急性心肌梗死患者D二聚体质量浓度与远期预后的关系

目的 探讨急性心肌梗死(acute myocardial infarction,AMI)患者D二聚体(D-dimer)质量浓度与病情严重程度和远期心源性死亡的关系。方法 选取2013年1月至2020年1月收入首都医科大学附属北京友谊医院的AMI患者3 990例,根据D-dimer质量浓度分为3组:≤0.50 mg/L、0.51～0.80 mg/L、≥0.81 mg/L,平均随访时间为2.1 (1.0～4.0) 年。应用Cox比例风险回归模型评估D-dimer对心源性死亡的影响。结果 D-dimer≥0.81 mg/L组患者年龄较大、女性居多、体质量指数较低,既往合并高血压、糖尿病者较多,3支病变较为多见,住院期间肾小球滤过率较低,N末端B型利钠肽原峰值明显升高,左室射血分数<50%患者比例明显升高。D-dimer≥0.81 mg/L组患者在随访期间累计心源性病死率(18.7%)高于D-dimer≤0.50 mg/L组(2.3%)和D-dimer 0.51～0.80 mg/L组(6.1%),且校正其他危险因素后,D-dimer能独立预测AMI患者的心源性死亡(HR=1.71,95%CI:1.34~2.18,P<0.001)。结论 D-dimer能反映AMI患者病情的严重程度,且D-dimer升高可在一定程度上预测AMI患者远期心源性死亡事件发生率升高。

Effect of D-dimer on long-term prognosis in patients with acute myocardial infarction

Objective To investigate the relationship between D-dimer and the risk of cardiac death in patients with acute myocardial infarction (AMI). Methods From January 2013 to January 2020, 3 990 patients admitted in Beijing Friendship Hospital with AMI were included in the present study. Patients were divided into 3 groups according to D-dimer:≤0.50 mg/L, 0.51-0.80 mg/L,≥0.81 mg/L. We used Cox proportional hazard regression to evaluate the influence of D-dimer on cardiac death. Results The patients in D-dimer≥0.81 mg/L group were older, thinner, more likely to be female, had higher prevalence of hypertension, diabetes, and multivessel disease, lower estimated glomerular filtration rate, higher levels of N-terminal pro-brain natriuretic peptide, and more likely to have left ventricular ejection fraction<50%. The cardiac mortality rate was highest in D-dimer≥0.81 mg/L group. After adjusting for other risk factors, D-dimer remained an independent risk factor of cardiac death in patients of AMI (HR=1.71,95%CI: 1.34-2.18,P<0.001). Conclusion Higher level of D-dimer reflected the severity of disease in patients with AMI. In addition, D-dimer was an independent risk factor of cardiac death in patients with AMI.