【摘要】 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,NTpro BNP)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-pro BNP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-pro BNP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-pro BNP的质量浓度>2 262.0 pg/m L,Ddimer的质量浓度>1.1 mg/d L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-pro BNP的预测价值.更多还原

【Abstract】 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-pro BNP) 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-pro BNP 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-pro BNP, 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/d L and NT-pro BNP level > 2 262.0 pg/m L 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-pro BNP.更多还原