›› 2011, Vol. 31 ›› Issue (10): 1436-.doi: 10.3969/j.issn.1674-8115.2011.10.017

• 论著(临床研究) • 上一篇    下一篇

联合生物学标志物检测在经皮冠状动脉介入治疗围术期心肌梗死危险分层中的价值

侯旭敏, 韩文正, 仇兴标, 陈 晖, 方唯一   

  1. 上海交通大学附属胸科医院心内科, 上海 200030
  • 出版日期:2011-10-28 发布日期:2011-10-27
  • 通讯作者: 方唯一, 电子信箱: fwychest@163.com。
  • 作者简介:侯旭敏(1975—), 女, 副主任医师, 博士;电子信箱: xmhou@medmail.com.cn。

Value of multibiomarker measurement in risk stratification for perioperative myocardial infarction of percutaneous coronary intervention

HOU Xu-min, HAN Wen-zheng, QIU Xing-biao, CHEN Hui, FANG Wei-yi   

  1. Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
  • Online:2011-10-28 Published:2011-10-27

摘要:

目的 了解联合多项生物学标志物检测是否可以有效筛选临床易发生围术期心肌梗死的高危患者。方法 行择期经皮冠状动脉介入治疗(PCI)的患者203例,平均年龄(65±9) 岁,其中68.5%为男性,60.6%的患者被诊断为急性冠脉综合征(ACS),所有患者在术前及术后12~18 h进行高敏C-反应蛋白(hsCRP)、脑钠肽(BNP)和D-二聚体的检测。结果 67例(33.0%)患者发生围术期心肌梗死,围术期心肌梗死组术前BNP>100 pg/mL和hsCRP>5.0 ng/mL的患者百分比均明显高于无围术期心肌梗死组(32.8% vs 19.9%, P=0.042; 25.4% vs 13.2%, P=0.031);但术后仅围术期心肌梗死组BNP>100 pg/mL的患者百分比高于围术期无心肌梗死组,差异有统计学意义(41.8% vs 27.2%, P=0.036)。两组术前、术后D-二聚体>0.5 mg/L的患者百分比比较差异均无统计学意义(P>0.05)。多变量回归分析显示,术前hs-CRP>5.0 ng/mL是预测发生围术期心肌梗死的独立危险因素(OR: 2.445, 95%CI: 1.082~5.521, P=0.032)。结论 PCI术前进行hs-CRP和BNP联合检测,可能有助于筛选易发生围术期心肌梗死的高危患者。

关键词: 经皮冠状动脉介入治疗, 心肌梗死, 高敏C-反应蛋白, 脑钠肽, D-二聚体

Abstract:

Objective To determine whether serum multibiomarkers are effective in screening patients with high risks for perioperative myocardial infarction. Methods A total of 203 patients undergoing elective percutaneous coronary intervention (PCI) were enrolled. The mean age of patients was (65±9) years, 68.5% were males, and 60.6% were diagnosed with acute coronary syndrome (ACS). Serum biomarkers including high-sensitivity C-reactive protein (hs-CRP), brain natriuretic peptide (BNP) and D-dimer were measured before PCI and 12 h to 18 h after PCI. Results Perioperative myocardial infarction occurred in 67 patients (33.0%). The percents of patients with preoperative BNP>100 pg/mL and hs-CRP>5.0 ng/mL in those with perioperative myocardial infarction were significantly higher than those in patients without perioperative myocardial infarction (32.8% vs 19.9%, P=0.042; 25.4% vs 13.2%, P=0.031). However, only the percent of patients with postoperative BNP>100 pg/mL in those with perioperative myocardial infarction was significantly higher than that in patients without perioperative myocardial infarction (41.8% vs 27.2%, P=0.036). There was no significant difference in the percents of patients with preoperative and postoperative D-dimer>0.5 mg/L between patients with perioperative myocardial infarction and those without perioperative myocardial infarction. Multivariate regression analysis revealed that hs-CRP> 5.0 ng/mL before PCI was an independent risk factor for perioperative myocardial infarction (OR: 2.445, 95%CI: 1.082-5.521, P=0.032). Conclusion The combined measurement of hs-CRP and BNP before PCI may help to screen patients with high risks for perioperative myocardial infarction.

Key words: percutaneous coronary intervention, myocardial infarction, high-sensitivity C-reactive protein, brain natriuretic peptide, D-dimer