收稿日期: 2016-04-22
网络出版日期: 2016-06-30
基金资助
国家科技支撑计划资助项目(2011BAI11B08)
Clinic significance of D-dimer in short-term prognosis of patients with acute heart failure
Received date: 2016-04-22
Online published: 2016-06-30
探讨D 二聚体(D-dimer)在急性心力衰竭(acute heart failure, AHF)短期预后评估中的临床价值. 共选206 例患者随访3 个月, 采集心脏病发作期间静脉血检测血常规、血生化、D-dimer 和N 末端B 型脑钠肽前体(N-terminal pro-brain natriuretic peptide, NTproBNP)等指标. 心血管(cardiovascular, CV)事件包括近期因慢性心力衰竭急性发作需再入院治疗或者死亡. 发生心血管事件组的NT-proBNP 及D-dimer 的质量浓度比未发生事件组显著升高(P <0.001). 受试者工作特征(receiver operating characteristic, ROC) 曲线分析显示: NT-proBNP 预测AHF 患者出院后90 d 内心血管事件曲线下面积为0.806, D-dimer为0.887. Kaplan-Meier 生存曲线分析发现: NT-proBNP 的质量浓度>2 262.0 pg/mL, Ddimer的质量浓度>1.1 mg/dL的患者出院后90 d 内发生心血管事件的危险性显著高于其他分组(P <0.001). 可见D-dimer 可作为评估急性心力衰竭短期预后的生物学标志物, 且其在联合分析时能提升NT-proBNP 的预测价值.
张加良, 高蓉蓉, 李新立, 王晖 . D二聚体评估急性心力衰竭短期预后的临床意义[J]. 上海大学学报(自然科学版), 2016 , 22(3) : 376 -380 . DOI: 10.3969/j.issn.1007-2861.2016.03.020
This paper investigates the clinic significance of D-dimer in short-term prognosis of patients with acute heart failure (AHF). A total of 206 patients with AHF were enrolled and followed up for 3 months. Baseline level of complete blood count, complete biochemistry, D-dimer and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured at admission or in the following morning. Primary endpoints of the study were cardiovascular (CV) events, defined as cardiac death and/or readmission for AHF. D-dimer and NT-proBNP were significantly higher in the patients who had a CV events in a 90-day period (P < 0.001). The analysis results of the receiver operating characteristic (ROC) curves showed that the area under the curves (AUCs) of NT-proBNP, and D-dimer for predicting CV events within 90 days were 0.806 and 0.887. Kaplan-Meier survival curves for the 90-day CV events showed that patients with a D-dimer level > 1.1 mg/dL and NT-proBNP level > 2 262.0 pg/mL were at high risk (P < 0.001) for short-term outcomes of AHF. D-dimer can be used as a new biomarker to enhance the value in early predicting cardiovascular events of AHF when combined with NT-proBNP.
Key words： D-dimer; prognosis; acute heart failure (AHF)
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