纤维蛋白原浓度对择期经皮冠状动脉介入术后心肌损伤及临床预后的预测价值

doi:10.3969/j.issn.1674-490X.2015.01.005

医学研究与教育 ›› 2015, Vol. 32 ›› Issue (1): 21-25.DOI: 10.3969/j.issn.1674-490X.2015.01.005

纤维蛋白原浓度对择期经皮冠状动脉介入术后心肌损伤及临床预后的预测价值

张伟¹，崔杏仙²，李靖³，张彩虹⁴，李海涛⁵，徐占稳³

1. 河北大学附属医院泌尿外科，河北保定 071000；2. 保定市耳鼻喉专科医院，河北保定 071000；3. 河北大学附属医院心脏内二科，河北保定 071000；4. 雄县昝岗镇卫生院，河北雄县 071800；5. 徐水县华北第一医院内一科，河北徐水 072550

出版日期:2015-02-25 发布日期:2015-02-25
通讯作者: 徐占稳（1978—），男，河北保定人，主治医师，硕士，主要从事冠心病诊治及介入治疗研究。E-mail: dannyxzw@163.com
作者简介:张伟（1976—），男，河北保定人，副主任医师，硕士，主要从事泌尿外科以及介入治疗研究。E-mail: zw001100@sina.com

Predictive value of fibrinogen concentration on post procedural myocardial injury and clinical prognosis following selective percutaneous coronary intervention

ZHANG Wei¹, CUI Xingxian², LI Jing³, ZHANG Caihong⁴, LI Haitao⁵, XU Zhanwen³

1. Department of Urology, Affiliated Hospital of Hebei University, Baoding 071000, China; 2. Baoding Minsheng ENT Specialist Hospital, Baoding 071000, China; 3. Department of Cardiology, Affiliated Hospital of Hebei University, Baoding 071000, China; 4. Xiongxian Zangang Hospital, Xiongxian 071800, Chian; 5. Xushui NorthChina No.1 Hospital, Xushui 072550, China

Online:2015-02-25 Published:2015-02-25

摘要/Abstract

摘要： 目的探讨血浆纤维蛋白原（fibrinogen，FIB）水平是否对于经皮冠脉介入（percutaneous coronary intervention，PCI）后心肌损伤及其临床预后具有预测价值。方法选取拟行择期PCI的患者，术前测定FIB 水平，应用ROC 曲线分析，选取灵敏度与特异度之和为最大值的点为最佳界值点，分析其对患者术后心肌损伤是否具有预测价值并划定界值水平；依据界值将患者分为 2 组，比较 2 组间术后心肌损伤发生率以及心肌肌钙蛋 I（cTnI）浓度；随访 1 年，观察2 组间不良心血管事件是否存在差异。结果术前 FIB 水平对 PCI 术后心肌损伤具有预测价值（Area Under Curve，AUC= 0.782，P<0.001）。FIB 界值划定为 3.85 g/L，灵敏度为 65.53%，特异度为 78.54%。FIB<3.85 g/L 组与 FIB ≥3.85 g/L组的心肌损伤发生率差异有统计学意义（13.93% vs 52.81%，χ² =36.959，P<0.001）；FIB≥3.85 g/L 组的术后 cTnI 水平较高[（0.25±0.67） ng/mL vs （0.55±0.65） ng/mL，t=-3.129，P=0.002]。2 组间不良心血管事件差异有统计学意义（Log Rank P=0.025）；FIB≥3.85 g/L 显著增加不良心血管事件发生（HR=2.069，95%CI：1.056～4.054）。结论术前 FIB 浓度对于择期 PCI 术后心肌损伤以及临床预后具有预测价值

