非ST段抬高型急性冠状动脉综合征患者入院肌酸激酶同工酶与肌钙蛋白I检测一致性分析

Analysis of CK-MB and cTnI accordance measured on admission in non-ST segment elevation acute coronary syndrome patients

目的：评价肌酸激酶同工酶（CK-MB）与肌钙蛋白I（cTnI）在非ST段抬高型急性冠状动脉综合征（NSTE-ACS）患者早期危险分层及处理中的作用及二者结果一致性的意义。方法：1 074例NSTE-ACS患者,入院早期（〈48 h）行冠状动脉造影检查并采集症状发作至入院36 h内cTnI和CK-MB检测结果。以〉1×正常值上限（ULN）作为阳性结果,以≤1×ULN作为阴性结果,将入选患者分为4组：CK-MB、cTnI均阴性组（CK-MB-/cTnI-组）,CK-MB阳性、cTnI阴性组（CK-MB＋/cTnI-组）,CK-MB阴性、cTnI阳性组（CK-MB-/cTnI＋组）,CK-MB、cTnI均阳性组（CK-MB＋/cTnI＋组）。评价组间结果一致与不一致的发生率及早期侵入性检查（〈48 h）应用情况,统计各组院内主要不良心脏事件（MACE）。结果：1 074例NSTE-ACS患者在CK-MB-/cTnI-组、CK-MB＋/cTnI-组、CK-MB-/cTnI＋组、CK-MB＋/cTnI＋组中分别为664例、90例、54例、266例。cTnI＋318例,CK-MB＋356例;CK-MB与cTnI结果一致者共930例（CK-MB-/cTnI-组664例,CK-MB＋/cTnI＋组266例）;CK-MB与cTnI结果不一致者144例（CK-MB＋/cTnI-组90例,CK-MB-/cTnI＋组54例）。CK-MB-/cT-nI＋组与CK-MB＋/cTnI-组在冠状动脉病变支数、SCAI分型及院内MACE比较差异无统计学意义（P〉0.05）。Logistic回归分析结果显示：冠状动脉病变SCAI分型、cTnI是CK-MB升高的危险因素;冠状动脉病变SCAI分型、冠状动脉病变支数、CK-MB是cTnI升高的危险因素。同时发现,在4组间存在风险逐渐上升的倾向。与CK-MB-/cTnI-组院内MACE进行比较,CK-MB＋/cTnI-组（OR=2.07,95%CI：1.04~4.84）、CK-MB-/cT-nI＋组（OR=3.57,95%CI：2.41~6.14）、CK-MB＋/cTnI＋组（OR=4.12,95%CI：2.98~8.32）院内风险有逐级升高趋势。结论：在NSTE-ACS患者,cTnI升高能够独立预测患者院内风险,CK-MB＋的预测价值与cTnI＋比较无明显差异。

Objective：We sought to evaluate the association between discordant cardiac marker results of CK- MB and cTnI on early risk stratification in patients with Non-ST Segment Elevation Acute Coronary Syndrome （NSTE-ACS）. Method.. The total of 1 074 NSTE ACS patients were admitted and whose CK MB and cTnI were measured within the first 36 hours from symptom onset after admission. All patients received coronary angiography within 48 h. Positive results were accepted if biomarker .〉1× upper limit of normal （ULN）, and negative results was accepted when biomarker ≤1 × ULN. We examined relationships between results of four different combinations （CK MB /cTnI , CK MB＋/cTnI , CK MB /cTnI- , and CK MB＋/cTnI＋） and incidences of in-hospital Major Adverse Cardiac Event （MACE） and early catheter-based interventions. Result： Among 1 074 NSTE- ACS patients, results from 930 patients were accordant in CK MB and cTnI level, and the other 144 were discord ant （n=90 [8.38%] CK-MB＋/cTnI ; n=54 [5.03%] CK-MB /cTnI＋ ）. The number and types of diseased coronary artery and the incidence of MACE did not have statistical difference between the CK-MB /cTnI＋ and CK MB-/cTnI group. Conclusion：Elevation of cTnI alone can predict a higher risk of NSTE-ACS patients in hospital. Prognostic value of isolated CK MB＋ is equal to isolated cTnI when the tests performed early after admission （〈36 h）.