赵博,颜红兵,赵汉军,宋莉,周鹏,刘臣

• 1:首都医科大学附属北京安贞医院
• 2:中国医学科学院阜外心血管病医院

摘要(Abstract)：

目的单血清标志物缺乏判断预后的特异性与敏感性。本研究评价接受直接经皮冠状动脉介入治疗(primary percutaneous coronary intervention,PPCI)的ST抬高心肌梗死(ST elevation myocardial infarction,STEMI)患者围手术期组合分析多血清标志物水平评估预后的价值。方法梗死相关动脉内灌注血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂改善心肌再灌注和减少出血并发症的研究(NCT01181388)连续入选接受PPCI的203例STEMI患者,本研究纳入其中化验指标完整可供分析的145例患者,按其术前肌钙蛋白I(20ng/ml)、高敏C反应蛋白(10mg/L),术后即刻B型钠尿肽(2000fmol/ml)的水平是否高于研究界定值分为低值组、单项高值组、两项高值组和三项高值组。比较住院期间超声评估的心功能、住院期间、术后30天、180天主要心脏不良事件(major adverse cardiac events,MACE)包括心因性死亡、再发心肌梗死、靶血管再次血运重建)和出血事件等预后指标的差异。结果住院期间共有4例患者发生MACE,其中低值组3例(6%),单项高值组0例,两项高值组0例,三项高值组1例(14%),三项高值组患者住院期间MACE发生率有增加趋势(χ2=7.922,P=0.048)。30天内共有7例患者发生MACE,其中死亡2例(均来自两项高值组),再发心肌梗死3例,靶血管再次血运重建2例,各组患者30天MACE发生率间差异无统计学意义(χ2=5.381,P>0.05),但是两项高值组患者死亡率较高(8%)并且差异具有统计学意义(χ2=9.282,P=0.026)。180天内共有10例患者发生MACE,其中死亡5例,再发心肌梗死3例,靶血管再次血运重建2例,各组患者180天MACE发生率间差异无统计学意义。结论多血清标志物异常可能在一定程度上提示预后不良,组合分析多种血清标志物来评估PPCI患者的预后可能比单独分析一种血清标志物更有意义。

关键词(KeyWords)： 心肌梗死;血管成形术,经腔,经皮冠状动脉;生物学标记;预后

Abstract:

Keywords:

基金项目(Foundation): 首都医学发展科研基金(2009-2076)

作者(Author): 赵博,颜红兵,赵汉军,宋莉,周鹏,刘臣

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