γ谷氨酰转移酶对急性ST段抬高心肌梗死患者预后的预测价值

幺天保; 龚兴荣; 沈玲红; 沈节艳; 金叔宣; 丁嵩; 何奔

γ谷氨酰转移酶对急性ST段抬高心肌梗死患者预后的预测价值

Prognostic values of gamma-glutamyltransferase for patients with acute ST-segment elevation myocardial infarction

摘要

摘要: 目的: 探讨γ谷氨酰转移酶（gamma-glutamyltransferase，GGT）对行急诊介入治疗的ST段抬高心肌梗死（ST-segment elevation myocardial infarction，STEMI）患者的主要心脏不良事件(major adverse cardiac events，MACE）的预测作用。方法： STEMI并行急诊经皮冠脉介入治疗患者112例。收集入选患者的基本资料，检测血清GGT，住院期间及出院后每月定期随访MACE。分析GGT预测MACE的价值。结果：应用ROC曲线分析GGT对112例患者发生MACE的预测作用，随访30 d ROC曲线下面积（AUC）为0.576，P>0.05。3个月及6个月AUC分别为0.661和0.632，均P<0.05。得到的截断点为28.65 U/L。但GGT>28.65 U/L 和GGT<28.65U/L两组间年龄存在统计学差异（P<0.01），不具可比性。对70岁及70岁以上患者进行分析时，在随访的30 d、3个月和6个月曲线下面积均<0.5，无预测价值。70岁以下患者，30 d、3个月和6个月时AUC分别为0.669，0.715和0.720，分别为P<0.05，P<0.01和P<0.01，得到的截断点为28.65 U/L。把70岁以下患者GGT水平以28.65 U/L为截断点分为两组，GGT>28.65 U/L与GGT<28.65U/L组30 d，3个月及6个月MACE发生率为(28% vs. 10%，P<0.05)，(47% vs. 12%，P<0.01)以及(50% vs. 15%，P<0.01)。在二项分类的多变量logistic回归分析中，GGT独立于年龄、性别、多支病变、心功能KillipⅡ级以上、前壁心肌梗死、血清肌酸激酶同工酶、左室射血分数预测3个月、6个月MACE发生（均P<0.01）。结论： GGT对行急诊介入治疗的年龄70岁以下STEMI患者预后有预测价值。

Abstract: AIM: To investigate the prognostic values of serum gamma glutamyl-transferase (GGT) for major adverse cardiac events (MACE) in patients with acute ST-segment elevation myocardial infarction (STEMI) and treatment of emergency percutaneous coronary intervention (PCI). METHODS: One hundred and twelve consecutive STEMI patients who were treated with emergency PCI and were hospitalized in the Department of Cardiology in our hospital were selected from December 2006 to October 2007. Baseline clinical data were collected and serum GGT was measured. MACE was documented during the follow-up and the prognostic values of GGT on MACE were analyzed. RESULTS: ROC curve analysis of the 112 STEMI patients showed that the area under the ROC curve (AUC) of 30 days was 0.576 (P=0.286), AUC of 3 months and 6 months was 0.661 and 0.632 (P=0.011 and 0.029, respectively) and the cut-off point was 28.65 U/L. However, significant difference in age was observed between GGT >28.65 U/L group and GGT<28.65 U/L group (P=0.005). No predictive values of GGT were seen in patients aged≥70 years and the AUC of 30 days, 3 months and 6 months was <0.5, whereas the AUC of 30 days, 3 months and 6 months in patients aged<70 years was 0.669, 0.715 and 0.720, respectively (P=0.048, 0.004 and 0.002, respectively). The cut-off point was 28.65 U/L. According to the cut-off point, patients aged<70 years were divided into two groups and the clinical data of the two groups were comparable (P>0.05). MACE incidence during 30 days, 3 months and 6 months in GGT>28.65U/L group and GGT<28.65U/L group was 28.1% vs. 10.4%, P<0.05, 46.9% vs. 12.5%, P<0.01 and 50.0% vs. 14.6%, P<0.01. The incidence of MACE in GGT>28.65 U/L group was higher than that in GGT<28.65 U/L group. In the two categories of multivariate logistic regression analysis, GGT was an independent predictor of MACE during 3 months and 6 months adjusted by age, sex, multivessel disease, Killip II grade or above, anterior myocardial infarction, CKMB and EF (P<0.05). CONCLUSION: GGT has prognostic value for acute STEMI patients aged <70 years treated with emergency PCI.

HTML全文

参考文献(0)

施引文献

资源附件(0)