D⁃二聚体/肌钙蛋白Ⅰ比值对二尖瓣成形术患者预后不良的预测价值分析

Analysis of the predictive value of D⁃dimer/troponin I ratio for poor prognosis in patients undergoing mitral valve replacement surgery

目的探讨D⁃二聚体/肌钙蛋白Ⅰ比值(D⁃D/cTnI)对二尖瓣成形术患者预后不良的预测价值。方法选取2020年8月至2022年8月期间在郑州市第七人民医院行二尖瓣成形术的86例患者作为本次研究对象,根据患者患者随访结果是否发生结局事件将患者分别分入预后良好组(n=61)、预后不良组(n=25)。检测所有患者二尖瓣成形术后D⁃二聚体,肌钙蛋白Ⅰ,计算比值,并收集所有患者的其他临床资料。采用受试者工作特性(ROC)曲线评估D⁃二聚体/肌钙蛋白Ⅰ比值对二尖瓣成形术后患者预后不良的预测价值;采用多因素Logistic回归分析探讨影响二尖瓣成形术后患者预后的相关因素。结果预后不良组≥60岁比例、机械通气时间≥48 h比例高于预后良好组患者,差异有统计学意义(χ^(2)=6.919、12.397,P均<0.05)。预后不良组患者D⁃D、cTnI及D⁃D/cTnI水平均高于预后良好组患者,差异有统计学意义(t=19.859、16.764、43.805,P均<0.05)。二分类Logistic逐步回归分析,结果显示:年龄≥60岁,机械通气时间≥48 h,D⁃D/cTnI≥8.34是影响二尖瓣成形术患者预后的危险因素(P<0.05)。D⁃D、cTnI及D⁃D/cTnI预测二尖瓣成形术患者预后的AUC分别为0.813、0.764、0.908。结论高水平的D⁃D/cTnI水平是二尖瓣成形术患者预后的影响因素,对评估二尖瓣成形术患者预后不良有一定预测价值。

Objective To explore the prognostic value of Ddimer/troponinⅠratio(DD/cTnI)in patients with mitral valvuloplasty.Methods 86 patients who underwent mitral valve replacement surgery at the Seventh People's Hospital of Zhengzhou from August 2020 to August 2022 were selected as the study subjects.The patients were then divided into two groups:the good prognosis group(n=61)and the poor prognosis group(n=25)based on their followup results.After mitral valvuloplasty,Ddimer and troponin I levels were measured in all patients,and ratios were calculated.Additionally,other clinical data were collected for all patients.The predictive value of the Ddimer/troponin I ratio in determining poor prognosis after mitral valvuloplasty was assessed using a receiver operating characteristic(ROC)curve.Multivariate logistic regression analysis was conducted to identify prognostic factors for patients after mitral valve plasty.Results The proportion of patients aged≥60 years with mechanical ventilation time≥48 hours in the group with a poor prognosis was higher than in the group with a good prognosis.These differences were statistically significant(χ^(2)=6.919,12.397,P<0.05).The levels of DD,cTnI,and DD/cTnI in patients with a poor prognosis were higher than in patients with a good prognosis,and these differences were statistically significant(t=19.859,16.764,43.805,P<0.05).Binary logistic stepwise regression analysis showed that age≥60 years(OR=4.076,95%CI:1.727~9.616),mechanical ventilation time≥48 hours(OR=3.121,95%CI:1.505~6.470),and DD/cTnI≥8.34(OR=5.333,95%CI:2.086~13.638)were risk factors affecting the prognosis of patients undergoing mitral valve replacement surgery(P<0.05).The AUC of DD,cTnI,and DD/cTnI predicting the prognosis of pa tients undergoing mitral valve replacement surgery were 0.813,0.764,and 0.908,respectively.Conclusion The high level of DD/cTnI is a prognostic factor for patients undergoing mitral valvuloplasty,and it has a cer tain predictive value in assessing the poor prognosis of these patients.