高敏感心肌肌钙蛋白Ⅰ对急性心肌梗死的预后价值

Prognostic value of high-sensitivity cardiac troponin Ⅰ in acute myocardial infarction

目的探讨入院时的高敏感心肌肌钙蛋白Ⅰ(hs-cTnI)对急性心肌梗死(AMI)的预后价值,以便为AMI的临床干预提供循证医学证据。方法 2009年8月19日～2011年12月26日,从广东省人民医院急诊科招募符合入选标准的AMI患者386例作为研究对象。入院时测定hs-cTnI等指标后进行随访,随访时主要记录死亡和再次发生AMI等预后指标。用受试者工作特征曲线(ROC曲线)选取hs-cTnI预测AMI预后的最佳临界点。根据随访结果,评价hs-cTnI对AMI的预后价值。结果随访的中位数为405 d,病死率为9.6%,因AMI而再次入院率为8.3%,hs-cTnI预测AMI预后的最佳临界点为0.17μg/L。Kaplan-Meier生存曲线显示,高水平组相对于低水平组,死亡与因AMI而再次入院的风险皆增加;Log Rank检验的P值(χL2值)分别:<0.001(16.46)、0.001(12.01)。经Cox回归校正各种混杂因素后,死亡的风险比(95%置信区间)为3.17(1.49～6.72);因AMI而再次入院的风险比(95%置信区间)为2.68(1.20～6.02)。结论入院时hs-cTnI水平的升高是AMI不良预后的独立危险因子,可作为AMI患者不良临床事件危险分层的指标。

【Objective】 To evaluate the prognostic value of high-sensitivity cardiac troponin Ⅰ（hs-cTnI） in acute myocardial infarction（AMI）,provided evidence-based medical evidence for clinical intervention in patients with AMI.【Methods】 386 patients who met the inclusion criteria were recruited from emergency department of Guangdong General Hospital between 19th August,2009～26th December,2011.After determined hs-cTnI,these patients underwent the follow-up visit when the prognostic indexes of death and happen AMI again were mainly recorded.We used the Receiver Operating Characteristic（ROC） curve to confirm the cut-off point.The prognostic value of hs-cTnI in AMI was evaluated based on the results of follow-up visit.【Results】 The median of follow-up visit was 405 days.The fatality rate was 9.6% while happen AMI again was 8.3%.Cut-off point of prediction was 0.17μg/L.Kaplan-Meier survival curve showed that the high level group compared to low level group,risk proportion of fatality and happen AMI again was increased.P value（χL2 value） of Log Rank test were 0.001（16.46）,0.001（12.01） respectively.Confounding factors were corrected by Cox regression,the high level group compared to low level group,hazard ratios（95%CI） for deaths was 3.17（1.49～6.72）,hazard ratios（95%CI） for happen AMI again was 2.68（1.20～6.02）.【Conclusion】 The increase of hs-cTnI is the independent risk factor for AMI poor prognosis,which can be used as the risk stratification index for clinical adverse events in AMI patients.