血清高心肌肌钙蛋白-Ⅰ预测高血压患者心脑血管事件

Elevated Cardiac Troponin Ⅰ Predicts Cardiovascular or Cerebrovascular Events in Hypertensive Patients

目的:血清心肌肌钙蛋白Ⅰ(cardiac troponinⅠ,cTnI)水平在发生进行性心肌损伤时增高,预示心肌事件的高风险。本文旨在研究是否血清高cTnI水平与无左心室(left ventricular,LV)收缩功能紊乱的高血压(hypertension,HT)患者不良转归相关。方法:收集检测170例无LV收缩功能紊乱HT患者,左室射血分数(left ventricular ejuction fraction,LVEF)≤55%,无肾功能衰竭,无早期心脑血管疾病及40例正常对照,并追踪(45±38)月。结果:血清cTnI升高(≥0.04ng/ml)15例,占高血压组8.8%,而正常对照组cTnI升高者为0;患糖尿病(diabetes mellitus,DM)率(9/15 versus 25/155,P<0.05)、心胸比率(54.2%±4.2%versus 51.4%±5.1%,P<0.05)、血清脑利钠肽N-末端前体(N-terminal-pro-B-type natriuretic peptide,NT-proBNP)(109.8±12.2 versus 38.6±4.2)pg/ml,P<0.05)、左室质量指数(222.9±86 versus 153.2±54g/m2,P<0.01)在cTnI增高HT患者中均明显高于cTnI未增高HT患者。Kaplan-Meier统计分析证实,cTnI未增高HT患者与cTnI增高HT患者相比较,前者无未来心脑血管事件风险(O<0.01)。Cox多变量分析显示,高水平cTnI(风险比,6.59,P<0.01),吸烟(风险比,2.26,P<0.05)均为独立预测事件风险变量。结论:血清cTnI水平可作为预测高血压患者未来心脑血管事件发生风险的生物学指标。

Objective Whether elevated cTnI is associated with cardiovascular or cerebrovascular events in patients with hypertension（HT） without left ventricular（LV） systolic dystunction is not clear.Method We measured cTnI serum level in 170 patients with essential HT without LV systolic dysfunction（LVEF 55%）,renal failure,and prior cardiovascular or cerebrovascular diseases.Besides,control group of 40 normal presons was established and following up（45±38）months.Results Level of cTnI was elevated（≥0.04ng/ml） in 15（8.8%） of the 170 patients and in 0（0%） of the 40 normal controls.The rate of diabetes mellitus（DM）,the cardiothoracic ratio,serum NT-proBNP value,and LV mass index were significantly higher in patients with than without evevated cTnI（DM,9/15 versus 25/155,P0.05;cardiothoracic ratio,54.2±4.2 versus 51.4±5.1%,P0.05;NT-proBNP,109.8±12.2 versus 38.6±4.2pg/ml,P0.05;LV mass index,222.9±86 versus 153.2±54g/m2,P=0.0001）.Kaplan-Meier analysis demonstrated that significantly fewer（P0.000001） patients with,than without elevated cTnI remained free of events（hospitalization due to cardiovascular or cerebrovascular disease）.Stepwise Cox multivariate analysis revealed that elevated cTnT（hazard ratio,6.59,P=0.000001）and smoking（hazard ratio,2.26,P=0.04） were independent predictors of events.Conclusion The present findings indicate that cTnI is a biomarker and useful predictor of future cardiovascular or cerebrovascular events in hypertensive patients.