hs-CRP联合D-二聚体对急性心梗PCI术后亚急性支架内血栓形成的预测价值

Predictive value of hs-CRP combined with D-dimer for subacute stent thrombosis in acute myocardial infarction patients after PCI

目的探究超敏C反应蛋白(hs-CRP)和D二聚体(D-dimer)联合预测急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)术后发生亚急性支架内血栓形成(SST)的价值。方法分析自2012年1月—2018年1月收治的因AMI接受PCI治疗的9 261例患者,其中术后发生SST的72例(0.78%)患者为SST组,根据年龄、性别比例在术后未发生SST的患者中抽取210例作为对照组。对比2组患者冠心病危险因素(性别、年龄、体质量指数等)、临床资料[收缩压、舒张压、磷酸肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)等]、冠脉造影结果情况(病变血管、支架贴壁不良等)。将上述资料统计学分析时P <0.1的指标纳入多因素Logistic回归分析。将hs-CRP和D-dimer进行ROC曲线分析,评估两者联合对SST的预测价值。结果 SST组患者术后D-dimer、hs-CRP和Glu水平、支架贴壁不良例数、支架置入数目均高于对照组,左室射血分数(LVEF)低于对照组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示D-dimer升高、hs-CRP升高、血糖升高、支架贴壁不良是SST的独立危险因素,LVEF>0.50是SST的保护因素。hs-CRP和D-dimer的联合指标hs-CRP-D-dimer在ROC曲线下面积为0.875,对SST的最佳cutoff值为14.28,其敏感度为77.8%,特异度为80.5%。结论 D-dimer、hs-CRP和血糖升高、支架贴壁不良是影响SST的独立危险因素,LVEF>0.50是SST的保护性因素。hs-CRP和D-dimer联合是预测AMI患者PCI术后发生SST的理想指标,值得临床推广应用。

Objective To investigate the value of hypersensitive C reactive protein （hs-CRP）-D-dimer, a combined indicator of hs-CRP and D-dimer, in predicting the occurrence of subacute stent thrombosis （SST） in patients with acute myocardial infarction （AMI） after percutaneous coronary intervention （PCI）. Methods Patients （n=9 261） undergoing PCI for AMI from January 2012 to January 2018 were enrolled in this study. Patients with postoperative SST were selected as SST group （n=72）, and patients without SST were selected as control group （n=210） according to their age and sex ratio. Data of coronary heart disease risk factors （sex, age, body mass index, etc.）, clinical data [systolic blood pressure, diastolic blood pressure, creatine kinase （CK）, creatine kinase isoenzyme （CK-MB）], results of angiography （disease vessels, stent malapposition） were compared between two groups. The index of P〈0.1 in general data comparison was included in muhivariate logistic regression analysis. ROC curves were used to analyze hs-CRP and D-dimer, and both hs-CRP and D- dimer were assessed for the predictive value of SST. Results The postoperative D-dimer, hs-CRP, glucose, stent malapposition, and number of stents were significantly higher in the SST group than those in the control group. The left ventricular ejection fraction （LVEF） was significantly lower in the SST group than that in the control group （P 〈 0.05）. Multivariate logistic regression analysis showed that the elevated D-dimer, hs-CRP and glucose, stent malapposition were independent risk factors for SST. LVEF 〉 0.50 was a protective factor for SST. The combined index of hs-CRP and D- dimer for hs-CRP-D-dimer was 0.875 under ROC curve, 14.28 for SST, with sensitivity of 77.8% and specificity of 80.5%. Conclusion D-dimer, hs-CRP, the elevated blood glucose and stent malapposition are independent risk factors for SST, LVEF〉0.50 is a protective factor for SST. Hs-CRP-D-dimer, a combined diagnostic index of hs-CRP and D-dimer, is an ideal indicator for predicting the occurrence of SST after PCI in AMI patients, and which is worthy of clinical application.