心肌肌钙蛋白T和超敏C反应蛋白在不稳定型心绞痛危险分层中的作用

Clinical signification of cTnT and hs-CRP for risk stratification in patients with unstable angina pectoris

目的研究不稳定型心绞痛(UAP)患者血清心肌肌钙蛋白T(cTnT)和超敏C反应蛋白(hs-CRP)水平变化与冠状动脉造影结果的关系,以评价cTnT和hs-CRP在UAP危险分层中的作用。方法序贯征集来住院的确诊为BraunwaldⅢB级UAP患者120例。在患者入院时(0h)及第一个24h内(3、6、12、18h)分别采集血样,测定cTnT、hs-CRP和肌酸激酶同工酶-MB(CK-MB)血浓度。根据cTnT水平不同,将患者分为cTnT阴性组(80例)和cTnT阳性组(40例)。所有患者出院前都进行冠状动脉造影。结果cTnT阴性组与cTnT阳性组比较,hs-CRP水平较低(2.3mg/L与12.6mg/L,P=0.001),3支血管患病率较低(26%与43%,P=0.001),左冠状动脉主干患病率较低(5%与15%,P=0.04),冠脉栓塞患病率较低(4%与20%,P=0.006),重度狭窄的血管较少(65%与95%,P=0.001),一年内心血管事件发病率较低(2.5%与25%,P<0.001)。结论cTnT和hs-CRP可对UAP进行危险分层,对UAP的诊断、疗效监测及预后判断有重要作用。

Objective To investigate the correlation between serum cardiac troponin T （cTnT）, high sensitivity C-reactive protein （hs-CRP） and coronary angiographic findings in patients with unstable angina pectoris （UAP）,and to evaluate the value of cTnT and hs-CRP for risk stratification in patients with UAP, Methods Consecutive patients （120 cases） with Braunwald class Ⅲ B UAP were included in the study. Sera samples for cTnT, hs-CRP and creatine kinase-MB isoenzyme （CK-MB） were obtained at admission （Oh） and 3,6,12,18h in the first 24h. These patients were divided into negative cTnT group （80 cases） and positive cTnT group （40 cases） according to sera cTnT level, All Patients underwent coronary angiography before discharge, Cardiac events including cardiac death and myocardial infarction were recorded. Results Comparison of negative cTnT group and positive cTnT group in patients with UAP,negative cTnT group patients had a lower hs-CRP ievel（2.3mg/L vs 12.6 mg/L,P=0. 001）,and a lower incidence of 3-vessel disease（26% vs 43%, P=0. 001）, left coronary artery main stem disease （5% vs 15% ,P=0.04） ,visible coronary thrombus（4% vs 20% ,P=0. 006）, less severe stenosis of the culprit artery（65 % vs 95 %, P= 0. 001 ）, the 1-year cardiac events rate were lower than that in group cTnT positive patients（2.5 % vs 25 %, P〈0. 001）. Conclusion cTnT and hsCRP may be used to the risk stratification in patients with UAP,and play an important role in the diagnosis,therapeutic effects monitoring and judgement of prognosis in patients with UAP.