天津医药

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急性心肌梗死介入术后血清TNF-α及hs-CRP对判断预后的意义

罗玮1,崔博2,孙根义3,王伟1   

  1. 1. 天津市胸科医院
    2. 南开大学医学院医学部
    3. 天津市胸科医院 心内科
  • 收稿日期:2011-03-02 修回日期:2011-08-29 出版日期:2011-12-15 发布日期:2011-12-15
  • 通讯作者: 罗玮

Prognostic significance of increased postprocedural tumor necrosis factor-α and high sensitivity C-Reactive Protein in acute myocardial infarction patients treated with percutaneous coronary intervention.

  • Received:2011-03-02 Revised:2011-08-29 Published:2011-12-15 Online:2011-12-15

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摘要： 目的：探讨经皮冠状动脉介入（PCI）治疗后血清肿瘤坏死因子-α（TNF-α）及超敏C-反应蛋白（hs-CRP）水平与急性心肌梗死（AMI）患者近、远期预后的关系。方法：连续入选成功接受PCI的初发AMI患者152例，PCI后12 h 内取血进行TNF-α及h s-CRP检测。采用Logistic回归评价PCI后血TNF-α及hs-CRP水平与患者30 d和1年内发生心脏不良事件（MACE）的关系。采用Kaplan-Meier生存曲线分析不同TNF-α及hs-CRP水平的患者30 d 和1年的生存率。结果：PCI后MACE组与无MACE组比较，前壁心肌梗死所占比例、肌酸激酶同工酶峰值、左心室射血分数、TNF-α及hs-CRP水平均差异有统计学意义。Logistic回归分析显示AMI患者PCI术后TNF-α30 d 和1年的OR值分别为1.43 (P=0.006）和1.62 (P=0.002），hs-CRP30 d 和1年的OR值分别为1.14（P=0.004）和1.22（P=0.005）。PCI后高TNF-α组的患者30 d和1年累积生存率明显低于低TNF-α组。高hs-CRP组与低hs-CRP组的患者相比30 d累积生存率差异无统计学意义，1年累积生存率明显减低。高TNF-α组1年的再发心肌梗死率、30d和1年的再次血运重建率均高于TNF-α组。高hs-CRP组PCI术后30 d和1年的再发心肌梗死率、再次血运重建率均明显高于低hs-CRP组。结论： TNF-α及hs-CRP升高与初发AMI患者成功PCI后近期和远期MACE事件发生率密切相关。

关键词: 心肌梗死, 经皮腔内冠状动脉成形术, 肿瘤坏死因子-α, 超敏C-反应蛋白, 预后

Abstract: Objective The aim of the study was to evaluate the prognostic value of the postprocedural tumor necrosis factor-α (TNF-α) and high sensitivity C-Reactive Protein(hs-CRP) in patients with first acute myocardial infarction(AMI) treated with successful percutaneous coronary intervention(PCI). Methods A total of 152 consecutive AMI patients underwent successful PCI were enrolled. TNF-α and hs-CRP were measured within 12 hours after PCI. All patients were followed up for 1 year. Logistic regerssion analysis was used to evaluate predictive values of postprocedural TNF-α and hs-CRP for MACE at 30 days and 1 year post PCI. Time-to-event analyses were performed using the Kaplan-Meier survival curves in patients with various ranges of postprocedural TNF-α and hs-CRP. Results The percentage of anterior myocardial infarction, the peak of Creatine Kinase MB, left ventricular ejection fraction, TNF-α and hs-CRP levels were all significantly different between MACE group and non-MACE group after PCI. Multivariable logistic analysis showed the OR of TNF-α were 1.43 (P=0.006) at 30 days and 1.62 (P=0.002) at 1 year. The OR of hs-CRP were 1.14 (P=0.004) at 30 days and 1.22 (P=0.005) at 1 year. The patients with higher postprocedural TNF-α level had significant lower survival rates at 30-day and at 1-year, compared with the patients with lower postprocedural TNF-α level. The patients with higher postprocedural hs-CRP level had significant lower survival rates at 1-year, compared with the patients with lower hs-CRP level. In higher TNF-α group recurrent myocardial infarction rates at 1-year, revascularization rates at 30-days and at 1-year were higher than those in lower TNF-α group. Compared with those in lower hs-CRP group, recurrent myocardial infarction rates and revascularization rates at 30-days and at 1-year all apparently increased in higher hs-CRP group. Conclusion Postprocedural TNF-α and hs-CRP levels are closely related with short and long-term MACE in first AMI patients treated with successful primary PCI.

Key words: myocardial infarction, percutaneous coronary intervention, tumor necrosis factor-α, high sensitivity C-Reactive Protein, prognosis