外周动脉张力测定对急性心肌梗死预后的预测价值

Correlation Between Endothelial Dysfunction Evaluated by Peripheral Arterial Tonometry and Prognosis of Acute Myocardial Infarction

目的探讨利用外周动脉张力测定技术评价入院时血管内皮细胞功能是否可以预测急性心肌梗死患者再发主要不良心血管事件。方法连续入选116名临床确诊的急性心肌梗死患者,入院72 h内利用外周动脉张力测定技术评价血管内皮细胞功能,计算反应性充血指数。以反应性充血指数正常值截点1.67将研究对象分为内皮功能障碍组(反应性充血指数<1.67)和内皮功能正常组(反应性充血指数≥1.67),随访住院期间、出院后主要不良心血管事件发生情况。院内随访中位数8.0天,院外随访243.8±68.3天。主要不良心血管事件包括心源性死亡、再发急性心肌梗死、住院期间再发不稳定型心绞痛、缺血性脑卒中、择期冠状动脉介入治疗或冠状动脉旁路移植手术、因心血管原因再住院。结果外周动脉张力测定内皮功能障碍组(反应性充血指数<1.67)和内皮功能正常组(反应性充血指数≥1.67)住院期间及出院后主要不良心血管事件发生率均无统计学差异(P值分别为0.098和0.104)。结论本研究中外周动脉张力测定未能预测急性心肌梗死患者再发主要不良心血管事件,外周动脉张力测定对急性心肌梗死预后的预测价值较小。

Aim To explore whether the use of peripheral arterial tonometry （PAT） in the evaluation of admission vascular endothelial function of acute myocardial infarction （AMI） patients can predict recurrence of major adverse cardiovascular events （MACE）. Methods For 116 consecutive patients clinically diagnosed with AMI received evaluation of vascular endothelial function using PAT technique within 72 hours of admission, reactive hyperemia index （RHI） was calculated. By the cut point of normal RHI （1.67） patients were divided into the normal endothelial function group （RHI≥1.67） and the endothelial dysfunction group （RHI〈1.67）, follow-up of MACE was conducted in both groups during hospitalization （median value 8.0 days） and after discharge from hospital （243.8±68.3 days）. MACE included cardiac death, recurrent acute myocardial infarction, recurrent unstable angina during hospitalization, ischemic stroke, elective percutaneous coronary intervention （PCI） or coronary artery bypass grafting （CABG）, and hospitalization due to cardiovascular causes. Result There was no significant difference in recurrence of MACE between PAT-determined endothelial dysfunction group （RHI〈1.67） and normal endothelial function group （RHI≥1.67） both during hospitalization and after discharge from hospital （P=0.098 and 0.104, respectively）. Conclusion PAT cannot predict recurrence of major adverse cardiovascular events in AMI patients both during hospitalization and after discharge from hospital.