目的 探讨急性心肌梗死（AMI）患者经皮冠状动脉介入治疗（PCI）术后2年内发生主要
不良心血管事件（MACE）的危险因素，并确立其预测意义。方法 回顾性分析2013年1月至2015年1月于
陕西省人民医院心内科收治的急性心肌梗死（AMI）患者140例的临床资料，通过门诊及电话进行随访，
将PCI术后2年内发生MACE者作为观察组（45例），未发生MACE者作为对照组（95例），并对两组进
行单因素分析，筛选有统计学意义的危险因素，纳入Logistic回归模型，探讨心肌梗死（心梗）患者PCI
术后发生MACE的独立危险因素，并预测其价值。结果 单因素分析显示，MACE组患者入院时低密度脂
蛋白胆固醇（LDL-C）水平、脂蛋白a和血浆凝血酶原时间（PT）较对照组明显升高，糖尿病、高脂血
症、颈动脉斑块形成和吸烟史在MACE组所占比例明显升高，MACE组较对照组患者入院时年龄普遍较
高，差异均有统计学意义（P＜0.05）。二元Logistic回归分析显示，入院时年龄（OR=1.069，95%CI：
1.012~1.13，P＜0.01）、糖尿病（OR=4.224，95%CI：1.323~13.484，P＜0.01）、吸烟史（OR=4.091，
95%CI：1.371~12.209，P＜0.01）、颈动脉斑块形成（OR=3.191，95%CI：1.158~8.793，P＜0.01）、
LDL-C水平（OR=2.852，95%CI：1.215~6.694，P＜0.01）和PT值（OR=1.833，95%CI：1.118~3.006，P
＜0.01）是AMI患者PCI术后发生MACE的独立危险因素。ROC曲线结果显示，入院时年龄的曲线下面积
为0.643（P=0.006），截断值为69.5岁；LDL-C的曲线下面积为0.741（P=0.000），截断值为3.02 mmol/L；
PT值的曲线下面积为0.636（P=0.011），截断值为11.35 s。结论 入院时患者年龄、糖尿病、颈动脉斑块
形成、吸烟史、LDL-C水平和PT值是AMI患者PCI术后发生MACE的独立危险因素。且年龄增高、LDL-C
水平升高和血浆凝血酶原时间延长对MACE的发生具有一定的预测价值。

Objective To discuss the risk factors of major adverse cardiovascular events (MACE) occurred within 2y after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI), and to definite their predictive significance. Methods The clinical materials were retrospectively analyzed from AMI patients (n=140) treated in Department of Cardiology in People’s Hospital of Shaanxi Province from Jan. 2013 to Jan. 2015. All patients were followed up through out-patient department and telephone, and then divided into observation group (with MACE within 2y after PCI, n=45) and control group (without MACE, n=95). A single-factor analysis was conducted in 2 groups for screening risk factors with statistical significance and included into Logistic regression model. The independent risk factors of MACE occurred after PCI and their predictive value to MACE were discussed in AMI patients. Results The results of single-factor analysis showed that the levels of low-density lipoprotein-cholesterol (LDL-C), lipoprotein-a and prothrombin time (PT) increased significantly, percentages of patients with diabetes, hyperlipidemia, carotid artery plaque and smoking history increased significantly, and age at admission was older in MACE group compared with control group (all P<0.05). The results of binary Logistic regression analysis showed that age at admission (OR=1.069, 95%CI: 1.012~1.13, P<0.01), diabetes (OR=4.224, 95%CI: 1.323~13.484, P<0.01), smoking history (OR=4.091, 95%CI: 1.371~12.209, P<0.01), carotid artery plaque (OR=3.191, 95%CI: 1.158~8.793, P<0.01), LDL-C (OR=2.852, 95%CI: 1.215~6.694, P<0.01) and PT value (OR=1.833, 95%CI: 1.118~3.006, P<0.01) were independent risk factors of MACE after PCI in AMI patients. The results of ROC curve analysis showed that AUC of age at admission was 0.643 (P=0.006) and cutoff value was 69.5, AUC of LDL-C was 0.741(P=0.000) and cutoff value was 3.02 mmol/L, and AUC of PT value was 0.636 (P=0.011) and cutoff value was 11.35 seconds. Conclusion Age at admission, diabetes, carotid artery plaque, smoking history,LDL-C level and PT value are independent risk factors of MACE after PCI in AMI patients. The increased age and LDL-C level and prolonged PT have some predictive value to MACE incidence.

心馨-默克心血管科研基金资助项目(Y20170719)