不稳定性心绞痛合并微小心肌损伤的预后观察

Observation on Prognosis of Unstable Angina with Minor Myocardial Damage

目的 根据血清cTnⅠ免疫放射测定的结果 ,判断不稳定性心绞痛 (UnstableAngina ,UA)患者的微小心肌损害(Minormyocardialdamage ,MMD)的情况 ,及其对预后的影响 ,进一步探讨UA患者高危亚组的筛选。 方法 在David提出的UA临床预后分级标准的基础上 ,以 41例健康人的血清标本为对照 ,对 10 3例UA患者进行血清肌钙蛋白Ⅰ (cTnⅠ )的免疫放射检测及肌酸激酶同工酶 (CK MB)的检测 ,观察 6个月随访期内终点事件的发生率。结果 Ⅳ级患者中cTnⅠ阳性持续 72小时以上者的比率和CK MB的阳性率与其他各级相比有显著差异 (P <0 .0 0 1)。Ⅲ级和Ⅳ级患者中cTnⅠ阳性率、cTnⅠ阳性者平均峰值浓度比Ⅰa级、Ⅰb级和Ⅱ级显著增高 (P <0 .0 5 )。但这两级间无显著差异。 6个月随访期内 ,Ⅳ级患者中的终点事件的发生率与其他各级相比有显著差异 (P <0 .0 5 )。结论 在David的UA临床预后分级中 ,Ⅳ级患者合并微小心肌损害者的比率最高 ,终点事件的发生率也最高 ,两者之间密切相关。

Objective To diagnose minor myocardial damage(MMD) in unstable angina and evaluate the prgnostic value of MMD,according to the results of serum cardiac troponin Ⅰ(cTnⅠ) detected by immunoradiometric assay.And to discuss the selection of the most serious subgroup of unstable angina.Method Based on the classification for hospital prognosis of unstable angina pectoris which was proposed by David,compared with 41 serum samples of healthy subjects,the serum samples of 103 UA cases were measured for cTnⅠ and CK-MB.The end cardiac events were followed within 6 months period.Results 72 hours continous positive ratio of cTnⅠ and CK-MB in class Ⅳ were significantly higher than that in other classes( P <0.001).The temporariy positive ratio of cTnⅠ and the peak value of cTnⅠ in class Ⅲ and Ⅳ were significantly higher than those in class Ⅰa,Ⅰb and Ⅱ( P <0.05),but no significant difference was found in these two classes.During the follow-up period,the end cardiac events in class Ⅳ were significantly higher than those in other classes( P <0.05).Conclusions In David classification for hospital prognosis of UA,MMD positive ratio in class Ⅳ was highest and the end cardiac events were highest too.