血清肌钙蛋白I轻度升高在初诊为非ST段抬高型急性冠状动脉综合征患者中的临床意义

Evaluation of low level elevation of troponin I in patients who primarily diagnosed as non-ST-segment elevation acute coronary syndrome

目的：探讨血清肌钙蛋白 I（cTnI）轻度升高在初诊为非 ST 段抬高型急性冠状动脉综合征（NSTE-ACS）的患者诊治中的临床意义。方法选取2012年7月至2013年7月于天津医科大学第二医院心脏内科初诊为NSTE-ACS，血清cTnI水平在0.02～1 ng/ml的患者80例，为cTnI轻度升高组；血清cTnI正常的患者60例，为cTnI正常组。所有患者在院期间均行冠状动脉造影术。据冠状动脉造影结果计算Gensini积分评价冠状动脉病变严重程度，分析其与cTnI水平的关系。结果（1）与cTnI正常组相比，cTnI轻度升高组患者肌酸激酶、肌酸激酶同工酶水平更高，病变支数更多，最大病变程度更严重（P＜0.05）；（2）以全部观察对象作为整体，Gensini 积分、病变支数均与cTnI 水平呈正相关（r＝0.365，r＆#39;＝0.343，P＜0.01）；（3）cTnI 轻度升高组患者超声心动图显示室壁节段性运动异常及瓣膜钙化的比例显著高于正常组（P＜0.05）；（4）cTnI轻度升高组的谷草转氨酶及尿素氮均显著高于cTnI正常组（P＜0.05），而白蛋白和二氧化碳结合力均显著低于cTnI正常组（P＜0.05）。结论对于初诊NSTE-ACS患者，cTnI轻度升高有重要的临床意义，提示冠状动脉病变范围较大、程度较重，且同时合并更复杂的临床情况。

Objective To evaluate the clinical significance of mild elevation of troponin I （cTnI） in patients with non-ST-segment elevation acute coronary syndrome. Methods One hundred and forty patients who primarily diagnosed with non-ST-segment elevation acute coronary syndrome were recruited from cardiology department of the Second Hospital of Tianjin Medical University, between July, 2012 and July, 2013.Patients were divided into normal group（cTnI＆lt;0.02 ng/ml）and low level elevated group（0.02 ng/ml＆lt;cTnI＆lt;1 ng/ml）, and completed coronary angiography during hospital stay. The Gensini score were calculated according to the coronary angiography to assess the coronary lesions. And the correlation between Gensini score and cTnI leve1 were analyzed. Results （1）Compared with the normal group, the low level elevated group had higher CK and CKMB, more coronary lesions counts and much more significantly more severe coronary lesions（P＆lt;0.05）; （2）For all patients in the study, Gensini score and coronary lesions counts were positively related with cTnI leve1（r=0.365, r＆#39;=0.343, P＆lt;0.01）;（3）There were more patients with segmental wall motion abnormality or valve calcification in mild level elevated group than those in normal group（P＆lt;0.05）;（4）Compared with the normal group, the low level elevated group had higher AST and BUN, while lower ALB and CO2CP. Conclusion For the patients who primarily diagnosed as non-ST-segment elevation acute coronary syndrome, the significance of low level elevation of cTnI can indicate more serious coronary lesion with more complicated clinical situation.