血栓弹力图对经皮冠状动脉介入治疗患者预后的预测作用

doi:10.3969/j.issn.1673-8640.2015.06.006

摘要/Abstract

摘要： 目的

评估经皮冠状动脉介入治疗(PCI)患者术后血栓弹力图(TEG)指标对其预后的预测作用。

方法

收集115例PCI患者资料,根据其TEG报告中二磷酸腺苷(ADP)诱导的最大血块强度(MA-ADP)将患者分为MA-MDP<50mm组和≥50mm组,随访观测其1年后心血管不良事件和支架再梗死及再狭窄的发生率。

结果

根据MA-ADP分组的2组患者的临床基本情况差异无统计学意义(P>0.05)。Logistic回归分析显示MA-ADP是PCI术后患者心血管不良事件复发风险的危险因素[OR=3.547(95% CI: 1.10311.412), P=0.034]。与MA-ADP正常(<50mm)的患者相比,MA-ADP升高(≥50mm)的患者的心血管不良事件和支架内再梗死的发生率均明显升高(P均<0.05)。

结论

MA-ADP对PCI术后患者的预后有预测作用,MA-ADP=50mm可作为PCI术后患者心血管不良事件复发风险的判断切点。

关键词: 血栓弹力图, 经皮冠状动脉介入治疗, ADP诱导的最大血块强度, 心血管不良事件, 预后判断

Abstract: Objective

To evaluate the prognosis prediction of thrombelastography (TEG) in patients undergoing percutaneous coronary intervention (PCI).

Methods

The data from 115 patients undergoing PCI were collected, and the patients were classified into 2 groups according to maximum amplitude-adenosine diphosphate (MA-ADP), MA-MDP<50 mm group and MA-ADP≥50 mm group. The percentages of adverse cardiovascular events, reinfarction and restenosis were followed up for 1 year.

Results

There was no statistical significance in the clinical characteristics of the 2 groups (P>0.05). Logistic regression analysis showed that MA-ADP was the risk factor of adverse cardiovascular event recurrence in patients undergoing PCI (OR=3.547, 95% CI: 1.103-11.412, P=0.034). Compared with MA-ADP normal patients (<50mm), the incidences of adverse cardiovascular events and reinfarction in patients with high MA-ADP (≥50mm) significantly increased (P<0.05).

Conclusions

MA-ADP can predict the prognosis after PCI. MA-ADP=50 can be the cut-off point in the prognosis prediction of patients undergoing PCI.

Key words: Thrombelastography, Percutaneous coronary intervertion, Maximum amplitude-adenosine diphosphate, Adverse cardiovascular event, Prognosis prediction

中图分类号:

R446.11

顾梅秀, 孙林, 王蓓丽, 任孝慈, 姚珂, 郭玮, 潘柏申. 血栓弹力图对经皮冠状动脉介入治疗患者预后的预测作用[J]. 检验医学, 2015, 30(6): 571-574.

GU Meixiu, SUN Lin, WANG Beili, REN Xiaoci, YAO Ke, GUO Wei, PAN Baishen. Prognosis prediction of thrombelastography in patients undergoing percutaneous coronary intervention[J]. Laboratory Medicine, 2015, 30(6): 571-574.

图/表 4

参考文献 9

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MA-ADP (mm)	例数	年龄(岁)	性别[例(%)]	PPI [例(%)]	他汀类药物 [例(%)]	β受体阻断剂 [例(%)]	ACE抑制剂 [例(%)]
MA-ADP (mm)	例数	年龄(岁)	男	PPI [例(%)]	他汀类药物 [例(%)]	β受体阻断剂 [例(%)]	ACE抑制剂 [例(%)]	女
<50	101	65.4±9.5	91(90.1)	10(9.9)	1(1.0)	72(71.3)	76(75.2)	39(38.6)
≥50	14	68.4±13.1	10(71.4)	4(28.6)	0(0.0)	12(85.7)	10(71.4)	9(64.3)
P值		0.307	0.068	0.999	0.346	0.749	0.068
MA-ADP (mm)	例数	高血压 [例(%)]	糖尿病 [例(%)]	吸烟 [例(%)]	CVD [例(%)]	血脂异常 [例(%)]	STEMI [例(%)]	左前降支梗死 [例(%)]
<50	101	68(67.3)	31(30.7)	55(54.5)	6(5.9)	10(9.9)	39(38.6)	61(60.4)
≥50	14	8(57.1)	4(28.6)	7(50.0)	0(0.0)	1(7.1)	8(57.1)	8(57.1)
P值		0.451	0.999	0.782	0.999	0.999	0.186	0.816
MA-ADP (mm)	例数	回旋支梗死 [例(%)]	右冠状动脉梗死 [例(%)]	TIMI分级 [例(%)]	支架数	支架长度 (mm)	左心室射血分数(%)	PLT (×10⁹/L)
<50	101	28(27.7)	32(31.7)	99(98.0)	1.9±1.0	51.3±29.3	62.0±9.4	192.9±57.2
≥50	14	5(35.7)	7(50.0)	14(100.0)	1.9±0.9	51.0±26.6	58.2±9.9	183.4±72.1
P值		0.536	0.175	0.999	0.966	0.969	0.160	0.572

