张小敏,肖栋,柏中胜,曹龙兴,彭朝梅,肖国胜

• 1:厦门大学附属心血管病医院心内科
• 2:厦门大学医学院

摘要(Abstract)：

目的 探讨定量血流分数（QFR）对冠心病患者经皮冠状动脉介入治疗（PCI）术后主要不良心血管事件（MACE）发生的预测价值。方法 纳入2020年1—6月在厦门大学附属心血管病医院接受药物洗脱支架置入术的231例患者，所有患者术后均进行靶血管QFR值测量，总共分析了231支血管，临床终点为随访患者2年内MACE发生情况，包括心原性死亡、非致死性心肌梗死、缺血驱动的血运重建。根据Youden指数将患者分成QFR>0.92组和QFR≤0.92组，根据患者是否发生MACE分成MACE组及Non-MACE组，采用单因素及多因素Cox回归分析，探讨QFR测量对PCI术后患者MACE发生的预测价值。结果 PCI术后血管的最大面积狭窄率是术后QFR值较低的预测因素。通过计算Youden指数得出PCI术后QFR预测2年内MACE的最佳临界值为0.92，根据该界值分成QFR>0.92(71.9%)组及QFR≤0.92(28.1%)组。受试者工作特征曲线得到MACE发生的曲线下面积（AUC）为0.768(95%CI 0.676～0.860,P<0.001)，敏感度为0.655，特异度为0.772。PCI术后随访2年发现共有29(12.6%)例发生MACE(MACE组)，其QFR值明显低于Non-MACE组患者[0.91(0.86,0.95)比0.96(0.93,0.97),P<0.05]。多因素Cox回归分析发现，PCI术后QFR≤0.92(HR 5.10,95%CI 2.27～11.44)、三支血管病变（HR 2.86,95%CI 1.31～6.24）、最大面积狭窄率（HR 1.03,95%CI 1.00～1.06）是患者发生MACE的独立危险因素。PCI术后QFR≤0.92的患者比QFR>0.92患者靶血管血运重建（TVR）的风险更高（HR 5.45,95%CI 1.36～21.77,P<0.001）。结论 QFR预测PCI术后患者2年内MACE发生的最佳临界值为0.92。发生MACE的患者QFR值较低，且QFR≤0.92、三支血管病变、最大面积狭窄率是患者PCI术后MACE发生的独立危险因素。QFR≤0.92也是患者PCI术后患者TVR的独立危险因素。

关键词(KeyWords)： 定量血流分数;冠心病;经皮冠状动脉介入治疗;主要不良心血管事件

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 张小敏,肖栋,柏中胜,曹龙兴,彭朝梅,肖国胜

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