Thromb Haemostasis:IPF作为非心脏手术后MACE的新生物学标志!

2017-08-16 xing.T MedSci原创

总之,IPF是术后modMACE发生的独立预测因素,其可能改善手术患者的危险分层。

近日,血栓和凝血疾病权威杂志Thrombosis and Haemostasis上发表了一篇研究文章,该研究旨在评估在麻醉后监护病房(PACU)测定的未成熟血小板(IPF)是否可以预测中等和高风险手术后的主要不良心血管事件(MACE)或其它血栓栓塞事件。在急性冠脉综合征患者中IPF有所增加,最近被认为是危险分层的生物标记物。

在这项前瞻性观察性试验中,研究人员纳入了732例中高危非心脏手术患者(NCT02097602)。研究人员在PACU测量了受试者术前和术后的IPF。该研究的主要终点定义为MACE、住院期间深静脉血栓或肺栓塞(modMACE)的复合终点。研究人员通过Log-rank优化的方法来计算区分低风险和高风险modMACE的IPF临界值。研究人员采用逐步多变量Cox回归来计算评估IPF临界值与modMACE以及其他已知风险因素(P<0.05)之间的相关性。

在术前,研究人员发现伴有和不伴有modMACE的患者IPF之间并没有显著差异(3.1%[2.2%-4.7%](中位数[四分位间距]) vs. 2.8%[1.9%-4.3%]。在PACU中,研究人员发现伴有modMACE的患者(28/730例;3.8 %)比不伴有modMACE的患者有较高的IPF值(3.6% [2.6-6 %] vs. 2.9%[2-4.4%];P=0.011)。IPF>5.4%作为最佳临界值在调整协变量后与modMACE风险增加相关(风险比为2.528;95%可信区间为1.156 %-5.528%,P=0.02)。

总之,IPF是术后modMACE发生的独立预测因素,其可能改善手术患者的危险分层。

原始出处:

A. Anetsberger ,et al. Immature platelets as a novel biomarker for adverse cardiovascular events in patients after non-cardiac surgery. Thrombosis and Haemostasis.2017. https://doi.org/10.1160/TH16-10-0804

