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗术(PCI)治疗后院内不良结局情况,为临床提供最新可供参考的生物标志物。方法:回顾性分析2017年1月—2021年12月南阳市第一人民医院收治的595例STEMI患者的临床资料,根据D-D浓度按四分位数法将其分为Q1组(D-D<0.31μg/mL,n=138)、Q2组(0.31≤D-D<0.77μg/mL,n=158)、Q3组(0.77≤D-D<1.64μg/mL,n=150)及Q4组(D-D≥1.64μg/mL,n=149)。比较四组患者的一般资料;采用logistic回归分析探寻影响主要心血管不良事件(MACE)的危险因素;绘制受试者工作特性(ROC)曲线,通过曲线下面积(AUC)评价D-D预测MACE的能力。结果:四组患者吸烟、高血压、糖尿病情况比较,差异均无统计学意义(χ^(2)=3.504、5.259、5.263,P>0.05);四组患者年龄、性别、肌钙蛋白I(cTnI)水平、N末端B型利钠肽原(NT-ProBNP)水平、左室射血分数(LVEF)水平、D-D水平比较,差异均有统计学意义(F=24.331,χ^(2)=28.251,Z=193.668、130.641、74.775、556.719,P<0.001)。logistic回归分析结果显示,年龄、性别及D-D水平升高是影响MACE的危险因素。D-D的AUC为0.70(95%CI:0.64~0.75)。D-D预测MACE能力的临界值为1.27 mg/L,敏感性、特异性分别为0.65和0.80。结论:年龄、性别及D-D水平升高是影响接受PCI的STEMI患者院内MACE发生的危险因素。Objective:To investigate the ability of D-D and to predict in-hospital adverse outcomes after percutaneous coronary intervention(PCI)in patients with ST segment elevation myocardial infarction(STEMI)based on changes in D-dimer(D-D)levels,so as to provide a new biomarker for clinical reference.Methods:A retrospective screening of STEMI patients admitted to the First People’s Hospital of Nanyang City from January 2017 to December 2021 was conducted.Patients were divided into four groups according to D-D concentration.According to the D-D concentration,they were divided into group Q1(D-D<0.31 ug/mL,n=138),group Q2(0.31≤D-D<0.77 ug/mL,n=158),group Q3(0.77≤D-D<1.64 ug/mL,n=150)and group Q4(D-D≥1.64,n=150).AUC was drawn to evaluated MACE.Results:There was no significant difference in smoking,hypertension and diabetes among the four groups(χ^(2)=3.504,5.259,5.263;P>0.05).There were significant differences in age,sex,cTnI level,NT-ProBNP level,LVEF level and D-D level among the four groups(F=24.331;χ^(2)=28.251,Z=193.668,130.641,74.775,556.719;P<0.001).Logistic regression analysis showed that age,sex and D-D level were the risk factors for MACE.The AUC of D-D was 0.70(95%CI:0.64~0.75).Conclusion:Age,sex,and elevated D-D levels are risk factors for MACE in STEMI patients undergoing PCI.

关 键 词：D-二聚体 ST段抬高型心肌梗死 经皮冠状动脉介入治疗术 主要心血管不良事件 

分 类 号：R542.22[医药卫生—心血管疾病] R446[医药卫生—内科学]