血清超敏肌钙蛋白T在不稳定型心绞痛患者危险分层和预后中的价值研究

The study of risk stratification and prognosis of serum high sensitivity troponin T in patients with unstable angina pectoris

目的 本研究旨在探讨血清超敏肌钙蛋白T（hs-nT）对不稳定型心绞痛（UAP）患者的临床诊断、冠脉病变严重程度和短期预后价值的关系.方法 人选161例常规血清TnT阴性的UAP患者,冠状动脉造影前所有患者均测定血清hs-TnT水平,随访30 d,记录主要心血管不良事件（MACE）.结果 血清hs-TnT随着冠脉病变的严重程度而升高,血清hs-TnT水平越高,冠脉狭窄程度及病变累及的血管越严重,重度狭窄、完全闭塞组hs-TnT水平分别为（0.0190±0.02419）ng/ml、（0.0652±0.0099）ng/ml,其组间差异均有统计学意义（P＜0.05）,三支病变组[hs-TnT（0.0261±0.0498）ng/ml]与正常组[hs-TnT（0.0069±0.0041）ng/ml]比较差异有统计学意义（P＜0.01）.对于UAP患者短期预后的预测,血清hs-TnT升高,其短期心血管事件（心源性猝死、急性心梗、心绞痛再入院）的风险较正常组高,差异有统计学意义（P＜0.01）.结论 在常规TnT阴性的UAP患者中,血清hs-TnT可检测出更多的心肌坏死,同时其血清学水平的高低可预测冠脉病变的狭窄严重程度与病变范围;其升高亦可提示短期预后不佳、主要心血管事件的增加,可作为对UAP的早期危险分层的一个指标并指导临床治疗.

Objective To explore the sensitivity of serum troponin T （hs-TnT） in unstable angina pectoffs （UAP） in patients with clinical diagnosis, and coronary artery disease severity and the relationship between short-term prognostic value. Methods 161 patients with TnT negative unstable angina pectoffs （UAP） patients were selected, and serum TnT was measured before coronary angiography, followed-up to 30 days. The main car- diovascular events（MACE） was recorded. Results Serum hs-TnT increased with the degree of coronary artery dis- ease, the higher levels of serum hs-TnT, more serious of coronary stenosis and vascular lesions. The levels of hs- TnT were （0.0190±0.02419）ng/ml, （0.0652±0.0099）ng/ml in total occlusion groups respectively（P〈0.05）. The levels of hs-TnT were （0.0261±0.0498）ng/ml and hs-TnT （0.0069±0.0041）ng/ml in three lesions and normal group （P〈0.01）; short-term cardiovascular events （heart sudden cardiac death, acute myocardial infarction, angina, readmission） in elevated serum hs-TnT patients was higher than normal risk group （P〈0.001）. Conclusion In TnT negative UAP patients, serum hs-TnT can detect more micro myocardial necrosis, while its serum levels may predict the severity of coronary stenosis; its rise may indicate short-term poor prognosis and the major cardiovascular events increase, and may be used as an early risk stratification in UAP patients.