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目的 :探讨经皮冠状动脉介入治疗术前血浆D 二聚体含量对术后心肌损伤的预测价值。方法 :68例择期行经皮冠状动脉介入治疗的患者 ,根据术后 12～ 2 4h肌钙蛋白I(cTnI)是否≥ 1 0ng/ml而分为肌钙蛋白阳性组及肌钙蛋白阴性组。采用酶联免疫吸附法测定手术前、后血浆D 二聚体含量 ,并进行两组间的比较。结果 :肌钙蛋白阳性组血浆D 二聚体含量术后即刻及术后 12～ 2 4h均高于术前 (P <0 0 5 ) ,在各时间点的血浆D 二聚体含量均高于肌钙蛋白阴性组 (P <0 0 5 )。多变量逐步Logistic回归分析表明术前及术后即刻血浆D 二聚体含量、术前血管狭窄程度是术后cTnI升高的独立预测指标 (P <0 0 5 )。ROC曲线分析显示预测术后cTnI升高的最佳界值为术前血浆D 二聚体含量≥ 0 3 45mg/L。结论 :术前血浆D 二聚体含量是术后心肌损伤的独立预测因素 ,术前血浆D 二聚体含量≥ 0 3 45mg/L者应视为术后cTnI升高的高危患者
Objective: To investigate the predictive value of preoperative plasma D-dimer level in patients with myocardial injury after percutaneous coronary intervention. Methods: Sixty-eight patients undergoing elective coronary intervention were divided into troponin-positive group and troponin-negative group according to whether or not troponin I (cTnI) ≥ 10 ng / ml 12 ~ 24 h postoperatively. Plasma D-dimer levels were measured before and after surgery by enzyme-linked immunosorbent assay and compared between the two groups. Results: Plasma D-dimer levels in the troponin-positive group were significantly higher than those before operation (P <0.05) at 12 and 24 hours after operation, and plasma D-dimer levels at all time points were higher Troponin negative group (P <0 05). Multivariate stepwise Logistic regression analysis showed that preoperative and postoperative immediate plasma D-dimer levels and preoperative stenosis were independent predictors of postoperative cTnI elevation (P <0.05). ROC curve analysis showed that the best value of predicting the postoperative cTnI elevation was preoperative plasma D-dimer level ≥ 0 45mg / L. Conclusion: Preoperative plasma D dimer level is an independent predictor of postoperative myocardial injury. Preoperative plasma D dimer level ≥ 0 45mg / L should be considered as a high risk of postoperative cTnI