择期PCI术后肌钙蛋白升高的临床指导意义

Clinical effect of troponin elevation after electively percutaneous coronary intervention

目的：探讨择期经皮冠状动脉介入治疗（PCI）术后肌钙蛋白I（cTnI）升高在PCI相关心肌损伤、心肌梗死诊断中的地位及对临床的指导意义。方法择期 PCI 的住院冠心病患者386例，平均年龄（61.84±9.94）岁，男297例（76.94%），女89例（23.06%），按照是否满足2012年心肌梗死通用定义专家共识分组为PCI相关心肌损伤（梗死）组（104例）和对照组（282例）。术前和术后24 h和48 h分别抽取外周静脉血用化学发光法检测 cTnI 水平。比较两组患者伴随疾病、术中支架数目、支架总长度、住院天数、住院总费用。结果 cTnI升高标准者（心肌损伤组）104例（发生比率为26.94%），同时能明确诊断PCI相关心肌梗死者23例（发生比率为5.96%）。心肌损伤组与对照组在年龄、住院总天数方面的差异无统计学意义（均P 〉0.05）。术后cTnI-术前cTnI≥0者303例。PCI术后cTnI升高程度与植入支架的总长度及总住院费用均呈线性正相关（分别为r=0.123，P =0.036；r=0.131，P =0.023）。PCI相关心肌损伤（包括PCI相关心肌梗死）组植入的支架数量及支架总长度、单次住院费用、合并高血压比率均显著高于对照组（均P 〈0.05）；合并糖尿病比率（37.50%）也高于对照组（29.43%），但差异无统计学意义（P =0.083）。结论 PCI术后肌钙蛋白I（cTnI）升高具有重要临床意义，其升高程度与心肌损伤程度有关。常规检测肌钙蛋白是必要的。

Objective To investigate the clinical instructive significance of troponin elevation （cTnl） after elective percutaneous coronary intervention （PCI）. Methods A total of 386 hospitalized patients with coronary heart disease who underwent elective PCI, 297 males and 89 females, aged （61.84 ± 9.94）, underwent collection of peripheral venous blood samples to examine the levels of cTnl by chemiluminescence method before PCI and 24hours and 48hours after PCI. Then they were divided into 2 groups based on the cTnl levels of the 2012 Expert Consensus Document on the Third Universal Definition of Myocardial Infarction： PCI-related myocardial injury （including infarction） group and control group. In addition, the incidence of concomitant diseases, the number of intraoperative stents, overall length of stents, hospitalization days and the total cost in hospital were compared. Results According to the cTnl levels 104 patients were included into the PCI-related myocardial damage group and 282 patients were in the control group. The incidence of PCI-related myocardial infarction was 5.96% . No significant differences in the age and hospitalization days were found between the two groups. The degree of cTnI elevation was positively correlated with the overall length of stents and the total hospitalization cost. The number of intraoperative stents, overall length of stents, total cost of single hospital admission, and incidence of hypertension of the PCI-related myocardial injury （infarction） group were all significantly higher than those of the control group （all P 〈0.05）. The incidence of diabetes of the PCI-related myocardial injury （infarction） group was 37.50%, but not significantly higher than that of the control group （29.43% , P=0.083）.Conclusion Correlated with myocardial damage, the elevation of troponin after elective PCI is of important significance in clinical application. And the routine detection of cTnI is necessary.