血栓前状态分子标志物在老年冠心病非心脏手术患者围术期的变化及意义

Analysis of prothrombotic state marker in noncardiac surgery patients with perioperative coronary heart disease

目的 研究血栓前状态（PTS）分子标志物在老年冠心病患者腹部手术围术期的变化及意义.方法 选择60～75岁择期行腹部手术的老年冠心病患者128例,分别于手术当天及术后1、2、3d测量血浆D-二聚体（D-D）、血栓前体蛋白（TpP）、P-选择素（CD62P）及血管性血友病因子（vWF）水平,分析其与心脏不良事件发生的相关性.结果 共有128例患者纳入本研究,其中心脏不良事件29例（22.7％）.与手术当天比较,术后1、2、3d患者血浆D-D、TpP、CD62P和vWF水平明显升高（P＜0.01）.女性（OR=22.5,95％CI 2.9～174.55）、合并糖尿病（OR=97.77,95％CI11.51～830.42）、手术时间延长（OR=1.08,95％CI 1.03～1.13）以及术前PTS分子标志物升高是心脏不良事件发生的危险因素,但都不是独立危险因素.结论 PTS分子标志物水平升高对于老年冠心病非心脏手术患者围术期心脏不良事件的发生有一定的预测价值.

Objective To investigate the markers of prethrombotic state （PTS） in predicting perioperative adverse cardiac events in the elderly patients with coronary heart disease （CHD） undergoing abdominal surgery. Methods A total of 128 consecutive elderly patients, aged 60-75 years, who received abdominal surgery were recruited. The plasma levels of D-dimer （D-D）, thrombus precusor protein （TpP）, P-selectin （CD62P） and von Willebrand factor （vWF） were measured on the day of surgery and 1,2,3 day after surgery. Multivariate logistic regression analysis was used to calculate the risk factors for adverse cardiac events. Results All 128 patients were analysed. The incidence of ad- verse cardiac events was 22.7 %. Compared with the day of surgery, the plasma levels of D-D, TpP, CD62P and vWF were increased significantly on 1,2,3 day after surgery （P〈0. 01）. Multivariate lo- gistic regression analysis showed that female （OR 22.5, 95 %CI 2.9-174.55）, complicated with dia- betes （OR 97.77, 95%CI 11.51-830.42）, prolonged operation （OR 1.08, 95%CI 1.03-1.13）, and raised preoperative PTS markers were risk factors for perioperative adverse cardiac events. Conclusion The elevation of PTS markers could predict the incidence of perioperative adverse cardiac events in the elderly patients with CHD.