冠心病患者PCI术后凝血纤溶指标变化及MACE影响因素分析  

Changes of coagulation and fibrinolysis indexes and influencing factors for MACE in patients with coronary heart disease after PCI

作　　者：吕皓 吕坚 LYU Hao;LYU Jian(Department of Laboratory Medicine,Lishui Second People's Hospital,Lishui 323000,China)

机构地区：[1]丽水市第二人民医院检验科,323000

出　　处：《心电与循环》2025年第1期41-45,共5页Journal of Electrocardiology and Circulation

摘　　要：目的分析冠心病(CHD)患者经皮冠状动脉介入治疗(PCI)术后凝血纤溶指标变化及主要不良心血管事件(MACE)影响因素。方法回顾性选取2017年1月至2023年5月在丽水市第二人民医院接受PCI的2320例CHD患者为研究对象,比较PCI前后凝血指标[包括凝血酶原时间(PT)、活化部分凝血活酶时间、纤维蛋白原(Fib)、D-二聚体(D-D)]及纤溶指标[包括凝血酶抗凝血酶复合物、血浆可溶性凝血酶调节蛋白(sTM)、纤溶酶-纤溶酶抑制物复合物(PAP)]。比较MACE组与无MACE组临床资料,采用多因素logistic回归分析CHD患者PCI术后发生MACE的影响因素。结果CHD患者PCI术后各项凝血纤溶指标均明显低于术前(均P<0.01)。CHD患者PCI术后12个月发生MACE 39例,MACE组与无MACE组患者在年龄、合并高血压、吸烟、术前Killip分级、术前左心室射血分数(LVEF)、术前估算肾小球过滤率、Fib、D-D、sTM、PAP等方面比较,差异均有统计学意义(均P<0.05);术前LVEF降低(OR=2.646)、术后Fib升高(OR=3.080)、术后sTM升高(OR=3.010)均是CHD患者PCI术后发生MACE的独立危险因素(均P<0.05)。结论CHD患者PCI术后各项凝血纤溶指标均明显降低,且术前LVEF降低和术后Fib、sTM升高均与MACE发生风险有关。Objective To analyze changes of coagulation and fibrinolysis indexes and influencing factors for major adverse cardiovascular event(MACE)in patients with coronary heart disease(CHD)after percutaneous coronary intervention(PCI).Methods A total of 2320 patients with CHD underwent PCI in Lishui Second People's Hospital were retrospectively enrolled between January 2017 and May 2023.The coagulation indexes[prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(Fib),D-dimer(D-D)]and fibrinolysis indexes[thrombin-antithrombin complex(TAT),soluble thrombomodulin(sTM),and plasmin-antiplasmin complex(PAP)]were compared before and after PCI.The clinical data in MACE group and non-MACE group were compared.The influencing factors for MACE in CHD patients after PCI were analyzed by multivariate logistic regression analysis.Results After PCI,levels of coagulation and fibrinolysis indexes were significantly decreased in CHD patients(all P<0.01).Among CHD patients at 12 months after PCI,39 had MACE.There were significant differences between MACE group and non-MACE group in age,hypertension,smoking,preoperative Killip grading,left ventricular ejection fraction(LVEF),estimated glomerular filtration rate,Fib,D-D,sTM and PAP(all P<0.05).Decreased LVEF before surgery(OR=2.646),increased Fib after surgery(OR=3.080)and increased sTM after surgery(OR=3.010)were all independent risk factors for MACE in CHD patients after PCI(all P<0.05).Conclusion The coagulation and fibrinolysis indexes are significantly decreased in CHD patients after PCI.Decreased LVEF before surgery,and increased Fib and sTM after surgery are all related to MACE risk.

关 键 词：冠心病 经皮冠状动脉介入治疗 纤维蛋白原 血浆可溶性凝血酶调节蛋白 主要不良心血管事件 

分 类 号：R541.4[医药卫生—心血管疾病]