肌钙蛋白Ⅰ对老年不稳定型心绞痛患者危险分层的判断价值

The value of cardiac troponin I in risk stratification of elderly patients with unstable angina pectoris

目的探讨心脏肌钙蛋白Ⅰ（cTnⅠ）对老年不稳定型心绞痛（UAP）患者危险分层的价值。方法对72例老年UAP患者、27例稳定型心绞痛（SAP）患者及22例健康对照者分别进行血清cTnⅠ测定，并观察住院1个月内心脏事件发生情况。结果UAP组血清cTnⅠ值为（1．96±0．61）μg／L，明显高于sAP组的（0．68±0．19）μg／L及对照组的（0．46±0．10）μg/L（P均〈0．01）。UAP组内，随着Braunwald临床分级增高，Ⅰ～Ⅲ级血清cTnⅠ值相应增高[分别为（1．25±0．38）μg/L、（2．12±0．34）μg/L及（3．06±0．72）μg/L]（P〈0．05）。对照组、SAP组及BraunwaldⅠ级UAP患者无一例发生心脏事件；18例Ⅱ级患者中，1例（其血清cTnⅠ≥1．5μg／L）发生非致命性心肌梗死（MI）；33例Ⅲ级UAP患者中，21例血清cTnⅠ≥1．5μg/L患者中的9例发生心脏事件（6例非致命性心肌梗死、3例心脏猝死），总心脏事件发生率16．7％；16例血清cTnⅠ〈1．5μg／L者仅1例发生非致命性MI，其总心脏事件发生率6．3％。血清cTnⅠ≥1．5μg/L者心脏事件发生率明显高于cTnⅠ〈1．5μg/L者（P〈0．05），比数比（OR）为2．05（16．7％／6．3％），95％可信限为1．02～9．78。血清cTnⅠ≥1．5μg／L时判断心脏事件的阳性预测值为44．3％，阴性预测值为84．8％。结论血清cTnⅠ检测对老年UAP患者危险分层有一定的临床价值。

Objective To study the value of serum troponin Ⅰ（cTnⅠ） in risk stratification of elderly patients with unstable angina peetoris （UAP）. Methods Serum cTnI levels were measured in 22 healthy subjects （ control group）, 27 stable angina peetoris （SAP） and 72 UAP elderly patients, respectively. Cardiac events （non fatal myocardial infarction, cardiac sudden death ）were observed within 1 month of hospitalization. Serum cTnⅠ≥ 1.5 μg/L was considered as the cutoff level for myocardial damage. Results Serum cTnⅠ levels in the UAP group were higher than those in the SAP and control group [ （ 1.96 ± 0.61 ） μg/L, （0.68 ± 0.19 ） μg/L and （ 0.46 ± 0.10 ） μg/L, respectively ] （ P 〈 0.01 ）. In the UAP group, s＇erum cTnI levels increased with increase of Braunwald classification class [ （ 1.25± 0.38） μg/L, （2. 12± 0.34） μg/L and （3. 06 ±0.72） μg/L, respectively ] （ P 〈 0.05 ）. In Braunwald class Ⅱ patients, the rate of eardiae events in patients with serum cTnⅠ ≥ 1.5 μg/L was much higher than that in those with cTnI 〈 1.5 μg/L （ 16.7% vs 6.3%, P 〈 0.05 ）, risk ratio 2.05 （ 95 % confidence limit 1.02 - 9.78 ）. The positive predictive value of serum cTnⅠ≥ 1.5 μg/L for cardiac events was 44. 3% and the negative predictive value was 84.8%. Conclusions Detection of serum cTnⅠ has clinical value in risk stratification of elderly patients with UAP.