肌钙蛋白T在慢性心力衰竭患者危险分层中的价值

The Value of Cardiac Troponin T on Risk Stratification in Chronic Heart Failure

目的探讨血浆心肌肌钙蛋白T（Cardiac troponin T，cTnT）在慢性心力衰竭（chronic heart failure，CHF）危险分层中的价值和对近期预后的影响。方法86例入院治疗的CHF患者（NYHAⅡ～Ⅳ级）和64例健康体检者，测定血浆cTnT，超声心动图等检测。经规范化治疗，随访3个月，观察的终点是心血管事件（心源性死亡及心力衰竭恶化再住院）。结果CTnT对CHF的诊断价值以ROC曲线下面积表示，为0．901（95％可信限：0．819～0．983）。根据ROC曲线，以诊断CHF的敏感度与特异度之和的最高值作为截断值，CTnT的截断值为0．01ng／ml。以此值将CHF患者分为2组：A组40例（cTnT〈0．01ng／ml）、B组46例（CTnT≥0．01ng／ml）。随访结束，失访2例（A、B组各1例）。发生心血管事件29例：心源性死亡6例（A组2例，B组4例），心力衰竭恶化再住院23例（A组8例、B组15例）。结论检测血浆CTnT浓度可对CHF患者进行危险分层和短期预后的判定。

Objective To study the role of cardiac troponin T （cTnT） in the diagnosis and short-term prognosis of chronic heart failure （CHF）. Methods Eightysix patients admitted with CHF （New York Association[NYHA] class Ⅱ-Ⅳ） and sixtyfour healthy controls were included. Plasma cTnT was measured. All patients received standard therapy and a follow-up for 3 months after admission. The primary end points were cardiac events including cardiac death and readmissions for worsening heart failure. Results The concentration of plasma cTnT were significantly higher in patients with CHF than in healthy controls （P〈 0.01）. There were significant difference in the concentration of cTnT with different classification （NYHA class Ⅱ-Ⅳ）. An area under the receiver operating characteristic （ROC） curve （AUC） was used for evaluating the diagnostic value of cTnT. The AUC for cTnT was 0.901. The cut-off value for cTnT, determined as the maximal sum of sensitivity plus specificity according to the ROC, was 0.01ng/mL. Patients with CHF were divided into two groups based on the cut-off values： Group A （cTnT 〈 0.01ng/mL, n = 40）, Group B （cTnT ≥ 0.01 ng/mL, n = 46）. At the end of 3 months, there were 29 adverse cardiac events, including 6 cardiac deaths （2 patients in Group A, 4 patients in Group B） and 23 readmissions for worsening heart failure （8 patients in Group A, 15 patients in Group B）.Conclusions Plasma cTnT measurement is helpful for CHF diagnosis. Plasma cTnT might be an effective means of risk stratification and short-term prognosis in hospitalized patients with CHF.