血浆血管性血友病因子抗原水平对老年急性心肌梗死患者长期预后的预测价值

doi:10.11958/20250518

天津医药 ›› 2025, Vol. 53 ›› Issue (6): 589-593.doi: 10.11958/20250518

血浆血管性血友病因子抗原水平对老年急性心肌梗死患者长期预后的预测价值

陈珍进¹(), 金晓青², 祁安宁¹, 韩崇旭³^,^△()

1 扬州大学六合临床医学院检验科（邮编211599）
2 扬州大学六合临床医学院老年医学科（邮编211599）
3 扬州大学附属苏北人民医院医学检验科

收稿日期:2025-02-12 修回日期:2025-04-08 出版日期:2025-06-15 发布日期:2025-06-20
通讯作者: ^△E-mail：hanchongxu@126.com
作者简介:陈珍进（1986），男，主管技师，主要从事临床检验方面研究。E-mail：chenzhenjin0430@126.com
基金资助:
国家自然科学基金资助项目(81703276)

Predictive value of plasma von Willebrand factor antigen levels for long-term prognosis of elderly patients with acute myocardial infarction

CHEN Zhenjin¹(), JIN Xiaoqing², QI Anning¹, HAN Chongxu³^,^△()

1 Department of Clinical Laboratory, Liuhe Hospital Affiliated to Yangzhou University Medical College, Liuhe 211599, China
2 Department of Geriatrics, Liuhe Hospital Affiliated to Yangzhou University Medical College, Liuhe 211599, China
3 Department of Medical Laboratory Medicine, Subei People's Hospital Affiliated to Yangzhou University

Received:2025-02-12 Revised:2025-04-08 Published:2025-06-15 Online:2025-06-20
Contact: ^△E-mail: hanchongxu@126.com

陈珍进, 金晓青, 祁安宁, 韩崇旭. 血浆血管性血友病因子抗原水平对老年急性心肌梗死患者长期预后的预测价值[J]. 天津医药, 2025, 53(6): 589-593.

CHEN Zhenjin, JIN Xiaoqing, QI Anning, HAN Chongxu. Predictive value of plasma von Willebrand factor antigen levels for long-term prognosis of elderly patients with acute myocardial infarction[J]. Tianjin Medical Journal, 2025, 53(6): 589-593.

摘要/Abstract

摘要：

目的探讨血浆血管性血友病因子（VWF）抗原水平对老年急性心肌梗死（AMI）患者长期预后的预测价值。方法选取老年AMI患者150例，入院后行经皮冠状动脉介入治疗（PCI）。于PCI后24 h内检测患者血浆VWF抗原水平。对患者进行为期12个月的随访，依照是否发生主要不良心脏事件（MACE）将患者分为MACE组和非MACE组，分析AMI患者12个月内发生MACE的危险因素。评估VWF抗原水平对AMI患者发生MACE的预测价值。通过受试者工作特征（ROC）曲线确定血浆VWF抗原水平的最佳截断值，依照最佳截断值进行分组，绘制Kaplan-Meier曲线比较不同血浆VWF抗原水平的患者MACE发生情况。结果 150例患者中有7例失访，最终纳入143例患者，其中MACE组53例（37.1%），非MACE组90例（63.9%）。MACE组患者年龄、B型尿钠肽（BNP）、D-二聚体、VWF抗原水平明显高于非MACE组患者。Cox比例风险模型结果显示，年龄增长（HR=1.085，95%CI：1.014~1.160）、血浆VWF抗原水平升高（HR=1.030，95%CI：1.017~1.045）、BNP升高（HR=1.016，95%CI：1.004~1.027）是老年AMI患者术后1年发生MACE的危险因素。血浆VWF抗原水平预测MACE的最大约登指数为0.616，最佳临界值为162.5 μg/L，敏感度为84.9%，特异度为76.7%。生存分析结果显示血浆VWF抗原≥162.5 μg/L组患者发生MACE的平均时间较血浆VWF抗原<162.5 μg/L组缩短（7.7个月vs. 11.6个月，Log-rank χ²=63.060，P<0.001）。结论血浆VWF抗原水平升高是老年AMI的独立危险因素，可作为AMI患者长期预后的预测因子。

关键词: 心肌梗死, 危险因素, 血管性血友病因子, 主要不良心脏事件

Abstract:

Objective To investigate the predictive value of plasma von Willebrand factor (VWF) antigen levels for the long-term prognosis of patients with acute myocardial infarction (AMI). Methods A total of 150 elderly patients diagnosed with AMI were selected and treated with percutaneous coronary intervention (PCI) at admission. The plasma VWF antigen level of the patients was detected within 24 hours after PCI. Patients were followed up for 12 months and were divided into the major adverse cardiac events (MACE) group and the non-MACE group according to the occurrence of MACE. The risk factors for MACE in AMI patients within 12 months were analyzed. The prognostic value of VWF antigen level in AMI patients were evaluated. The optimal cut-off value of plasma VWF antigen level was determined by receiver operating characteristic (ROC) curve. Patients were groups according to the optimal cut-off value. Kaplan-Meier curve was drawn to compare the occurrence of MACE in patients with different plasma VWF antigen levels. Results Among the 150 observed patients, 7 patients were lost to follow-up, and eventually 143 patients were included. In 143 patients there were 53 patients (37.1%) in the MACE group and 90 cases (63.9%) in the non-MACE group. The age, B-type natriuretic peptide (BNP), D-dimer and VWF antigen levels were significantly higher in the MACE group than those in the non-MACE group. The results of the Cox proportional hazards model showed that age increase (HR=1.085, 95%CI：1.014-1.160), increased plasma VWF antigen level (HR=1.030, 95%CI: 1.017-1.045) and increased BNP (HR=1.016, 95%CI: 1.004-1.027) were risk factors for elderly patients in the MACE group one year after surgery. The maximum approximately Youden index of plasma VWF antigen level for predicting MACE was 0.616, the optimal cut-off value was 162.5 μg/L, the sensitivity was 84.9% and the specificity was 76.7%. The results of survival analysis showed that the average time to MACE in the group with plasma VWF antigen ≥162.5 μg/L was shorter than that in the group with plasma VWF antigen < 162.5 μg/L (7.7 months vs. 11.6 months, Log-rank χ²=63.060, P<0.001). Conclusion The increased plasma VWF antigen is an independent risk factor for AMI and can be used as a predictor of long-term prognosis in patients with AMI.

