稳定性冠心病患者血清超敏心肌肌钙蛋白T水平与冠状动脉病变程度的相关性研究

Relationship Between Serum Levels of High Sensitivity Cardiac Troponin T and the Severity of Coronary Lesions in Patients With Stable Coronary Artery Disease

目的：探讨稳定性冠心病（SCAD）患者血清超敏心肌肌钙蛋白T（hs-c Tn T）与冠状动脉病变之间的关系。方法：回顾性分析450例在我院行冠状动脉造影且均在术前3天内检测了hs-c Tn T基础值的SCAD患者。根据三分位法,将患者按Gensini评分分为三组,即低积分组（Gensini积分〈14分;n=153）,中积分组（Gensini积分14~28分;n=145）,高积分组（Gensini积分〉28分;n=152）。分析三组之间的Gensini积分与hs-c Tn T水平的关系。采用受试者工作特征曲线（ROC曲线）分析hs-c Tn T水平预测Gensini高积分及需要血运重建的最佳诊断界点,并进一步用Logistic回归分析hs-c Tn T水平与Gensini高积分及需要血运重建的相关性。结果：低积分组、中积分组及高积分组hs-c Tn T中位数（P25,P75）分别为6.72（4.20,8.93）pg/ml、7.90（5.74,12.68）pg/ml及14.99（10.26,24.30）pg/ml,组间比较P值均〈0.001,差异有统计学意义。在ROC曲线分析中,hs-Tn T对于Gensini高积分及需要血运重建曲线下面积（AUC）分别为0.837[95%可信区间：（CI）0.803~0.874]及0.772[95%CI：0.728~0.817],hs-Tn T最佳诊断界点为10.04 pg/ml及8.56 pg/ml。Logistic回归分析显示,调整年龄、性别、高血压、糖尿病史、吸烟史、血肌酐、低密度脂蛋白胆固醇及高敏C反应蛋白后,hs-c Tn T仍然为预测高Gensini积分[比值比（OR）=1.13,95%CI：1.06~1.20,P〈0.001]及需要血运重建（OR=1.19,95%CI：1.14~1.24,P〈0.001）的独立预测因子。结论：SCAD患者冠状动脉造影术前的hs-c Tn T水平和冠状动脉病变程度显著相关,可以作为术前预判严重冠状动脉病变及需要血运重建的指标之一。

Objective： To investigate the relationship between serum levels of high sensitivity cardiac troponin T （hs-cTnT） and the severity of coronary lesions in patients with stable coronary artery disease （SCAD）. Methods： A total of 450 SCAD patients with coronary angiography （CAG） confirmed diagnosis in our hospital were studied, and serum levels of hs-cTnT were examined at 3 days prior CAG in all patients. Based on tertiles of Gensini score, the patients were divided into 3 groups： Low score group, n=153 patients with Gensini score〈14, Intermediate score group, n=145 patients with Gensini score at 14-28 and High score group, n=152 patients with Gensini score〉28. The relationships between Gensini score and hs-cTnT levels were analyzed among 3 groups. The optimal cut-offvalue of hs-cTnT for predicting high Gensini score and the need of revascularization were studied by ROC curve, the relationships between hs-cTnT and high Gensini score, the need of revascularization were further detected by Logistic regression analysis. Results： The median values （25%-75%） ofhs-cTnT in Low score group, Intermediate score group and High score group were 6.72 （4.20, 8.93） pg/ml, 7.90 （5.74, 12.68） pg/ml and 14.99 （10.26, 24.30） pg/ml respectively, all P〈0.01. ROC curveanalysis indicated that the area under curve （AUC） of hs-cTnT for predicting high Gensini score was 0.837 （95% CI 0.803- 0.874）, for the need of revascularization was 0.772 （95% CI 0.728-0.817）; the best cut-off value of hs-TnT for predicting high Gensini score was 10.04 pg/ml and for the need of revascularization was 8.56 pg/ml, Logistic regression analysis suggested that with adjusted age, gender, the history of hypertension, diabetes, smoking, blood levels of creatinine, LDL-C and hs-CRP, hs-cTnT was still an independent predictor for high Gensini score （OR= 1.13, 95% CI 1.06-1.20, P〈0.001） and for the need of revascularization （OR=I. l 9, 95% CI 1.14-1.24, P〈0.001）. Conclusion： Serum level of hs-cTnT has been related to severity of coronary lesions in SCAD patients, hs-cTnT might be used as one of the pre-operative predictor for severe coronary disease and for the need of revascularization.