非急性心肌梗死患者高灵敏度肌钙蛋白T升高原因分析

Causes of elevated high-sensitive troponin T in patients without acute myocardial infarction

目的分析急诊非急性心肌梗死患者高灵敏度肌钙蛋白T(hs-c Tn T)升高的原因。方法回顾性分析该院急诊科2011年3月-2013年12月收诊的给予检测hs-c Tn T的980例患者的临床资料,剖析非急性冠状动脉综合征患者hs-c Tn T增加的原因,并了解心脏病高危因素对hs-c Tn T增加患者的影响。结果 980例患者中,102例患者因诊断有急性冠状动脉综合征而排除,共有878例患者纳入研究,其中,145例(32.1%)患者,没有明确的依据能判断hs-c Tn T升高的原因,其他引起hs-c Tn T升高的原因有:肾功能不全173例(57.1%),脑缺血58例(19.1%),外伤45例(14.9%),心脏衰竭27例(8.9%)。有明确原因的303例患者的hs-c Tn T水平明显高于145例无明确原因者(P<0.01);前者的年龄也显著高于后者。结论非急性冠状动脉综合征患者hsc Tn T水平升高最常见的原因为肾功能不全和急性脑血管事件。

【Objective】 To investigate the causes of non-coronary high-sensitive troponin T（hs-c Tn T） elevations. 【Methods】 A retrospective analysis of 980 patients, who had the detection of high-sensitive troponin T in the Emergency Department of our hospital from March 2011 to December 2013, was made. The causes of elevated non-acute coronary syndrome hs-c Tn T were analyzed so as to understand the influence of the risk factors for heart diseases on the level of hs-c Tn T. 【Results】 During the study period a total of 980 patients received serial measurements of high-sensitive troponin T. Of these, 102 patients were found to have acute coronary syndrome; therefore, only 878 patients were included in the study. In 145（32.1%） of the patients, no putative cause described in the literature could be attributed to the elevation in high-sensitive troponin T observed. The most commonly encountered mechanism underlying the troponin T elevation was renal insufficiency that was present in 173 patients（57.1%）, followed by cerebral ischemia in 58 patients（19.1%）, trauma in 45patients（14.9%） and heart failure in 27 patients（8.9%）. The patients with a detectable putative cause of hsc Tn T elevation had a significantly higher troponin level than the patients without a detectable cause, the patients with a detectable putative cause of hs-c Tn T elevation were significantly older than the patients whose cause for troponin elevation remained unknown. 【Conclusion】 Non-acute coronary syndrome-associated elevation of high-sensitive troponin T level is commonly observed in the Emergency Department. Renal insufficiency and acute cerebral events are the most common conditions associated with high-sensitive troponin T elevation.