心肌肌钙蛋白T与老年慢性心力衰竭预后的关系

Effect of cardiac troponin T on prognosis in the elderly patients with chronic heart failure

目的探讨心肌肌钙蛋白 T(cTnT)对老年慢性心力衰竭预后的影响。方法对60例不同心功能级别老年慢性心力衰竭患者测定血清 cTnT、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB),并根据 cTnT 是否阳性分组,比较其住院期间的心脏事件(恶性心律失常、心力衰竭反复或加重、死亡)的发生情况。结果心功能Ⅱ级者 CK(89.1±13.6)mmol/L,CK-MB(7.9±1.4)mmol/L,cTnT阳性0例;心功能Ⅲ级者 CK(88.2±13.4)mmol/L,CK-MB(7.5±1.8)mmol/L,cTnT 阳性4例;心功能Ⅳ级者 CK-MB(8.0±1.6)mmol/L,CK(93.3±14.2)mmol/L,cTnT 阳性14例。cTnT 阳性组恶性心律失常发生6例(33.3%),心力衰竭反复或加重8例(44.4%),死亡3例(16.7%);cTnT 阴性组恶性心律失常发生1例(2.4%),心力衰竭反复或加重2例(4.8%),死亡1例(2.4%)。cTnT 阳性组心脏事件发生率高于 cTnT 阴性组(P<0.05)。结论 cTnT 与老年慢性心力衰竭的预后有密切的关系,对判断估测老年慢性心力衰竭患者预后有较好的预测价值。

Objective To study the effect of cardiac troponin T （cTnT） on the prognosis of chronic heart failure in the elderly patients. Methods Serum level of cTnT, and serum activities of ereatine kinase （CK） and ereatine kinase-MB （CK-MB） were measured in 60 elderly patients of chronic heart failure with varied classes of cardiac function. Cardiac events, including malignant cardiac arrhythemia, repeated or aggravated heart failure or cardiac death, in patients with increased cTnT during hospitalization were compared to those without it. Results Serum level averaged （ 89.1 ± 13.6） mmol/L for CK and （7.9 ± 1.4） mmol/L for CK-MB in 20 patients with Class II cardiac function by New York Heart Association （NYHA） classification and without increased cTnT, （88.2 ± 13.4） mmol/L for CK and （7.5 ± 1.8） mmol/L for CK-MB in 19 patients with Class Ⅲ cardiac function and four of them with increased cTnT, and （93.3 ± 14.2） mmol/L for CK and （8.1 ± 1.6） mmol/L for CK-MB in 21 patients with Class Ⅳ cardiac function and 14 of them with increased cTnT. Malignant cardiac arrhythemia occurred in six, repeated heart failure in eight, and death in three of 18 patients with increased cTnT, and one, two and one in 22 patients without increased cTnT, respectively. Incidence of cardiac events was higher in patients with increased cTnT than those without it （ P 〈 0. 05 ）. Conclusions Serum level of cTnT is associated closely with the prognosis in the elderly patients with chronic heart failure, which can be used as a prognosis predicting indicator for them.