关键词: 纤维蛋白原, 经皮冠状动脉介入术, 心肌损伤

Abstract: Objective To explore whether the fibrinogen (FIB) level can predict post procedural myocardial injury and clinical prognosis after percutaneous coronary intervention (PCI). Methods FIB level was measured preopratively in patients scheduled to undergo PCI to analyze its predictive value of postoperative myocardial injury. ROC analysis was performed to determine the cutoff point, at which sensitivity and specificity would be maximal. Based on the boundary value, the study subjects were divided into two groups. Compared the incidence of postoperative myocardial injury and cTnI concentration between two groups, and observed if there any differences. Follow-up of 1 year, surveyed if the adverse cardiovascular events had any differences. Results The preoperative FIB level had predictive value for myocardial injury of post-PCI (Area Under Curve, AUC =0.782, P<0.001). FIB boundary value was 3.85 g/L, sensitivity 65.53%, specificity 78.54%. The incidence of myocardial injury had a significant difference between the FIB <3.85 g/L group and FIB≥3.85 g/L group(13.93% VS 52.81%, χ²=36.959, P<0.001). The cTnI levels of postoperative was higher in the FIB≥3.85 g/L group[(0.25±0.67) ng/mL vs (0.55±0.65) ng/mL, t=-3.129, P=0.002]. The incidence of adverse cardiovascular events had statistical differences between the two groups(Log Rank P=0.025). FIB≥3.85 g/L led to a significant increase in adverse cardiovascular events (HR=2.069, 95%CI: 1.056-4.054). Conclusion The preoperative fibrinogen concentration has predictive values on post procedural myocardial injury and clinical outcomes on patients underwent selective PCI.

Key words: fibrinogen, percutaneous coronary intervention, myocardial injury

中图分类号:

张伟，崔杏仙，李靖，张彩虹，李海涛，徐占稳. 纤维蛋白原浓度对择期经皮冠状动脉介入术后心肌损伤及临床预后的预测价值[J]. 医学研究与教育, 2015, 32(1): 21-25.

ZHANG Wei, CUI Xingxian, LI Jing, ZHANG Caihong, LI Haitao, XU Zhanwen. Predictive value of fibrinogen concentration on post procedural myocardial injury and clinical prognosis following selective percutaneous coronary intervention[J]. Medical Reserch and Education, 2015, 32(1): 21-25.

参考文献

[1] FELDMAN D N, KIM L, RENE A G, et a1. Prognostic value of cardiac troponin-I or Troponin-T elevation following nonemergent percutaneous coronary intervention: a meta-analysis[J]. Catheter Cardiovasc Interv, 2011, 77(7): 1020-1030.
[2] ANG L, THANI K B, ILAPAKURTI M, et al. Elevated plasma fibrinogen rather than residual platelet reactivity after clopidogrel pre-treatment is associated with an increased ischemic risk during elective percutaneous coronary intervention[J]. J Am Coll Cardiol, 2013, 61(1): 23-34.
[3] Fibrinogen Study Collaboration. Plasma fibrinogen level and the risk of major cardiovascular diseases and nonvascular mortality: an individual participant meta-analysis[J]. JAMA, 2005, 294(14): 1799-1809.
[4] THYGESEN K, ALPERT J S, JAFFE A S, et al. Third universal definition of myocardial infarction[J]. Eur Heart J, 2012, 33(20): 2551-2567.
[5] TRICOCI P, LEONARDI S, WHITE J, et al. Cardiac troponin after percutaneous coronary intervention and 1-year mortality in non-ST-segment elevation acute coronary syndrome using systematic evaluation of biomarker trends [J]. J Am Coll Cardiol, 2013, 62(3): 242-251.
[6] DAVALOS D, AKASSOGLOU K. Fibrinogen as a key regulator of inflammation in disease[J]. Semin Immunopathol, 2012, 34(1): 43-62.
[7] TSIKARIS V. The anti-platelet approach targeting the fibrinogen ligand of the GPⅡB/Ⅲa receptor[J]. J Pept Sci, 2004, 10(10): 589-602.
[8] MAHMUD E, CAVENDISH J J, TSIMIKAS S, et al. Elevated plasma fibrinogen level predicts suboptimal response to therapy with both single- and double-bolus eptifibatide during percutaneous coronary intervention[J]. J Am Coll Cardiol, 2007, 49(22): 2163-2171.
[9] 鲁静朝, 崔炜, 都军, 等. 术前血浆 D-二聚体含量对择期经皮冠状动脉介入治疗术后心肌损伤的预测价值[J]. 中国循环杂志, 2004, 19(3): 180-182.

纤维蛋白原浓度对择期经皮冠状动脉介入术后心肌损伤及临床预后的预测价值

Predictive value of fibrinogen concentration on post procedural myocardial injury and clinical prognosis following selective percutaneous coronary intervention

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 1

编辑推荐

Metrics

本文评价