D-二聚体水平与STEMI患者PCI术后STR的相关性研究

Correlation between D-Dimer and ST-segment Resolution in Patients with Acute ST-segment Elevation Myocardial Infarction Undergoing Primary PCI

目的:探讨急性ST段抬高型心肌梗死(STEMI)患者入院D-二聚体(D-D)水平与经皮冠状动脉介入治疗(PCI)后ST段回落率(STR)的相关性。方法:选取2017年10月—2018年10月STEMI且行急诊PCI及冠状动脉血栓抽吸术患者共46例,完成术前D-二聚体、肌钙蛋白I(cTNI)、磷酸肌酸激酶同工酶(CKMB)、肌酐(Cr)水平检测。采集首次医疗接触和术后90min的12或18导联体表心电图;术中进行冠状动脉血流的评估;收集冠状动脉血栓并行病理学检测。按术前D-二聚体水平四分位数间距分为四组,即D-D≤0.150mg/L组(n=12)、D-D 0.150~0.335mg/L组(不含0.150mg/L,n=11)、D-D 0.335~0.750mg/L组(不含0.335mg/L,n=12)、D-D>0.750mg/L组(n=11),比较四组间基层临床数据及冠脉血栓抽吸物成分。依据PCI术后心电图STR分为<30%组(n=17),30%~70%组(n=15),>70%组(n=14),并观察STR与术前D-二聚体水平的关系。应用ROC曲线判断D-二聚体对心肌灌注不足的预测价值。结果:46例STEMI患者心血管事件(主要表现为急性心肌梗死、急性左心衰竭、心律失常)发生率在D-D≤0.150 mg/L、D-D 0.150~0.335mg/L、D-D 0.335~0.750mg/L、D-D>0.750mg/L中有显著性差异(P=0.022),且冠状动脉血栓抽吸物中红细胞及血小板含量在D-D>0.750 mg/L组显著高于D-D≤0.150mg/L组(P<0.05)。术前D-二聚体水平在STR<30%组显著高于STR 30%~70%组、STR>70%组(P<0.05),心血管事件发生率在三组间有显著性差异(P=0.024)。ROC曲线显示,术前D-二聚体对于STEMI患者直接PCI治疗术后发生心肌灌注不足现象具有一定的预测价值[STR<30%时ROC曲线下面积(AUC)=0.767,95%CI 0.622~0.912,P=0.003]。以STR<30%评估心肌灌注不足指标时,D-二聚体临界值为0.835 mg/L,灵敏度0.52,特异度0.93。结论:术前D-二聚体水平与STEMI患者PCI术后的STR水平相关,可能有预测PCI术后心肌灌注不足的价值。

Objective:To study the correlation between D-Dimer and ST-segment resolution(STR)in patients with acute ST-segment elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary intervention(PCI).Methods:A total of 46 STEMI patients were selected for emergency primary PCI from October 2017 to October 2018.Their plasma D-dimer,cTnI,CKMB and Cr level were tested before surgery.Standard 12-leador 18-lead ECG tracings were recorded at first medical contact and 90 minutes after PCI.Their information on thrombi characteristics and interventional data were collected.D-dimer was divided into quartile[D-D≤0.150mg/ml(n=12),D-D 0.150~0.335mg/L(not including 0.150mg/L,n=11),D-D 0.335~0.750mg/L(not including 0.335mg/L,n=12),D-D>0.750mg/L(n=11)].The baseline and thrombi characteristics were compared among four group.STR was classified as total(>70%,n=14),partial(30%~70%,n=15)or none(<30%,n=17),and was observed the correlation with D-dimer.Receiver operator characteristics(ROC)analysis was performed to determine the value of plasma D-dimer level predicting myocardial reperfusion.Results:The ratio of adverse cardiovascular events(AMI,acute heart failure and arythmia)in 46 STEMI patients had significantly difference between D-D≤0.150 mg/L,D-D 0.150~0.335mg/L,D-D 0.335~0.750mg/L,D-D>0.750mg/L groups(P=0.022).The content of erythrocyte and platelet in D-D>0.750mg/L group was significantly greater than that in D-D≤0.150mg/ml group(P<0.05).D-Dimer in STR<30%group was higher than it in STR 30%~70%group and STR>70%group(P<0.05).The ratio of adverse cardiovascular events in three groups was significantly difference(P=0.024).According to ROC curve,D-dimer helps predict the condition of myocardial perfusion(when STR<30%,AUC=0.767,95%CI 0.622~0.912,P=0.003).The cutoff value was 0.835mg/L,when STR<30%,sensitivity was 0.52,specificity was 0.93.Conclusion:D-dimer level was associated with STR in patients with STEMI undergoing primary PCI,and maybe a predictor of the condition of myocardial perfusion.