摘要： 目的 探索D-二聚体（D-dimer）与慢性心力衰竭（简称心衰）患者发生院内死亡的相关性。方法 回顾性分析慢性心衰患者2 840例，按照是否发生院内死亡分组，分为生存组和院内死亡组。采用Spearman相关分析，得出与D-dimer相关的血液指标和超声心动图指标。以Spearman相关分析中具有相关性的指标为自变量，D-dimer为因变量，通过多元逐步回归分析显示与D-dimer密切相关的患者临床资料。通过受试者操作特征（ROC）曲线确定D-dimer预测院内死亡的最佳界值。利用单因素和多因素logistic回归分析得出慢性心衰发生院内死亡的独立危险因素。比较各独立危险因素的ROC曲线下面积（AUC），判断各因素对院内死亡发生的预测价值。结果 2 840例患者中发生院内死亡46例。院内死亡组D-dimer较生存组升高[分别为788（342~1 418）μg/L和212（120~420）μg/L，P < 0.001]。Spearman相关分析和多元逐步回归分析显示，D-dimer与脑钠肽（BNP）呈正相关（P=0.017），与白蛋白、血钠、淋巴细胞计数呈负相关（分别为P < 0.001，P < 0.001，P=0.021）。通过ROC曲线，D-dimer预测院内死亡的最佳界值为614 μg/L，AUC_D-dimer=0.815。单因素和多因素logistic回归分析显示，D-dimer>614 μg/L是慢性心衰发生院内死亡的独立危险因素（单因素分析OR=11.147，95%CI：5.967~20.822；多因素分析OR=5.691，95%CI：2.750~11.778）。其他独立危险因素BNP、血红蛋白、血肌酐的AUC比较结果显示（AUC_BNP=0.729，AUC_血红蛋白=0.679，AUC_血肌酐=0.621），D-dimer预测慢性心衰院内死亡发生的价值高于血红蛋白和血肌酐，但与BNP无差异。结论 D-dimer升高是慢性心衰发生院内死亡的独立危险因素。

D-二聚体与慢性心力衰竭院内死亡的相关性

佟菲, 王传合, 韩苏, 李影, 李志超, 孙志军

中国医科大学附属盛京医院心血管内科, 沈阳 110022

收稿日期:2020-03-17出版日期:2020-08-30发布日期:2020-08-04
通讯作者:孙志军E-mail:18940251218@163.com
作者简介:佟菲(1987-),男,医师,硕士.
基金资助:辽宁省自然科学基金（2018225003）


关键词: 慢性心力衰竭, D-二聚体, 院内死亡
Abstract: Objective To investigate the association between D-dimer level and in-hospital mortality in patients with chronic heart failure. Methods A total of 2 840 patients with chronic heart failure were retrospectively evaluated and divided into either the survivor group or in-hospital death group. The blood test and echocardiography indexes related to PTA were found using Spearman's rank correlation analysis and multivariate stepwise regression analysis. Single factor and multiple factor logistic regression analyses were used to obtain the independent risk factors for predicting in-hospital mortality. The predictive value of each factor for in-hospital mortality were compared using the areas under the receiver operating characteristic (ROC) curve of each independent risk factor. Results There were 46 in-hospital deaths among the 2 840 patients. Spearman's rank correlation analysis and the multivariate stepwise regression analysis revealed that D-dimer level positively correlated with brain natriuretic peptide (BNP) (P=0.017) and negatively correlated with albumin,serum sodium,and lymphocyte count (P < 0.001,P < 0.001,P=0.021). The ROC curve revealed that the best D-dimer cut-off value for predicting in-hospital mortality was 614 μg/L (AUCD-dimer=0.815). The univariate and multivariate logistic regression analyses revealed that elevated D-dimer level (>614 μg/L) was an independent risk factor of in-hospital mortality (univariate analysis OR=11.147,95% CI:5.967-20.822;multivariate analysis OR=5.691,95% CI:2.750-11.778). The predictive value of D-dimer for in-hospital mortality was higher than that of hemoglobin and creatinine levels. However,no difference with BNP was observed (AUC_BNP=0.729,AUC_hemoglobin=0.679,AUC_creatinine=0.621). Conclusion Elevated D-dimer level is an independent risk factor of in-hospital mortality in patients with chronic heart failure.
Key words: chronic heart failure, D-dimer, in-hospital mortality
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