慢性心力衰竭患者超敏肌钙蛋白T与左室质量指数的相关性研究

Study on relationship between high-sensitive troponin T and the left ventricular mass index in patients with chronic heart failure

目的 探讨慢性心力衰竭（CHF）患者超敏肌钙蛋白T（hs-TnT）水平与NYHA心功能分级和左室质量指数（LVMI）之间的关系,以及其在评价CHF患者病情严重程度及预后中的价值.方法 入选230例于我院心衰专科住院的CHF患者作为研究对象.入院后2h采取肘静脉血2ml,测定hs-TnT和NT-proBNP水平,根据公式计算LVMI.结果 ①随着NYHA心功能分级的增高,hs-TnT水平亦呈增高趋势,Ⅱ～Ⅳ级分别为（0.012±0.960）μg/L、（0.187±0.820）μg/L和（0.238±0.730）μg/L,不同级别间比较差异均有统计学意义（P＜0.05）.NT-proBNP水平随着心功能分级的升高而增加（P＜0.05）.②不同病因所致CHF各亚组间hs-TnT水平差异无统计学意义（P＞0.05）.③以hs-TnT均数0.014μg/L为界,CHF组升高hs-TnT亚组6个月内心血管事件发生率明显高于正常hs-TnT亚组（49.3％比19.8％,P＜0.01）.④Spearman等级相关分析显示,血浆hs-TnT、NT-proBNP、LVMI分别与心功能分级呈显著正相关（r=0.931,P＜0.01;r=0.857,P＜0.01;r=0.917,P＜0.01）.单因素相关分析示,CHF组患者血浆hs-TnT水平分别与NT-proBNP、LVMI呈正相关（r=0.278,P＜0.05;r=0.513,P＜0.01）.多因素分析表明,在校正患者年龄、左室射血分数、NT-proBNP等因素后,hs-TnT水平与LVMI独立相关.结论 CHF患者hs-TnT水平明显升高;hs-TnT水平与心力衰竭程度显著相关,提示hs-TnT水平可作为评价心力衰竭进程及预后的重要指标.

Objective To investigate the relationship between high-sensitive troponin T and left ventricular mass index,compared with N-terminal pro-B-type natriuretic peptide,and to explore the value of the condition and prognosis of CHF patients.Methods 230 patients with chronic heart failure were as study group.Fasting blood 2 ml was drawn into EDTA tubes in resting states.It was promptly placed in centrifuge to separate plasma.NT-proBNP was measured using an enzyme-linked immunosorbent assay system.Left ventricular ejection fraction index was measured.Observed hs-TnT,NT-proBNP and LVMI level changes and correlation in study group.Results （1）Hs-TnT levels tended to increased as higher NYHA class.From group Ⅱ to group Ⅳ,the levels of hs-TnT ranged from（0.012±0.960）μg/L,（0.187±0.820）μg/L,（0.238±0.730）μg/L.There was significantly difference compared with different NYHA class （P＜0.05）.NT-proBNP also increased significantly in CHF group as higher NYHA class（P＜0.05）.（2）There was no significant difference in hs-TnT levels in patients with CHF due to different causes （P＞0.05）.（3）The patients with CHF were divided into high-hs-TnT subgroup （178 persons） and normal-hs-TnT subgroup （42 persons） according to hs-TnT mean 0.014 μg/L,the incidence of cardiovascular events was 49.3％ in high-hs-TnT.group,significantly higher than 19.8％ in normal-hs-TnT group in six months （P＜0.01）.（4）Spearman rank correlation analysis showed that NT-proBNP,LVMI and hs-TnT was positive correlated with cardiac function class significantly （r=0.931,P＜0.01,r=0.857,P＜0.01,r=0.917,P＜0.01）.Pearsonrelated analysis showed that hs-TnT levels were positively correlated with LVMI and NT-proBNP in CHF group（r=0.278,P＜0.05,r=0.513,P＜0.01）.Hs-TnT remained an independent predictor for LVMI after adjustment for the known clinical risk factors.Conclusion The levels plasma hs-TnT were elevated in patients with CHF.The levels of hs-TnT were associated with the NYHA class and increased as severity of heart failure.The levels of hs-TnT measured in patients with heart failure can be as a predictor in evaluation of the process and prognostic value of heart failure.