Key words: myocardial infarction, risk factor, von Willebrand factor, major adverse cardiac events

中图分类号:

R541.4

图/表 4

参考文献 22

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组别		n			性别（男/女）	年龄/ 岁			BMI/ （kg/m²）			吸烟史	饮酒史
非MACE组		90			58/32	71.8±5.5			23.2±3.7			42（46.7）	46（51.1）
MACE组		53			36/17	74.4±5.9			23.5±3.4			30（56.6）	29（54.7）
t或χ²					0.179	2.657^＊＊			0.482			1.318	0.174
组别				高血压史			糖尿病史			血管病变（单支/多支）
非MACE组				48（53.3）			53（58.9）			38/52
MACE组				28（52.8）			30（56.6）			24/29
χ²				0.003			0.072			0.127
组别	cTnT/（μg/L）				cTnI/（μg/L）				CK-MB/（μg/L）			BNP/（ng/L）
非MACE组	3.5±1.6				6.7±3.6				23.4±9.4			515.6±332.8
MACE组	3.2±1.1				6.2±3.3				22.8±8.0			815.9±537.2
t	1.207				0.827				0.389			4.130^＊＊
组别				D-D/ （mg/L）			FIB/ （g/L）			LDL-C/ （mmol/L）		HDL-C/ （mmol/L）
非MACE组				1.37±1.05			3.88±1.42			2.60±0.98		1.07±0.34
MACE组				2.33±1.82			4.05±1.38			2.64±1.03		0.99±0.28
t				4.004^＊＊			0.699			0.231		1.448
组别			TC/（mmol/L）					TG/（mmol/L）			VWF抗原/（μg/L）
非MACE组			4.20±1.39					1.50±1.07			154.3±23.3
MACE组			4.31±1.42					1.54±1.01			187.1±21.5
t			0.453					0.220			8.365^＊＊

组别		n			性别（男/女）	年龄/ 岁			BMI/ （kg/m²）			吸烟史	饮酒史
非MACE组		90			58/32	71.8±5.5			23.2±3.7			42（46.7）	46（51.1）
MACE组		53			36/17	74.4±5.9			23.5±3.4			30（56.6）	29（54.7）
t或χ²					0.179	2.657^＊＊			0.482			1.318	0.174
组别				高血压史			糖尿病史			血管病变（单支/多支）
非MACE组				48（53.3）			53（58.9）			38/52
MACE组				28（52.8）			30（56.6）			24/29
χ²				0.003			0.072			0.127
组别	cTnT/（μg/L）				cTnI/（μg/L）				CK-MB/（μg/L）			BNP/（ng/L）
非MACE组	3.5±1.6				6.7±3.6				23.4±9.4			515.6±332.8
MACE组	3.2±1.1				6.2±3.3				22.8±8.0			815.9±537.2
t	1.207				0.827				0.389			4.130^＊＊
组别				D-D/ （mg/L）			FIB/ （g/L）			LDL-C/ （mmol/L）		HDL-C/ （mmol/L）
非MACE组				1.37±1.05			3.88±1.42			2.60±0.98		1.07±0.34
MACE组				2.33±1.82			4.05±1.38			2.64±1.03		0.99±0.28
t				4.004^＊＊			0.699			0.231		1.448
组别			TC/（mmol/L）					TG/（mmol/L）			VWF抗原/（μg/L）
非MACE组			4.20±1.39					1.50±1.07			154.3±23.3
MACE组			4.31±1.42					1.54±1.01			187.1±21.5
t			0.453					0.220			8.365^＊＊

变量	β	SE	Wald χ²	P	HR	HR 95%CI
年龄	0.081	0.034	5.565	0.018	1.085	1.014~1.160
VWF抗原	0.030	0.007	18.630	<0.001	1.030	1.017~1.045
D-D	0.008	0.006	1.629	0.202	1.008	0.996~1.019
BNP	0.016	0.006	7.307	0.007	1.016	1.004~1.027

变量	β	SE	Wald χ²	P	HR	HR 95%CI
年龄	0.081	0.034	5.565	0.018	1.085	1.014~1.160
VWF抗原	0.030	0.007	18.630	<0.001	1.030	1.017~1.045
D-D	0.008	0.006	1.629	0.202	1.008	0.996~1.019
BNP	0.016	0.006	7.307	0.007	1.016	1.004~1.027

血浆血管性血友病因子抗原水平对老年急性心肌梗死患者长期预后的预测价值

Predictive value of plasma von Willebrand factor antigen levels for long-term prognosis of elderly patients with acute myocardial infarction

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