摘要目的:分析D-二聚体联合活化部分凝血活酶时间(APTT)对急性冠状动脉综合征(ACS)患者冠状动脉介入(PCI)术中慢/无复流的预测价值。方法:选取2017年6月至2019年6月于贵港市人民医院拟行PCI术的316例ACS患者作为研究对象，术中根据心肌梗死溶栓治疗(TIMI)血流分级将患者分为慢/无复流组(SNR组)和正常血流组(CON组)，比较两组患者术前D-二聚体、APTT等指标的差异，分析D-二聚体联合APTT对SNR的预测价值。结果:PCI术中根据TIMI血流分级，SNR组患者71例(22.47%)，CON组患者245例(77.53%)。SNR组患者的D-二聚体水平明显高于CON组，而APTT明显低于CON组( P均<0.05)。Logistic多因素回归分析显示患者D-二聚体升高( OR＝1.011，95% CI：1.008～1.015， P<0.001)是ACS患者PCI术中慢/无复流的独立危险因素，而APTT升高( OR＝0.868，95% CI：0.818～0.921， P<0.001)是其保护因素。D-二聚体和APTT预测PCI术中慢/无复流的受试者工作特征(ROC)曲线下面积分别为0.814、0.738，二者联合检测的ROC曲线下面积提升至0.869，灵敏度和特异度分别为87.3%、75.1%。 结论:D-二聚体和APTT对ACS患者PCI术中慢/无复流的预测价值较高，二者联合检测有助于及早识别患者PCI术中慢/无复流现象的发生。

abstractsObjective:To analyze the predictive value of D-dimer combined with activated partial thromboplastin time (APTT) for slow / no reflow in patients with acute coronary syndrome (ACS) during percutaneous coronary intervention(PCI).Methods:From June 2017 to June 2019, 316 cases of patients with ACS who were to undergo PCI in Guigang People′s Hospital were selected as the study objects. The patients were divided into slow / no reflow group (SNR) and normal blood flow group (CON) according to the blood flow grading of thrombolysis in myocardial infarction (TIMI) during the operation. The differences of D-dimer and APTT between the two groups before operation were compared, and the predictive value of D-dimer combined with APTT for SNR was analyzed.Results:According to TIMI blood flow grading, all the patients were divided into SNR group ( n=71, 22.47%) and CON group ( n=245, 77.53%). The level of D-dimer in SNR group was significantly higher than that in CON group, while APTT was significantly lower than that in CON group ( P<0.05). Logistic regression analysis showed that D-dimer elevation ( OR=1.011, 95% CI: 1.008-1.015, P<0.001) was an independent risk factor of slow / no reflow in PCI for ACS patients, while APTT elevation ( OR=0.868, 95% CI: 0.818-0.921, P<0.001) was a protective factor. The D-dimer and APTT predicted that the area under receiver operating characteristic (ROC) curve of slow / no reflow in PCI were 0.814 and 0.738 respectively. The area under ROC curve of combined detection of D-dimer and APTT increased to 0.869, and the sensitivity and specificity were 87.3% and 75.1% respectively ( P<0.001). Conclusions:The D-dimer and APTT have a high predictive value of slow / no reflow during PCI in ACS patients. The combined detection of the two is helpful to identify the occurrence of slow / no reflow in PCI.