CAJ | 학술논문

目的研究非体外循环冠状动脉旁路移植(OPCAB)手术后D-二聚体水平的变化特点,探讨其在术后心血管缺血事件风险评估中的价值.方法回顾性队列分析.随机选择天津医科大学总医院于2010年至2012年间收治的非ST段抬高型心肌梗死(NSTEMI)患者203例进行回顾性队列分析,男151例,女52例,平均年龄(66.9±8.4)岁.采用法国梅里埃VIDAS荧光免疫分析仪测定血浆D-二聚体水平.采用ROC曲线评价D-二聚体的诊断敏感度和特异度;利用x2检验评估D-二聚体与临床病理因素的关系,对预后因素进行Cox回归模型分析.结果恢复不良组术后第14天D-二聚体水平显著高于稳定组(U=75.09,P＜0.01).患者组术后第14天的D-二聚体诊断术后第31 ～90天缺血事件的临界值为2 590 μg/L时,曲线下面积为0.867(95％ CI:0.791 ～0.943),Logistic回归分析显示D-二聚体水平受性别、年龄、左心室射血分数、左主干病变、旁路移植血管数量、使用乳内动脉和高血压等因素的影响,OR值分别为0.495(95％CI:0.327～0.694)、0.527(95％CI:0.370 ～0.812)、0.564(95％ CI:0.419～0.638)、0.331(95％ CI:0.278 ～0.426)、0.592(95％ CI:0.440 ～0.785)、2.093(95％CI:1.533 ～ 2.856)、0.580(95％CI:0.451～0.709)(均P＜0.01).Cox比例回归模型显示,第14天的血浆D-二聚体不是远期预后的独立评价指标.结论 OPCAB术后血浆D-二聚体受到多种病理因素影响,术后第14天的血浆D-二聚体水平可作为OPCAB术后第31 ～90天内不良事件有效的评价指标.
목적 연구비체외순배관상동맥방로이식(OPCAB)수술후D-이취체수평적변화특점,탐토기재술후심혈관결혈사건풍험평고중적개치.방법 회고성대렬분석.수궤선택천진의과대학총의원우2010년지2012년간수치적비ST단태고형심기경사(NSTEMI)환자203례진행회고성대렬분석,남151례,녀52례,평균년령(66.9±8.4)세.채용법국매리애VIDAS형광면역분석의측정혈장D-이취체수평.채용ROC곡선평개D-이취체적진단민감도화특이도;이용x2검험평고D-이취체여림상병리인소적관계,대예후인소진행Cox회귀모형분석.결과 회복불량조술후제14천D-이취체수평현저고우은정조(U=75.09,P＜0.01).환자조술후제14천적D-이취체진단술후제31 ～90천결혈사건적림계치위2 590 μg/L시,곡선하면적위0.867(95％ CI:0.791 ～0.943),Logistic회귀분석현시D-이취체수평수성별、년령、좌심실사혈분수、좌주간병변、방로이식혈관수량、사용유내동맥화고혈압등인소적영향,OR치분별위0.495(95％CI:0.327～0.694)、0.527(95％CI:0.370 ～0.812)、0.564(95％ CI:0.419～0.638)、0.331(95％ CI:0.278 ～0.426)、0.592(95％ CI:0.440 ～0.785)、2.093(95％CI:1.533 ～ 2.856)、0.580(95％CI:0.451～0.709)(균P＜0.01).Cox비례회귀모형현시,제14천적혈장D-이취체불시원기예후적독립평개지표.결론 OPCAB술후혈장D-이취체수도다충병리인소영향,술후제14천적혈장D-이취체수평가작위OPCAB술후제31 ～90천내불량사건유효적평개지표.
Objective To study the variation of D-dimer after the off-pump coronary artery bypass grafting(OPCAB),and to evaluate its value for the assessment of postoperative cardiovascular ischemia events.Methods This is a retrospective cohort study.203 patients with non-ST-segment elevation myocardial infarction(NSTEMI) were random selected from the Tianjin medical university general hospital from 2010 to 2012,including 151 males and 52 females with a mean age of (66.9 ±8.4) years.The level of D-dimer was analysed by using the Biomerieux VIDAS fluor-euzymelinked immunoassay Analyzer assay.Receiver operating characteristic curve (ROC) was used to evaluate the sensitivity and specificity,the relevance between D-dimer and clinical pathological factors was analysed by x2 test,the effect on prognosis was evaluated by using cox regression analysis model.Results Compared the group with stable disease,the level of D-dimer was increased remarkable in the group with poor recovery on the 14th day after surgery,(U =75.09,P ＜0.01).The optimum cut-off point with D-dimer(the 14th day after surgery) for the diagnosis of ischemic events within the 31th-90th day after surgery was 2 590μg/L,the area under ROC curve was 0.867(95％ confidence interval:0.791-0.943).The logistic analysis showed that the D-dimer was influenced by the sex,age,left ventricular ejection fraction,left main coronary artery disease,the number of vascular with bypass grafts,using internal mammary artery,hypertension and other factors,OR value was 0.495(95％ CI:0.327-0.694),0.527(95％ CI:0.370-0.812),0.564(95％ CI:0.419-0.638),0.331(95％ CI:0.278-0.426),0.592(95％ CI:0.440-0.785),2.093(95％ CI:1.533-2.856),0.580 (95 ％ CI:O.451-0.709) respectively (P ＜ 0.01).The Cox analysis showed that the level of Ddimer on the 14th day after surgery was not the independent assessment parameter for long-term prognosis.Conclusion The serum D-dimer was influenced by multiple pathological factors after the OPCAB,the level of serum D-dimer(on the 14th day after surgery) could be used as effective estimate parameter for the adverse events within the 31 th-90th after OPCAB.