摘要
目的探讨D-二聚体能否作为急性心肌梗死（心梗）危险程度的预警信号，以帮助急诊医生对心梗患者进行风险评估。方法回顾性分析2009年1月1日至2010年12月31日急诊人院的3134例患者病历资料，记录其年龄、性别、既往史，未接受治疗前的D-二聚体、肌酸激酶同工酶（CK—MB）、心肌肌钙蛋白I（cTnI）、N末端脑钠肽前体（NT—proBNP）、心电图变化，以及接受经皮冠状动脉介入治疗（PCI）或药物溶栓治疗2h后的CK—MB、cTnI、心脏彩超左室射血分数（LVEF）值和住院期间是否死亡及发病至死亡时间；根据多因素logistic回归分析结果绘制受试者工作特征曲线（ROC曲线）和拟合曲线，分析治疗前D-二聚体与心梗预后的相关性。结果多因素logistic回归分析显示，年龄[优势比（OR）=1．109，95％可信区间（95％CI）为（1．073，1．147），P=0．000]、是否行急诊PCI[OR=-4．162，95％CI（1．980，8．748），P=0．000]、治疗前D-二聚体[OR=1．001，95％CI（1．000，1．002），P=0．001]、LVEF[OR=0．946，95％Ct（0．928，0．964），P=0．000]和治疗2hcTnI[OR=1．011，95％CI（1．004，1．018），P=0．0023与28d死亡相关。ROC曲线显示，年龄[曲线下面积（AUC）0．796、P=O．000]、是否行急诊PCI（AUC0．704、P=0．000）、治疗前D-二聚体（AUC0．797、P=0．000）与28d死亡呈正相关，LVEF（Auc0．261、P=0．000）与28d死亡呈负相关；进一步绘制治疗前D-二聚体与发病至死亡时间及LVEF拟合曲线显示均不存在线性相关。结论D-二聚体与心梗患者早期预后相关，但与发病至死亡时间并不存在线性关系；早期D-二聚体升高对提示心梗患者病情危重程度有帮助。
Objective To investigate whether D-dimer could be an early warning signal for patients with acute myocardial infarction （AMI）, then may be helpful in risk accessment in emergency department. Methods Three thousand one hundred and thirty-four emergency AMI cases admitted to the hospital from January 1, 2009 to December 31, 2010 were retrospectively reviewed, and their age, gender, past medical history, D-dimer, MB isoenzyme of creatine kinase （CK-MB）, cardiac troponin I （cTnI）, the precursor of the N-terminal pro-brain natriuretic peptide （NT-proBNP）, electrocardiogram （ECG） before treatment, and the CK-MB, cTnI and echocardiography left ventricular ejection fraction （LVEF） 2 hours after the treatment of percutaneous coronary intervention （PCI） or thrombolytic drugs, whether died and time from onset to death were recorded. According to the results of multivariate logistic regression analysis,, draw the receiver operating characteristic curve （ROC curve） and fitting curve, and analyzed the relativity between the D-dimer before the treatment and prognosis of myocardial infarction. Results Muhivariate logistic regression analysis showed that age [odds ratio （OR）： 1.109, 95% confidence interval （95% CI） 1.073 to 1.147, P=0.000, whether undergoing emergency PCI （0R=4.162, 95%CI 1.980 to 8.748, P=0.000）, D-dimer before treatment （ OR= 1.001,95%CI 1.000 to 1.002, P=0.001 ）, the LVEF values （ OR=0.946, 95%CI 0.928 to 0.964, P= 0.000） and cTnI after 2 hours of treatment （ OR： 1.011, 95% CI 1.004 to 1.018, P=0.002 ） were correlated to 28-day death. The ROC curves showed that age [area under curve （AUC） 0.796, P--~O.000~, whether undergoing emergency PCI （AUC 0.704, P=0.000）, D-dimer before treatment （AUC 0.797, P=O.O00） were positively correlated with the 28-day death; the LVEF values （AUC 0.261, P=0.000） were negative correlated with the 28-day death. The fitting curve of D-dimer before treatment, the time from onset to death and the LVEF showed no linear correlation. Conclusions D-dimer was correlated with the early prognosis of patients with myocardial infarction, but was not correlated with the time from onset to death. The rise in D-dimer at the early stage of AMI may be helpful to indicate the critical condition of the AMI patients.
出处
《中国危重病急救医学》
CAS
CSCD
北大核心
2012年第12期725-729,共5页
Chinese Critical Care Medicine
基金
国家自然科学基金资助项目（30972863）
关键词
D-二聚体
急性心肌梗死
预后
D-dimer
Acute myocardial infarction
Prognosis