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    2018-05-14 mhm289
  4. 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createdName=sjzlzc007, createdTime=Fri Dec 22 21:36:00 CST 2017, time=2017-12-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1794295, encodeId=5c8b1e9429500, content=<a href='/topic/show?id=fb7d16e489b' target=_blank style='color:#2F92EE;'>#STAS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16748, encryptionId=fb7d16e489b, topicName=STAS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=af60254, createdName=mhm289, createdTime=Mon May 14 00:36:00 CST 2018, time=2018-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1655782, encodeId=bbda1655e8216, content=<a href='/topic/show?id=2a011829d7' target=_blank style='color:#2F92EE;'>#ACE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1829, encryptionId=2a011829d7, topicName=ACE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=635024767990, createdName=shanyongle, createdTime=Tue Oct 03 22:36:00 CST 2017, time=2017-10-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2008298, encodeId=43db20082981d, content=<a href='/topic/show?id=1066844469' target=_blank style='color:#2F92EE;'>#HAE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8444, encryptionId=1066844469, topicName=HAE)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=32d177, createdName=changfy, createdTime=Sun Mar 25 02:36:00 CST 2018, time=2018-03-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1819373, encodeId=25ca18193e330, content=<a href='/topic/show?id=210c9941411' target=_blank style='color:#2F92EE;'>#非心脏手术后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99414, encryptionId=210c9941411, topicName=非心脏手术后)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=325a197, createdName=amyloid, createdTime=Mon Mar 26 06:36:00 CST 2018, time=2018-03-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1996035, encodeId=c7d119960351a, content=<a href='/topic/show?id=ed881120ec8' target=_blank style='color:#2F92EE;'>#MAC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11207, encryptionId=ed881120ec8, topicName=MAC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4b65161, createdName=yb6560, createdTime=Wed Dec 06 22:36:00 CST 2017, time=2017-12-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1339900, encodeId=b85d13399006d, content=<a href='/topic/show?id=1f669990c9' target=_blank style='color:#2F92EE;'>#IPF#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9990, encryptionId=1f669990c9, topicName=IPF)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eqTLTjicBiccpdUyHMGZV43nOBI6QIQqxVcy2EzXz67E390Q5j0R7QWjym391HxsyiaYt7NzbrcojRDw/132, createdBy=64462500151, createdName=ms705947299214030, createdTime=Fri Aug 18 12:36:00 CST 2017, time=2017-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1488275, encodeId=d38a14882e57a, content=<a href='/topic/show?id=f37799413a6' target=_blank style='color:#2F92EE;'>#非心脏手术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99413, encryptionId=f37799413a6, topicName=非心脏手术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b5438409695, createdName=bnurmamat, createdTime=Fri Aug 18 12:36:00 CST 2017, time=2017-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1575185, encodeId=a49b15e51857b, content=<a href='/topic/show?id=6b10112139c' target=_blank style='color:#2F92EE;'>#MACE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11213, encryptionId=6b10112139c, topicName=MACE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2c1f16064818, createdName=lfyang, createdTime=Fri Aug 18 12:36:00 CST 2017, time=2017-08-18, status=1, ipAttribution=)]
    2017-10-03 shanyongle
  5. [GetPortalCommentsPageByObjectIdResponse(id=1933108, encodeId=a8b11933108f8, content=<a href='/topic/show?id=ced969314e4' target=_blank style='color:#2F92EE;'>#生物学标志#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69314, encryptionId=ced969314e4, topicName=生物学标志)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b70c362, createdName=jiadan198782, createdTime=Sun Dec 24 04:36:00 CST 2017, time=2017-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1819268, encodeId=6e491819268be, content=<a href='/topic/show?id=aba89940943' target=_blank style='color:#2F92EE;'>#非心脏#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99409, encryptionId=aba89940943, topicName=非心脏)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=917c196, createdName=sjzlzc007, createdTime=Fri Dec 22 21:36:00 CST 2017, time=2017-12-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1794295, encodeId=5c8b1e9429500, content=<a href='/topic/show?id=fb7d16e489b' target=_blank style='color:#2F92EE;'>#STAS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16748, encryptionId=fb7d16e489b, topicName=STAS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=af60254, createdName=mhm289, createdTime=Mon May 14 00:36:00 CST 2018, time=2018-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1655782, encodeId=bbda1655e8216, content=<a href='/topic/show?id=2a011829d7' target=_blank style='color:#2F92EE;'>#ACE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1829, encryptionId=2a011829d7, topicName=ACE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=635024767990, createdName=shanyongle, createdTime=Tue Oct 03 22:36:00 CST 2017, time=2017-10-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2008298, encodeId=43db20082981d, content=<a href='/topic/show?id=1066844469' target=_blank