MA-ADP (mm)	例数	年龄(岁)	性别[例(%)]	PPI [例(%)]	他汀类药物 [例(%)]	β受体阻断剂 [例(%)]	ACE抑制剂 [例(%)]
MA-ADP (mm)	例数	年龄(岁)	男	PPI [例(%)]	他汀类药物 [例(%)]	β受体阻断剂 [例(%)]	ACE抑制剂 [例(%)]	女
<50	101	65.4±9.5	91(90.1)	10(9.9)	1(1.0)	72(71.3)	76(75.2)	39(38.6)
≥50	14	68.4±13.1	10(71.4)	4(28.6)	0(0.0)	12(85.7)	10(71.4)	9(64.3)
P值		0.307	0.068	0.999	0.346	0.749	0.068
MA-ADP (mm)	例数	高血压 [例(%)]	糖尿病 [例(%)]	吸烟 [例(%)]	CVD [例(%)]	血脂异常 [例(%)]	STEMI [例(%)]	左前降支梗死 [例(%)]
<50	101	68(67.3)	31(30.7)	55(54.5)	6(5.9)	10(9.9)	39(38.6)	61(60.4)
≥50	14	8(57.1)	4(28.6)	7(50.0)	0(0.0)	1(7.1)	8(57.1)	8(57.1)
P值		0.451	0.999	0.782	0.999	0.999	0.186	0.816
MA-ADP (mm)	例数	回旋支梗死 [例(%)]	右冠状动脉梗死 [例(%)]	TIMI分级 [例(%)]	支架数	支架长度 (mm)	左心室射血分数(%)	PLT (×10⁹/L)
<50	101	28(27.7)	32(31.7)	99(98.0)	1.9±1.0	51.3±29.3	62.0±9.4	192.9±57.2
≥50	14	5(35.7)	7(50.0)	14(100.0)	1.9±0.9	51.0±26.6	58.2±9.9	183.4±72.1
P值		0.536	0.175	0.999	0.966	0.969	0.160	0.572

项目	OR(95%CI)	P值
年龄	1.013 (0.9751.052)	0.511
性别	0.244 (0.0521.148)	0.074
PPI	0.000 (0.0000.000)	0.999
他丁类药物	1.359 (0.5693.247)	0.490
β受体阻断剂	0.798 (0.3381.887)	0.608
ACE抑制剂	0.741 (0.3421.606)	0.447
高血压	0.933 (0.4212.069)	0.865
糖尿病	0.985 (0.4332.240)	0.971
吸烟	0.621 (0.2901.329)	0.220
CVD	1.725 (0.3328.955)	0.516
血脂异常	0.915 (0.4241.977)	0.563
STEMI/NSTEMI	0.871 (0.4701.617)	0.822
左前降支梗死	0.650 (0.3011.402)	0.272
回旋支梗死	2.288 (1.0025.228)	0.050
右冠状动脉梗死	0.908 (0.4072.023)	0.813
TIMI分级	0.000 (0.0000.000)	0.999
支架数	1.239 (0.8441.817)	0.274
支架长度	1.009 (0.9961.022)	0.181
左心室射血分数	1.015 (0.9741.057)	0.481
PLT	0.997 (0.9901.003)	0.330
MA-ADP	3.547 (1.10311.412)	0.034
Inh-ADP	1.001 (0.9861.016)	0.877
MA-AA	1.690 (0.10327.742)	0.713
Inh-AA	0.000 (0.0000.000)	0.999

项目	OR(95%CI)	P值
年龄	1.013 (0.9751.052)	0.511
性别	0.244 (0.0521.148)	0.074
PPI	0.000 (0.0000.000)	0.999
他丁类药物	1.359 (0.5693.247)	0.490
β受体阻断剂	0.798 (0.3381.887)	0.608
ACE抑制剂	0.741 (0.3421.606)	0.447
高血压	0.933 (0.4212.069)	0.865
糖尿病	0.985 (0.4332.240)	0.971
吸烟	0.621 (0.2901.329)	0.220
CVD	1.725 (0.3328.955)	0.516
血脂异常	0.915 (0.4241.977)	0.563
STEMI/NSTEMI	0.871 (0.4701.617)	0.822
左前降支梗死	0.650 (0.3011.402)	0.272
回旋支梗死	2.288 (1.0025.228)	0.050
右冠状动脉梗死	0.908 (0.4072.023)	0.813
TIMI分级	0.000 (0.0000.000)	0.999
支架数	1.239 (0.8441.817)	0.274
支架长度	1.009 (0.9961.022)	0.181
左心室射血分数	1.015 (0.9741.057)	0.481
PLT	0.997 (0.9901.003)	0.330
MA-ADP	3.547 (1.10311.412)	0.034
Inh-ADP	1.001 (0.9861.016)	0.877
MA-AA	1.690 (0.10327.742)	0.713
Inh-AA	0.000 (0.0000.000)	0.999

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