急性心肌梗死患者发病第七天肌钙蛋白I水平在预后中的判断价值

Prognostic value of cardiac troponin I level on the 7th day in patients after Acute Myocardial Infarction

目的探讨急性心肌梗死（AMI）患者发病第7天肌钙蛋白I（cTnI）水平在预后中的判断价值。方法161例AMI患者依照采取的治疗方法分为急诊冠状动脉介入（PCI）治疗组（35例），延期PCI组36例和药物治疗组90例，30例无器质性心脏病者为对照组。观察第7天不同cTnI水平组的主要心血管事件（MACE）发生率。结果AMI患者发病第7天cTnI水平[（5．76±4．27）μg/L]显著高于对照组[（0．15±0．10）μg/L]（P〈0．01）；按第7天cTnI转阴率分析：总转阴率39．1％，其中急诊PCI治疗组转阴率（68．6％）高于延期PCI组（36．1％）和单纯药物治疗组（28．9％）；按心血管事件（MACE）发生率分析：cTnI阳性组总MACE发生率（34．7％）高于cTnI阴性组（1．6％）（P〈0．01）；发生MACE者第7天cTnI值（13．99±8．39）μg／L明显高于不发生MACE者（3．65±2．55）μg/L（P〈0．01）；按cTnI水平分析：心脏性死亡、总MACE的发生率随cTnI的水平升高而增加（P〈0．05），cTnI〉9．0μg／L者最高。结论发病第7天cTnI水平在AMI患者预后判断中有重要价值，是预测AMI患者总MACE发生率增高的独立预后因素。

Objective To investigate whether the serum level of cardiac troponin I （cTnI） at the 7th day after acute myocardial infarction （AMI） is a predictive factor of the prognosis of patients. Methods One hundred and sixty-one patients with AMI were divided into three groups （emergency percutaneous coronary intervention （PCI） group, delayed PCI group and drug therapy group）. Thirty patients without organic heart disease as a control group. The levels of cTnI at the 7th day after AMI were measured by chemoluminescence technique. Major cardiovascular events （MACEs） were recorded on admission and during follow-up period. The correlation between cTnI serum levels and the incidence of MACEs was analyzed. Results Compared to the control group, the levels of cTnI were significantly increased at the 7th day in AMI patients （P 〈0.01 ）. The total negative-conversion rate on the 7th day was 39.1%, the negative-conversion rate was higher in emergency PCI group compared to delayed PCI group and drug therapy group （68.6% vs 36.1% and 28.9%, P 〈0.01 ）. The incidence of MACEs in AMI patients with cTnI 〈 1.5 μg/L was significantly lower than that in AMI patients with cTnI ≥ 1.5 μg/L（ 1.6% vs 34.7%, P 〈 0.01 ）. The serum level of cTnI in AMI patients with MACEs was higher than that in AMI patients without MACEs （ P 〈 0.01 ）. The incidence of MACEs was correlated with the serum level of cTnI in AMI patients （ P 〈 0.05 ）. The incidence of MACEs in AMI patients with cTnI 〉 9.0 μg/L was the highest among all AMI patients （ P 〈 0.05 ）. Conclusions The serum level of cTnI at the 7th day in patients after an episode of AMI is an independent predictor for the prognosis.