术前D-二聚体联合检测活化部分凝血活酶时间对急性冠脉综合征急诊PCI术中慢/无复流现象的预测价值

Predictive value of preoperative D-dimer combined with activated partial thromboplastin time for slow/no-reflow phenomenon in emergency percutaneous coronary intervention

目的 探讨D-二聚体(D-Dimer)联合活化部分凝血活酶时间(activated partial thromboplastin time,APTT)对急性冠状动脉综合征(acute coronary syndrome,ACS)患者行急诊经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)发生慢/无复流现象的预测价值.方法 分析2015年11月至2018年6月间陆军军医大学第二附属医院心血管内科就诊后拟行急诊PCI的ACS患者181例,术前检测所有患者的血浆D-二聚体、APTT等指标,根据TIMI血流分级方法将患者分为慢/无复流组和正常血流组,比较两组间D-二聚体和APTT与慢/无复流发生的相关性,并根据Cutoff值分为高危组和非高危组,比较两组慢/无复流发生率.结果 Logistics多因素回归分析显示本研究总人群中术前D-二聚体(OR=2.801,95%CI=1.399-5.610,P=0.004)和APTT(OR=O.881,95%CI=0.810-0.959,P=O.003)分别与发生慢/无复流现象呈正相关和负相关,ROC曲线分析D-二聚体AUC=0.612(95%CI=0.537-0.683,P=0.036),APTT AUC=0.653(95%CI=0.579-0.722,P=0.004),当D-二聚体联合APTT后AUC提高到0.697(95%CI=0.624-0.763,P<0.001).根据D-二聚体和APTT的Cutoff值分组,高危组中慢/无复流的发生率较非高危组明显升高,分别为36.17%和14.92% (P=0.002).结论 D二聚体越高,慢/无复流发生率越高,而术前活化部分凝血活酶时间与慢/无复流发生率呈负相关,联合检测D-二聚体和活化部分凝血活酶时间水平有助于预测ACS患者行急诊PCI术中慢/无复流现象的发生.

Objective To investigate the predictive value of D-dimer combined with activated partial thromboplastin time(APTT) for slow/no-reflow of percutaneous coronary intervention(PCI) in patients with acute coronary syndrome(ACS). Methods A total of 181 ACS patients undergoing emergency PCI in our department from November 2015 to June 2018 were recruited in this study. Their plasma D-dimer level and APTT were tested before surgery. According to thrombolysis in myocardial infarction(TIMI), the patients were divided into slow/no-reflow group and normal blood flow group. The correlations of D-dimer level and APTT were analyzed with the incidence of slow/no-reflow. According to the cutoff values of the 2 indicators, the patients were assigned into high-risk group and non-high-risk group, and the incidence of slow/no-reflow was compared between the 2 groups. Results Logistics multivariate regression analysis showed preoperative D-dimer(OR=2.801, 95% CI=1.399~5.610, P=0.004) was positively, and APTT(OR=0.881, 95%CI=0.810~0.959, P=0.003) was negatively correlated with slow/no-reflow phenomenon. According to ROC curve, D-dimer AUC=0.612(95% CI=0.537~0.683, P=0.036), APTT AUC=0.653(95% CI=0.579~0.722, P=0.004), and AUC increased to 0.697(95% CI=0.624~0.763, P<0.001) when D-dimer was combined with APTT index. According to the cutoff values of D-dimer and APTT, the incidence of slow/no-reflow in high-risk and non-high-risk groups was 36.17% and 14.92%, respectively(P=0.002). Conclusion Higher preoperative D-dimer indicates higher incidence of slow/no-reflow in ACS patients after emergency PCI, while preoperative APTT is negatively correlated with the incidence. So combined detection of the 2 indicators helps predict the occurrence of slow/no-reflow in the patients.