肿瘤坏死因子α与急性冠脉综合征患者预后的关系研究

摘要

Objective To investigate the relationship between tumor necrosis factor - alpha(TNF-α)and prognosis of patients with acute coronary syndrome( ACS). Methods A total of 371 patients with ACS were selected in the People′s Hospital of Xinjiang Uygur Autonomous Region from April 2014 to January 2015,and they were divided into A group (complicated with cardiovascular endpoint events,n = 55)and B group(did not complicated with cardiovascular with endpoint events,n = 316)according to the follow - up results. Clinical data was collected,risk factors of cardiovascular endpoint events and predictive value of TNF-α on prognosis of patients with ACS were analyzed. Results No statistically significant differences of age,male proportion,incidence of myocardial infarction,hypertension or hyperlipidaemia,BMI,WBC,PLT,utilization rates of calcium channel blocker,beta - blocker,statins or ACEI/ ARB was found between the two groups(P > 0. 05);positive rate of smoking history,incidence of diabetes and serum TNF-α of A group were statistically significantly higher than those of B group(P < 0. 05). Multivariate logistic regression analysis showed that,smoking history〔 OR = 1. 302,95% CI(1. 113, 4. 843)〕,diabetes〔OR = 2. 216,95% CI(1. 318,5. 192)〕 and TNF-α〔OR = 1. 645,95% CI(1. 203,5. 843)〕 were risk factors of cardiovascular endpoint events in patients with ACS(P < 0. 05). The AUC of TNF-α in predicting prognosis of patients with ACS was 0. 769 〔 95% CI( 0. 714,0. 822 )〕,when it was 27. 9 ng/ L,the sensitivity was 76. 36% ,the specificity was 67. 41% ,the diagnosis index was 43. 77. Conclusion TNF-α has certain predictive value on prognosis of patients with ACS,smoking history,diabetes and TNF-α are risk factors of cardiovascular endpoint events in patients with ACS.%目的：探讨肿瘤坏死因子α（TNF-α）与急性冠脉综合征（ACS）患者预后的关系研究。方法选取2014年4月—2015年1月新疆维吾尔自治区人民医院收治的 ACS 患者371例，按随访结果分为心血管终点事件组55例与对照组316例。收集所有患者临床资料，分析 ACS 患者发生心血管终点事件的危险因素及TNF-α对 ACS 患者预后的预测价值。结果两组患者年龄、男性比例、心肌梗死发生率、高血压发生率、高脂血症发生率、体质指数（BMI）、白细胞计数（WBC）、血小板计数（PLT）、钙离子拮抗剂使用率、β-受体阻滞剂使用率、他汀类药物使用率、血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂（ACEI/ ARB）使用率比较，差异无统计学意义（P >0.05）；心血管事件组患者吸烟史阳性率、糖尿病发生率、血浆TNF-α水平高于对照组（P <0.05）。多因素 logistic 回归分析结果显示，吸烟史〔OR =1.302，95% CI（1.113，4.843）〕、糖尿病〔 OR =2.216，95% CI（1.318，5.192）〕、TNF-α〔OR =1.645，95% CI（1.203，5.843）〕是 ACS 患者发生心血管终点事件的危险因素（P <0.05）。TNF-α预测 ACS 患者发生心血管终点事件的曲线下面积为0.769〔95% CI（0.714，0.822）〕，其为27.9 ng/ L 时灵敏度为76.36%，特异度为67.41%，诊断指数为43.77。结论 TNF-α对 ACS 患者预后具有一定预测价值，吸烟史、糖尿病、TNF-α是 ACS患者发生心血管终点事件的危险因素。