style='color:#2F92EE;'>#HAE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8444, encryptionId=1066844469, topicName=HAE)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=32d177, createdName=changfy, createdTime=Sun Mar 25 02:36:00 CST 2018, time=2018-03-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1819373, encodeId=25ca18193e330, content=<a href='/topic/show?id=210c9941411' target=_blank style='color:#2F92EE;'>#非心脏手术后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99414, encryptionId=210c9941411, topicName=非心脏手术后)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=325a197, createdName=amyloid, createdTime=Mon Mar 26 06:36:00 CST 2018, time=2018-03-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1996035, encodeId=c7d119960351a, content=<a href='/topic/show?id=ed881120ec8' target=_blank style='color:#2F92EE;'>#MAC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11207, encryptionId=ed881120ec8, topicName=MAC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4b65161, createdName=yb6560, createdTime=Wed Dec 06 22:36:00 CST 2017, time=2017-12-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1339900, encodeId=b85d13399006d, content=<a 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authenticateStatus=null, createdAvatar=null, createdBy=b5438409695, createdName=bnurmamat, createdTime=Fri Aug 18 12:36:00 CST 2017, time=2017-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1575185, encodeId=a49b15e51857b, content=<a href='/topic/show?id=6b10112139c' target=_blank style='color:#2F92EE;'>#MACE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11213, encryptionId=6b10112139c, topicName=MACE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2c1f16064818, createdName=lfyang, createdTime=Fri Aug 18 12:36:00 CST 2017, time=2017-08-18, status=1, ipAttribution=)]
    2018-03-25 changfy
  6. [GetPortalCommentsPageByObjectIdResponse(id=1933108, encodeId=a8b11933108f8, content=<a href='/topic/show?id=ced969314e4' target=_blank style='color:#2F92EE;'>#生物学标志#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69314, encryptionId=ced969314e4, topicName=生物学标志)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b70c362, createdName=jiadan198782, createdTime=Sun Dec 24 04:36:00 CST 2017, time=2017-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1819268, encodeId=6e491819268be, content=<a href='/topic/show?id=aba89940943' target=_blank style='color:#2F92EE;'>#非心脏#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99409, encryptionId=aba89940943, topicName=非心脏)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=917c196, 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channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99414, encryptionId=210c9941411, topicName=非心脏手术后)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=325a197, createdName=amyloid, createdTime=Mon Mar 26 06:36:00 CST 2018, time=2018-03-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1996035, encodeId=c7d119960351a, content=<a href='/topic/show?id=ed881120ec8' target=_blank style='color:#2F92EE;'>#MAC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11207, encryptionId=ed881120ec8, topicName=MAC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4b65161, createdName=yb6560, createdTime=Wed Dec 06 22:36:00 CST 2017, time=2017-12-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1339900, encodeId=b85d13399006d, content=<a 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  7. [GetPortalCommentsPageByObjectIdResponse(id=1933108, encodeId=a8b11933108f8, content=<a href='/topic/show?id=ced969314e4' target=_blank style='color:#2F92EE;'>#生物学标志#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69314, encryptionId=ced969314e4, topicName=生物学标志)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b70c362, createdName=jiadan198782, createdTime=Sun Dec 24 04:36:00 CST 2017, time=2017-12-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1819268, encodeId=6e491819268be, content=<a href='/topic/show?id=aba89940943' target=_blank style='color:#2F92EE;'>#非心脏#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99409, encryptionId=aba89940943, topicName=非心脏)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=917c196, 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authenticateStatus=null, createdAvatar=null, createdBy=b5438409695, createdName=bnurmamat, createdTime=Fri Aug 18 12:36:00 CST 2017, time=2017-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1575185, encodeId=a49b15e51857b, content=<a href='/topic/show?id=6b10112139c' target=_blank style='color:#2F92EE;'>#MACE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11213, encryptionId=6b10112139c, topicName=MACE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2c1f16064818, createdName=lfyang, createdTime=Fri Aug 18 12:36:00 CST 2017, time=2017-08-18, status=1, ipAttribution=)]
    2017-12-06 yb6560
  8. 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  9. 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  10. 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    2017-08-18 lfyang

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由此可见,该研究表明空气污染对IPF预后具有不利的影响,并且首次证实了臭氧对AEs的作用,长期暴露于PM10和PM2.5对总体死亡率具有潜在作用。

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客观地说,目前临床医生对纤维化性肺疾病仍知之甚少:病因和发病机制不清楚;在诊断和判断病情、预后方面仍存在很多困惑;重要的是,至今未找到确定有效且不良反应小的治疗药物。然而,这并不等于临床和科研工作毫无建树。事实上,自首次报道间质性肺疾病至今的近 80 年内,经过大量艰苦而细致的工作,人们对这类疾病的认识已取得长足进展,积累了有价值的循证医学证据。 【分类】从单一病理标准到兼顾临床与病