血浆sTNFR1浓度联合GRACE评分评估急性冠脉综合征患者预后的临床价值

Clinical value of plasma concentration of s TNFR1 combined with GRACE score in evaluating prognosis of patients with acute coronary syndrome

目的研究血浆s TNFR1浓度联合GRACE评分评估急性冠脉综合征(acute coronary syndrome,ACS)患者预后的临床价值。方法以深圳市孙逸仙心血管医院2012年6月至2015年12月收治的200例ACS患者为研究对象,200名正常人群作为对照。检测ACS(观察组)以及正常人群(对照组)血浆s TNFR1浓度,对ACS患者以及正常人群进行GRACE评分,记录患者主要不良心血管事件发生情况,确定血浆s TNFR1浓度联合GRACE评分评估ACS患者预后的临床价值。结果 ACS患者血浆s TNFR1浓度高于正常人群,差异有统计学意义[(429.56±98.73)pg/m L vs.(274.19±47.64)pg/m L,P=0.004]。ACS患者中低危组43例、中危组65例、高危组92例,其主要不良心血管事件发生率分别为13.95%、24.62%、36.96%。GRACE评分、血浆s TNFR1浓度、联合使用GRACE评分和血浆s TNFR1浓度预测ACS患者远期死亡的受试者工作特征曲线下面积(AUC)分别为0.857、0.739、0.936。结论血浆s TNFR1浓度是影响ACS预后的独立危险因素之一,血浆s TNFR1浓度联合GRACE评分可以有效提高评估ACS患者预后的能力。

Objectives To study the clinical value of plasma concentration of s TNFR1 combined with GRACE score in evaluating the prognosis of patients with acute coronary syndrome（ACS）. Methods From June 2012 to December2015, 200 patients with ACS in The Sun Yat-sen Cardiovascular Hospital were selected as the subjects（ACS group） in this study. At the same period, 200 normal people were selected as control group. Plasma concentrations of s TNFR1 were tested and GRACE scores were recorded. Major adverse cardiac events（MACEs） were also recorded. Clinical value of plasma concentration of s TNFR1 combined with GRACE score in evaluating the prognosis of patients with ACS was estimated. Results Plasma concentration of s TNFR1 in ACS group was significantly higher than that in control group[（429.56 ±98.73） pg / m L vs.（274.19 ±47.64） pg / m L, P =0.004 ]. Among patients with ACS, there were 43 cases with low risk, 65 cases with moderate risk and 92 cases with high risk, and the incidences of MACEs were 13.95%,24.62% and 36.96% respectively. Areas under the receiver operating characteristic curve（AUC） for long-term mortality predicted by plasma concentration of s TNFR1, GRACE score, plasma concentration of s TNFR1 combined with GRACE score were 0.857, 0.739 and 0.936 respectively. Conclusions Plasma concentration of s TNFR1 is one of the independent risk factors in influencing the prognosis of patients with ACS. Plasma concentration of s TNFR1 combined with GRACE score can effectively evaluate the prognosis of patients with ACS.