高敏肌钙蛋白T对急性非ST段抬高型心肌梗死的早期诊断价值

Value of high-sensitive cardiac troponin T to early diagnosis of acute non-ST-segment elevation myocardial infarction

目的探讨高敏肌钙蛋白T(hs-c Tn T)对急性非ST段抬高型心肌梗死的早期诊断价值。方法选取2014年5月~2015年12月于长江航运总医院心内科就诊的非ST段抬高型急性冠状动脉综合征的患者106例,其中非ST段抬高型心肌梗死(NSTEMI)37例,不稳定型心绞痛(UA)69例,同时选取在本院健康体检的无冠状动脉粥样硬化性心脏病(冠心病)患病史的志愿者30例作为对照组,比较各组患者和正常对照组的hs-c Tn T的差异,分析患者血清hs-c Tn T与冠状动脉病变程度的关系,分析血清hs-c Tn T诊断NSTEMI的价值。结果 NSTEMI患者与UA患者的年龄、性别、基础疾病、家族史、吸烟史等基线资料的差异均无统计学意义(P均>0.05)。非ST段抬高型急性冠脉综合征患者与健康对照在年龄和性别比上的差异无统计学意义(P均>0.05)。NSTEMI患者的血清hs-c Tn T水平(25.85±11.59)pg/ml显著高于UA患者(8.12±3.65)pg/ml和正常对照组(3.59±1.82)pg/ml,差异有统计学意义(P均<0.05)。在NSTEMI患者和UA患者中血清hs-c Tn T均随着冠状动脉病变程度的增加而上升,且血清hs-c Tn T水平在两支病变和多支病变的NSTEMI组中高于UA组,差异有统计学意义(P均<0.05)。以UA组作为对比,hs-c Tn T诊断NSTEMI的阈值为15.02 pg/ml,AUC曲线下面积为97.18%,灵敏度为91.89%,特异度为98.55%,约登指数为0.904;以健康对照组作为对比,hs-c Tn T诊断NSTEMI的阈值为8.10pg/ml,AUC曲线下面积为97.39%,灵敏度为94.59%,特异度为100%,约登指数为0.946。结论 NSTEMI患者的血清hs-c Tn T水平高于UA患者和正常对照组,且与冠状动脉病变程度相关,其可作为诊断早期NSTEMI的重要临床指标。

Objective To investigate the value of high-sensitive cardiac troponin T(hs-cTnT)to early diagnosis of acute non-ST-segment elevation myocardial infarction(NSTEMI).Methods The patients with non-ST-segment elevation acute coronary syndrome(NSTEACS,n=106),among them37with acute non-ST-segment elevation myocardial infarction(NSTEMI group)and69with unstable angina pectoris(UAP group),were chosen from the Department of Cardiology of Yangzte River Shipping General Hospital from May2014to Dec.2015,and at the same time the controls(n=30)without history of coronary heart disease(CHD)were chosen as control group.The difference in level of serum hs-cTnT was compared among all groups,relationship between level of serum hs-cTnT and severity of coronary artery lesions was analyzed,and diagnostic value of hs-cTnT to NSTEMI was reviewed.Results The difference in age,sex,basic diseases,family history and smoking history had no statistical significance between NSTEMI group and UA group(all P>0.05).The difference in age ratio and sex ratio had no statistical significance between NSTEACS patients and health controls(all P>0.05).The level of serum hs-cTnT was significantly higher in NSTEMI group[(25.85±11.59)pg/mL]than that in UA group[(8.12±3.65)pg/mL]and in control group[(3.59±1.82)pg/mL,all P<0.05].The level of serum hs-cTnT increased as the severity of coronaryartery lesions increased in NSTEMI group and UA group,and was higher in patients with2-vessel lesions and multi-vessel lesions in NSTEMI group than that in UA group(all P<0.05).Compared with UAP group,threshold value was15.02pg/mL,AUC was97.18%,sensitivity was91.89%,specificity was98.55%and Youden’s index was0.904in NSTEMI diagnosis with hs-cTnT.Compared with control group,threshold value was8.10pg/mL,AUC was97.39%,sensitivity was94.59%,specificity was100%,and Youden’s index was0.946in NSTEMI diagnosis with hs-cTnT.Conclusion The level of serum hs-cTnT is higher in NSTEMI patients than that in UAP patients and controls,and related to severity of coronary artery lesions,which can be taken as an important clinical index for early diagnosis of NSTEMI.