CK-MB、cTn及红细胞分布宽度在非ST段抬高ACS中的意义

CK-MB,cTn,and red cell distribution width in patients withnon-ST-elevated acute coronary syndrome

目的:评价非ST段抬高急性冠状动脉综合征(NSTE-ACS)患者肌酸激酶同工酶(CK-MB)与心肌钙蛋白(cTn)不一致的发生率及临床特点,并探讨红细胞分布宽度(RDW)在其中的价值。方法:NSTE-ACS患者320例,根据标记物特征分为4组:CK-MB-/cTn-组,CK-MB+/cTn-组,CK-MB-/cTn+组,CK-MB+/cTn+组;根据RDW值大小将其分为高RDW组(H-RDW组:RDW>14.5%)和低RDW组(L-RDW组:RDW<14.5%)。分析各组院内心力衰竭(心衰)发生率及死亡率。结果:24.4%患者存在CK-MB与cTn结果不一致,其中CK-MB-/cTn+占15%,CK-MB+/cTn-占9.4%,两者RDW水平差异无统计学意义(P>0.05)。在前述4种组合中,患者住院期间心衰的发生率分别是3.4%、4.4%、6.3%和10.3%,死亡率分别是0.63%、0.94%、1.25%和2.81%;H-RDW与L-RDW组院内心衰发生率分别为16.9%和7.5%,死亡率分别为3.75%和1.88%,均差异有统计学意义(均P<0.01)。结论:不论CK-MB阳性与否,cTn+的NSTE-ACS患者急性期内心脏事件风险均明显增加,而单独的CK-MB阳性对于短期内心脏事件的判断价值有限。RDW水平升高的NSTE-ACS患者急性期内心脏事件风险明显增加,RDW可作为新的危险分层重要标记物。

Objective： To explore creatine kinase-MB （CK-MB） and cardiac troponin （cTn） in patients with non-ST-segment elevation acute coronary syndromes （NSTE-ACS）, and investigate the clinical value of red cell distribution width （ RDW ） in these patients. Method . A total of 3 2 0 patients with NSTE ACS were enrolled and dividedintofourgroups（CK-MB /cTn ,CK-MB＋ /cTn- ,CK-MB /cTn＋ ,CK-MB＋ /cTn＋ ） according to the results of cardiac injury markers （CK-MB, cTn）. These patients were also divided into two groups （H-RDW group and L-RDW group） according to the level of RDW. In-hospital mortality and mobility of heart failure were analyzed. Result：Discordant cardiac injury markers were observed in 24.4 percent of the population, in which 15 % of the patients were CK-MB-/cTn＋ , and 9.4% were CK-MB＋/cTn . However, there was no significant differ- ence in RDW levels between CK-MB /cTn＋ group and CK-MB＋/cTn group （P〉0.05）. The incidence of heart failure in four groups was 3.4%, 4.4%, 6.8% and 10.30/00 respectively, while in hospital mortality was 0.63%, 0.94%, 1.25% and 2.81% respectively. The incidence of heart failure in H-RDW and L-RDW group was respec- tively 16.9G and 7.5G （P〈0.01）, and the in hospital mortality was respectively 3. 75G and 1. 88% （P〈0.01）. Conclusion： Regardless of the results of CK-MB, the risk of cardiac events is significantly higher in the NSTE-ACS patients with positive cTn. The value of isolated positive CK-MB is insuffiecent for forecasting the short-term prognosis. Increased RDW levels are closely associated with the risk of cardiac events during the acute period. Thus, RDW may act as a new important cardiac marker in risk classification in NSTE ACS patients.