肌钙蛋白I对老年不稳定性心绞痛患者危险分层的判断价值

The role of cardiac troponin I in risk stratification of elderly patients with unstable angina pectoris

目的 探讨心脏肌钙蛋白I(cTnI)对老年不稳定性心绞痛 (UAP)患者危险分层的判断价值。 方法 对 6 8例老年UAP患者、17例稳定性心绞痛 (SAP)患者及 11例健康对照者分别进行血清cTnI测定 ,并观察住院 1个月内心脏事件发生情况。 结果 UAP组血清cTnI值为 (1 94± 0 6 3)μg/L ,明显高于SAP组的 (0 6 1± 0 11) μg/L及对照组的 (0 47± 0 0 8) μg/L(均为P <0 0 1)。UAP组内 ,随着Braunwald临床分级增高 ,Ⅰ～Ⅲ级血清cTnI值相应增高〔分别为 (1 35± 0 2 8)、(2 0 4± 0 31)及(3 17± 0 74) μg/L〕(P <0 0 5 )。对照组、SAP组及BraunwaldⅠ级UAP患者无 1例发生心脏事件 ;BraunwaldⅡ级 1例患者发生非致命性心肌梗死 ;BraunwaldⅢ级患者中 ,血清cTnI≥ 1 5 μg/L者心脏事件发生率为 42 1% ,高于血清cTnI <1 5 μg/L者的 13 3% (P <0 0 5 ) ,比数比 (OR) 3 15 ,95 %可信限为1 0 1～ 9 81。血清cTnI≥ 1 5 μg/L时判断心脏事件的阳性预测值为 42 1% ,阴性预测值为 86 7%。 结论 血清cTnI检测对老年UAP患者危险分层有较好的判断价值。

Objective To evaluate the role of serum troponin I(cTnI) in risk stratification of elderly patients with unstable angina pectoris (UAP). Methods Serum cTnI levels were measured in 11 healthy subjects(control group), 17 stable angina pectoris(SAP) and 68 UAP elderly patients,respectively. Cardiac events(nonfatal myocardial infarction,cardiac sudden death )were observed within 1 month of hospitalization.Serum cTnI≥1 5 μg/L was considered as the cutoff level for myocardial damage. Results Serum cTnI levels in the UAP group were higher than those in the SAP and control group〔(1 94±0 63), (0 61±0 11) and (0 47±0 08) μg/L, respectively〕(P<0 01). In the UAP group, serum cTnI levels increased with increase of Braunwald classification class 〔(1 35±0 28), (2 04±0 31) and (3 17±0 74), respectively〕(P<0 05). In Braunwald class Ⅲ patients,the rate of cardiac events in patients with serum cTnI≥1 5 μg/L was much higher than that in those with cTnI<1 5 μg/L (42 1% vs 13 3%, P<0 05),risk ratio 3 15(95% confidence limit 1 01～9 81).The positive predictive value of serum cTnI≥1 5 μg/L for cardiac events was 42 1% and the negative predictive value was 86 7%. Conclusions Detection of serum cTnI is of clinical value in risk stratification of elderly patients with UAP.