肿瘤坏死因子α与急性冠脉综合征患者预后的关系研究

Relationship between Tumor Necrosis Factor-alpha and Prognosis of Patients with Acute Coronary Syndrome

目的探讨肿瘤坏死因子α(TNF-α)与急性冠脉综合征(ACS)患者预后的关系研究。方法选取2014年4月—2015年1月新疆维吾尔自治区人民医院收治的ACS患者371例,按随访结果分为心血管终点事件组55例与对照组316例。收集所有患者临床资料,分析ACS患者发生心血管终点事件的危险因素及TNF-α对ACS患者预后的预测价值。结果两组患者年龄、男性比例、心肌梗死发生率、高血压发生率、高脂血症发生率、体质指数(BMI)、白细胞计数(WBC)、血小板计数(PLT)、钙离子拮抗剂使用率、β-受体阻滞剂使用率、他汀类药物使用率、血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂(ACEI/ARB)使用率比较,差异无统计学意义(P>0.05);心血管事件组患者吸烟史阳性率、糖尿病发生率、血浆TNF-α水平高于对照组(P<0.05)。多因素logistic回归分析结果显示,吸烟史〔OR=1.302,95% CI(1.113,4.843)〕、糖尿病〔OR=2.216,95% CI(1.318,5.192)〕、TNF-α〔OR=1.645,95% CI(1.203,5.843)〕是ACS患者发生心血管终点事件的危险因素(P<0.05)。TNF-α预测ACS患者发生心血管终点事件的曲线下面积为0.769〔95% CI(0.714,0.822)〕,其为27.9 ng/L时灵敏度为76.36%,特异度为67.41%,诊断指数为43.77。结论 TNF-α对ACS患者预后具有一定预测价值,吸烟史、糖尿病、TNF-α是ACS患者发生心血管终点事件的危险因素。

Objective To investigate the relationship between tumor necrosis factor - alpha （TNF-a ） and prognosisof patients with acute coronary syndrome （ ACS）. Methods A total of 371 patients with ACS were selected in the People＇sHospital of Xinjiang Uygur Autonomous Region from April 2014 to January 2015, and they were divided into A group（ complicated with cardiovascular endpoint events, n =55） and B group （ did not complicated with cardiovascular with endpointevents, n = 316） according to the follow - up results. Clinical data was collected, risk factors of cardiovascular endpoint eventsand predictive value of TNF-a on prognosis of patients with ACS were analyzed. Results No statistically significant differencesof age, male proportion, incidence of myocardial infarction, hypertension or hyperlipidaemia, BMI, WBC, PLT, utilizationrates of calcium channel blocker, beta - blocker, statins or ACEI/ARB was found between the two groups （ P 〉 0. 05 ） ; positiverate of smoking history, incidence of diabetes and serum TNF-a of A group were statistically significantly higher than those of Bgroup （ P 〈 0. 05 ）. Multivariate logistic regression analysis showed that, smoking history [ OR = 1. 302, 95% Cl （ 1. 113,4.843）], diabetes [0^=2.216, 95%CI （1.318, 5.192）] and TNF-ct [ OR = 1.645, 95% Cl （1.203, 5.843）] wererisk factors of cardiovascular endpoint events in patients with ACS （ P 〈 0. 05 ）. The AUC of TNF-a in predicting prognosis ofpatients with ACS was 0.769 [95% Cl （0 .714 , 0 .822 ） ] , when it was 27 .9 ng/L , the sensitivity was 7 6 .3 6 % , thespecificity was 67. 41% , the diagnosis index was 43.77. Conclusion TNF-a has certain predictive value on prognosis ofpatients with ACS, smoking history, diabetes and TNF-a are risk factors of cardiovascular endpoint events in patients with ACS.