活化部分凝血活酶时间与急性ST段抬高心肌梗死血栓负荷的相关性

Correlation between activated partial thromboplastin time and thrombus burden in patients with acute myocardial infarction

摘要:

目的 探讨急性心肌梗死患者的活化部分凝血活酶时间(aPTT)与冠状动脉内血栓负荷之间的关系。方法 收集2011年1月至2013年12月首都医科大学附属北京友谊医院急诊住院的急性ST段抬高心肌梗死(STEMI)患者424例,且均在6h内接受了直接经皮冠状动脉介入(PCI)治疗。根据冠状动脉造影及介入治疗术中情况,将患者分为高血栓负荷组(199例)和低血栓负荷组(225例)。所有患者均在急诊就诊时测量基线的血液学指标和血栓负荷状态。采用SPSS 19.0统计学软件对数据进行处理,组间多因素分析采用logistic分析。结果 高血栓负荷组与低血栓负荷组平均年龄[(59.4±11.7)和(61.9±11.8)岁]、aPTT[(24.9±3.2)和(26.6±4.0) s]、凝血酶原时间(PT)[(11.3±0.8)和(11.5±1.0)s]、左回旋支(LCX)比例[9.5%(19/199)和18.0%(40/225)]、男性比例[84.3%(168/199)和74.3%(167/225)]、白细胞计数[(10.0±3.1)×10⁹和(9.3±3.1)×10⁹/L]、右冠状动脉(RCA)比例[45.2%(90/199)和29.8%(68/225)]比较,差异均有统计学意义(均P＜0.05)。2组吸烟状况、用药、既往患有高血压及糖尿病比例、肝肾功能、电解质、PTA、AT-Ⅲ、FBG等指标比较,差异均无统计学意义(均P>0.05)。组间多因素logistic分析结果显示,aPTT(OR=1.175,95％CI 1.102~1.252)和RCA(OR=2.783,95％CI 1.409~5.497)为高血栓负荷的独立预测因子(P<0.01)。aPTT的受试者工作特征曲线下面积为0.660(95％CI 0.608~0.711,P＜0.001)。结果提示,排除高血栓负荷的aPTT的最佳临界值为26.05(灵敏度为53.5％,特异度为72.6％)。结论 急性ST段抬高型心肌梗死患者急诊就诊时缩短的aPTT值与PCI治疗时所见的高血栓负荷相关。

Abstract:

Objective To explore the relationship between activated partial thromboplastin time (aPTT) and intracoronary thrombus burden in patients with acute myocardial infarction. Methods From January 2011 to December 2013, a total of 424 patients with acute ST-segment elevation myocardial infarction were enrolled, who were admitted to the Emergency Department of Beijing Friendship Hospital affiliated to Capital Medical University and received primary percutaneous coronary intervention (PCI) within 6 hours. According to the findings of coronary artery angiography and the coronary intervention, they were divided into the high thrombus burden (HTB) group (n=199) and the low thrombus burden (LTB) group (n=225). Baseline hematologic indices and thrombus burden were measured on the visit at the Emergency Department. SPSS statistics 19.0 was used to process the data and multivariate logistic regression analysis was employed for comparison between groups. Results Compared with the LHB group, the HTB group had lower average age[(59.4±11.7) vs(61.9±11.8)years], aPTT[(24.9±3.2) vs(26.6±4.0)s], PT [(11.3±0.8) vs(11.5±1.0)s]and LCX proportion[9.5%(19/199) vs 18.0%(40/225)], but higher male proportion[84.3%(168/199) vs 74.3%(167/225)] , white blood cell count[(10.0±3.1)×10⁹ vs(9.3±3.1)×10⁹/L] and RCA proportion [45.2%(90/199) vs 29.8%(68/225)], the differences being statistically significant (all P<0.05). aPTT in the HTB group was significantly lower than that of the LTB group. There was no statistically significant difference between the two groups in smoking status, medication, previous hypertension and diabetes, liver function, kidney function, electrolytes, PTA, AT-Ⅲ, FBG and other indicators (P>0.05). Multivariate logistic regression analysis showed aPTT (OR=1.175,95%CI 1.102-1.252) and RCA (OR=2.783,95%CI 1.409-5.497)as independent predictors for thrombus burden (P<0.01). The area under the receiver operating characteristic curve of aPTT was 0.660 (95%CI 0.608-0.711, P<0.001). The results suggest that the best cut-off value for aPTT excluding high thrombus load was 26.05 with a sensitivity of 53.5% and a specificity of 72.6%. Conclusion Shortened aPTT on admission is significantly related to angiographic thrombus burden in the patients with acute ST-segment elevation myocardial infarction.