D-二聚体对急性非ST段抬高型心肌梗死患者预后的预测价值*

Prognostic value of D-dimer in patients with non-ST-segment myocardial infarction*

摘要:

目的 评估血浆D-二聚体水平对急性非ST段抬高型心肌梗死患者预后的影响。方法 前瞻队列研究，选取2015年1月—2016年12月中国医科大学附属盛京医院确诊为急性非ST段抬高型心肌梗死并进行择期经皮冠状动脉介入治疗（PCI）的患者648例。根据入院次日血浆D-二聚体水平分成两组，低D-二聚体组和高D-二聚体组。收集所有患者临床资料、冠状动脉病变情况、冠状动脉介入治疗情况，以及随访1年记录临床终点事件。通过Cox回归分析研究血浆D-二聚体水平对急性非ST段抬高型心肌梗死患者预后的影响。结果 与血浆低D-二聚体水平患者比较，血浆D-二聚体水平较高患者中男性比例更低、心率更快、肌酐水平更高，并且患者全因死亡率和心源性病死率更高（P?<0.05）。根据Cox分析提示，血浆中D-二聚体水平是急性非ST段抬高型心肌梗死患者预后预测因素（P?<0.05）。结论 血浆D-二聚体水平较高患者长期的全因死亡率及心源性病死率更高，血浆D-二聚体水平可以作为预测急性非ST段抬高型心肌梗死患者预后的危险因素。

Abstract:

Objective To determine the predictive values of D-dimer in patients with non-ST-segment elevation myocardial infarction (NSTEMI). Methods A total of 648 patients with acute NSTEMI admitted in Shengjing Hospital of China Medical University from January 2015 to December 2016 were enrolled for the study. All patients underwent percutaneous coronary intervention. Patients were divided into two groups according to the plasma levels of D-Dimer. Clinical characters and 1 year follow-up were recorded. Results Compared with the patients in low D-dimer group, patients in high plasma D-dimer group experienced less male gender, older age, lower total cholesterol level, higher white blood cell and creatinine level. Patients with higher D-dimer suffered increased risk of all-cause deaths and cardiovascular related deaths. Multivariate COX analysis suggested D-dimer was a predictive biomarker in patients with NSTEMI after PCI. Conclusions Patients with high levels of plasma d-dimer may be a poor prognostic biomarker on patients with NSTEMI.