Correlation between plasma thrombomodulin level and early prognosis in patients with radial coronary artery bypass grafting
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摘要: 目的 分析桡动脉冠状动脉旁路移植术患者血浆血栓调节蛋白(TM)水平与早期预后的相关性。 方法 将193例桡动脉冠状动脉旁路移植术患者根据术后24 h血浆TM水平分为TM低水平组97例和TM高水平组96例。根据出院6个月心脑血管事件发生情况,将患者分为预后良好121例和预后不良72例。采用ELISA法检测血浆TM水平,分析2组一般资料、手术情况、合并疾病情况及预后情况,分析影响桡动脉冠状动脉旁路移植术患者早期预后的因素。 结果 与TM低水平组比较, TM高水平组体质量指数(BMI)较高、左室射血分数(LVEF)较低、吸烟史例数较多,差异均有统计学意义(P<0.05)。与TM低水平组比较, TM高水平组合并2型糖尿病、新发及陈旧性心肌梗死例数较多,差异均有统计学意义(P<0.05)。TM高水平组预后良好率低于TM低水平组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示, TM、新发及陈旧性心肌梗死是影响冠心病患者桡动脉冠状动脉旁路移植术后发生不良预后的独立危险因素(P<0.05), LVEF是影响冠心病患者桡动脉冠状动脉旁路移植术后发生不良预后的保护因素(P<0.05)。 结论 血浆TM水平与患者术前身体状况有一定联系, TM高水平患者术后不良心脑血管事件发生率高于低水平患者, TM水平变化对评估冠心病患者预后有重要意义。Abstract: Objective To analyze the correlation between plasma thrombomodulin(TM)level and early prognosis in patients with radial coronary artery bypass grafting. Methods According to plasma TM level within 24 h after operation, 193 patients with radial coronary artery bypass grafting were divided into low TM group(n=97)and high TM group(n=96). According to incidence of cardiovascular and cerebrovascular events within 6 months after discharge, the patients were divided into good prognosis cases(n=121)and poor prognosis cases(n=72). The level of plasma TM was detected by ELISA. The general information, operation condition, complicated diseases conditions and prognosis were analyzed in both groups. The factors influencing the early prognosis of patients with radial coronary artery bypass grafting were analyzed. Results Compared with the low TM group, a higher body mass index(BMI), a lower left ventricular ejection fraction(LVEF)and a higher ratio of cases with smoking history were found in high TM group, and differences were statistically significant(P<0.05). Compared with the low TM group, higher ratios of cases with type 2 diabetes mellitus as well as new and old myocardial infarction were found in high TM group, and differences were statistically significant(P<0.05). The good prognosis rate of the high TM group was significantly lower than that of the low TM group(P<0.05). Multivariate Logistic regression analysis showed that TM, new and old myocardial infarction were the independent risk factors for adverse prognosis of patients after radial coronary artery bypass grafting(P<0.05), and LVEF was a protective - factor for adverse prognosis after radial coronary artery bypass grafting(P<0.05). Conclusion The plasma TM level is related to the preoperative physical condition of patients. The incidence of adverse cardiovascular and cerebrovascular events in patients with high TM level is higher than that in patients with low TM level, and the change of TM level is of great significance in evaluating the prognosis of patients with coronary heart disease.
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