超敏肌钙蛋白T对慢性收缩性心力衰竭患者危险分层和短期预后价值的探讨

The value of high sensitive cardiac troponin T in risk stratification and short-time prognosis in heart failure with reduced ejection fraction

目的 探讨超敏肌钙蛋白T（hs-TnT）对慢性收缩性心力衰竭（HF-rEF）患者危险分层和短期预后价值的影响.方法 158例HF-rEF患者入院后2h内测定血浆hs-TnT水平.经规范化治疗,随访3个月,观察终点是心血管事件（心源性死亡及心力衰竭恶化再入院）.结果 ①随着NYHA心功能分级的增高,hs-TnT水平亦呈增高趋势,Ⅱ～Ⅳ级hs-TnT水平分别为（0.011±0.740）mmol/L、（0.176±0.900）mmol/L和（0.236±0.810）mmol/L,不同级别间比较,差异均有统计学意义（P＜0.05）.②不同病因所致HF-rEF各亚组间hs-TnT水平无明显差异（P＞0.05）.③以hs-TnT均数0.014μg/L为界,升高hs-TnT亚组3个月内心血管事件发生率明显高于正常hs-TnT亚组（49.0％比27.8％,P＜0.01）.结论 检测超敏肌钙蛋白T升高提示短期预后不佳,主要心血管事件的增加可作为对早期HF-rEF患者危险分层的一个指标,并指导临床治疗.

Objective To investigate the value of high sensitive cardiac troponin T in risk stratification and short-time prognosis in heart failure with reduced ejection fraction patients. Methods 158 patients in heart failure with reduced ejection fraction were as study group. All patients admitted to hospital in serum hs-TnT level were completed and received standard therapy and followed up for 3 months. The primary end points were cardiac events including cardiac death and readmission for worsening heart failure. Results （1）Hs-TnT levels tended to increase as higher NYHA class. From group II to group IV, the levels of hs-TnT ranged from（0.011±0.740） retool/L, （0.176±0.900）mmol/L to （0.236±0.810）mmol/L. There was significantly difference compared with dif- ferent NYHA class （P〈0.05）. （2）There was no significant differenee in hs-TnT levels in patients of heart failure with reduced ejection fraction due to different causes （P〉0.05）. （3）The patients in heart failure with reduced ejection fraction were divided into high-hs-TnT subgroup （104 persons） and normal- hs-TnT subgroup （54 persons） according to hs-TnT mean 0.014 μg/L, the incidence of cardiovascular events was 49.0% in high-hs-TnT group, signifieanfly higher than 27.8% in normal-hs-TnT group in three months （P〈0.01）. Conclusion In heart failure with redueed ejection fraction patients, the levels plasma hs-TnT ean detect more myocardial necrosis, while the levels of hs-TnT can be as a predictor in evaluation of the risk stratification and short-time prognosis in heart failure with reduced ejection fraction and guide clinical treatment.