和肽素联合cTnI在急性冠状动脉综合征早期诊断中的意义

目的探讨和肽素和心肌肌钙蛋白I(c Tn I)联合检测在急性冠状动脉综合征早期诊断中的的临床意义。方法收集确诊为急性冠状动脉综合征患者68例,根据冠状动脉病变程度分为左主干病变组(n=21),三支病变组(n=18)、双支病变组(n=15)以及单支病变组(n=14);按类型分为VAP组26例,NSTEMI组24例,STEMI组18例;同时选取30例基本资料相同的志愿者作为对照组。检查急性冠状动脉综合征患者和对照组3、6、12、24 h的和肽素、c Tn I水平,并分析copeptin、c Tn I在冠状动脉不同病变程度组的表达。结果 UAP组、NSTEMI组、以及STEMI组在3、6、12、24 h 4个时间点的和肽素均高于对照组,差异有统计学意义(P<0.05),其中STEMII组和肽素水平最高(P<0.05)。UAP组、NSTEMI组及STEMII组3 h和肽素水平与12 h、24 h相比,差异有统计学意义(P<0.05)。UAP组、NSTEMI组及STEMII组3 h的c Tn I水平与对照组相比,差异无统计学意义;6、12 h以及24 h的c Tn I水平与对照组相比,差异有统计学意义(P<0.05)。左主干病变组、三支病变组、双支病变组以及单支病变组的和肽素水平相互比较,差异有统计学意义(P<0.05);各组间c Tn I水平相互比较,差异无统计学意义。结论和肽素水平在ACS发病早期水平明显升高,在一定程度内可以反映冠状动脉病变程度,可成为早期诊断ACS的标志物。

Objective To explore the clinical meaning of applying copeptin combined with cTnI to diagnose acute coronary syndrome（ACS）. Methods 68 cases diagnosed with acute coronary syndrome, was picked up, the onset of chest pain to admission time was within 3 hours, while 30 healthy volunteers was enrolled in the control group. The copeptin and cTnI of the ACS patients and the control group at the 3, 6, 12, 24 h time point were detected and the expression of the copeptin and cTnI of coronary artery lesions with different degrees were analyzed. Results The copeptin at the 3, 6, 12, 24 h time point of UAP group, NSTEMI group, STEMII group was higher than that at the control group（P〈0.05）, and among the four groups, the copeptin level at the STEMII group was the highest（P〈0.05）; the copeptin at 3 h was higher than that at 12 h and 24 h among UAP, NSTEMI, STEMII group, which was statistical（P〈0.05） ; there is no statistical meaning to compare the cTnI at 3 h among the four groups; while to compare the cTnI at 6, 12, 24 h of the UAP, NSTEMI, STEMII group with that at the control group, statistical meaning existed（P〈0.05）; it was statistical to compare the copeptin level among the left main coronary artery group, triple vessel group and double vessel group（P〈0.05）; and there was no statistical meaning comparing the cTnI level among the three groups. Conclusion Copeptin level was elevated during the early acute coronary syndrome, it could reflect the severity of impaired coronary arteries, which may be a good marker for patients with early ACS.