心肌肌钙蛋白T在不稳定冠心病中的预后价值

Prognostic Value of Cardiac Troponin T in Unstable Coronary Artery Disease

目的 为了解在不稳定心绞痛(UA)和非Q波心梗(NQMI)患者的血液中检测到心肌特异性的收缩蛋白,如心肌肌钙蛋白T(cardiactroponinT,cTnT)是否有预后价值。方法 系列测定78例不稳定冠心病(20例NQMI和58例UA)患者血清cTnT浓度,观察住院期间心脏性死亡和非致死性心梗的发生率。结果 cTnT阳性组37例(20例NQMI和17例UA),住院期间发生9例心梗或死亡(NQMI组2例死亡和3例再梗,UA阳性2例死亡和2例心梗);阴性组(41例UA)仅有1例于PTCA术后发生NQMI。阳性组住院期间心梗或死亡比阴性组高(24.3%vs2.4%,P<0.05),在BraunwaldⅢ级的48例UA(阳性15例、阴性33例)中为26.7%和3.0%(P<0.05);cTnT阳性的UA预后NQMI相同(P>0.05)。结论 在不稳定冠心病中,无论是否伴心肌酶的升高。

Cardiac troponin T is a regulatory contractile protein with highly cardiac specificity.Whether its presence in the serum of patients with unstable angina and non Q wave AMI is a prognostic indicator remains uncertain. Methods Serial serum cTnT concentration was determined in 78 patients with unstable coronary artery disease(58 with unstable angina,20 with non Q wave AMI).The endpoints during hospitalization were cardiac death or non fatal MI. Results Troponin T was detected in the serum of 17 of the 58 UA patients (15 of the 48 patiens with acute angina at rest) and all the 20 patients with non Q wave AMI.Of the 37 patients who were positive for troponin T,9 (24.3%) had MI or cardiac death (3 reinfarction and 2 Death in NQMI group,2 infarction and 2 death in UA group).In contrast,only 1 of the 41 patients who were negative for troponin T had an AMI after PTCA(24.3% vs 2.4%, P <0.05)。Similar results were found in the 48 patients with acute angina at rest (26.7% vs 3.0%, P <0..05).There was no difference in the outcomes between the two groups of patients who were positive for troponin T. Results Troponin T was detected in the serum of 17 of the 58 UA patients (15 of the 48 patiens with acute angina at rest) and all the 20 patients with non Q wave AMI.Of the 37 patients who were positive for troponin T,9 (24.3%) had MI or cardiac death (3 reinfarction and 2 Death in NQMI group,2 infarction and 2 death in UA group).In contrast,only 1 of the 41 patients who were negative for troponin T had an AMI after PTCA(24.3% vs 2.4%, P <0.05)。Similar results were found in the 48 patients with acute angina at rest (26.7% vs 3.0%, P <0..05).There was no difference in the outcomes between the two groups of patients who were positive for troponin T. Conclusions The detection of troponin T in the serum of patients with unstable coronary artery disease is a powerful prognostic indicator regardless of the levels of cardiac enzymes.