超敏肌钙蛋白Ⅰ水平与青年男性心肌梗死冠脉病变程度的相关分析

Correlation analysis between hypersensitive troponin Ⅰ level and coronary artery lesion degree in young male myocardial infarction

目的研究超敏肌钙蛋白Ⅰ水平与青年男性心肌梗死患者冠脉病变程度的相关性。方法回顾性分析2014年1月至2018年10月于泰山医学院附属医院住院期间行经皮冠状动脉造影术的青年男性(16岁≤年龄≤45岁)患者105例,其中心肌梗死(心肌梗死组)49例,非心肌梗死56例(非心肌梗死组:非冠心病30例,冠心病UA26例)。搜集患者临床资料及化验检查结果,应用GRACE评分计算研究对象(非冠心病除外)入院后6个月内死亡率。根据Gensini评分将心肌梗死组分为轻中度冠脉病变组(GS1-59,n=29)、重度冠脉病变组(GS≥60,n=20)。超敏肌钙蛋白Ⅰ水平与Gensini评分、入院后6个月内死亡率相关性采用spearman相关分析,Gensini评分与入院后6个月内死亡率相关性采用spearman相关分析,应用ROC曲线计算超敏肌钙蛋白Ⅰ水平用于评估重度冠脉病变的最佳切点。结果心肌梗死组超敏肌钙蛋白Ⅰ水平、Gensini评分、入院后6个月内死亡率高于非心肌梗死组,且差异有统计学意义(P<0.05),超敏肌钙蛋白Ⅰ、Gensini评分重度冠脉病变组高于轻中度冠脉病变组,且差异有统计学意义(P<0.05)。重度冠脉病变组与轻中度冠脉病变组入院后6个月内死亡率差异无统计学意义(P=0.934>0.05)。术前超敏肌钙蛋白Ⅰ水平与Gensini评分成正相关(r=0.391,P=0.005<0.05),与入院后6个月内死亡率无明显相关性(P=0.138>0.05);Gensini评分与入院后6个月内死亡率无相关性(P=0.509>0.05);ROC曲线提示超敏肌钙蛋白Ⅰ预测冠脉出现重度病变的最佳切点为2.525μg/L,敏感度为0.5,特异度为0.931。结论术前超敏肌钙蛋白Ⅰ水平与青年男性心肌梗死冠脉病变程度相关,当超敏肌钙蛋白≥2.525μg/L,可预测出现冠脉重度病变,敏感度差,特异度极佳。超敏肌钙蛋白Ⅰ、冠脉病变程度与入院后6个月内死亡率无相关性。

Objective To investigate the correlation between hypersensitive troponin Ⅰ level and the degree of coronary artery lesions in young male patients with myocardial infarction. Methods A retrospective analysis was performed on 105 young male patients (aged no more than 45 and no more than 16 years old) who underwent percutaneous coronary angiography from January 2014 to October 2018 during their stay in the affiliated hospital of taishan medical college. Among them, there were 49 cases of myocardial infarction (myocardial infarction group), 56 cases of non-myocardial infarction (non-myocardial infarction group, 30 cases of non-coronary heart disease, 26 cases of coronary heart disease and UA). General data and laboratory results of the patients were collected, and GRACE score was used to calculate the mortality rate of the subjects (except non-coronary heart disease cases) within 6 months after admission. According to Gensini score, the myocardial infarction group was divided into mild to moderate coronary artery disease group (GS 1-59, n=29) and severe coronary artery disease group (GS>60, n=20). Spearman correlation was used to analyze the correlation between hypersensitive troponin I level and Gensini score and mortality within 6 months after admission.Gensini' s score was based on a spearman analysis of the death rates in the six months after admission.The ROC curve was used to calculate the hypersensitive troponin Ⅰ level to evaluate the optimal tangential point of severe coronary artery disease. Results Myocardial infarction group allergic Ⅰ troponin levels, Gensini score, within 6 months after admission, mortality is higher than the myocardial infarction group, and the difference was statistically significant (P< 0.05), allergic troponin Ⅰ, Gensini score severe coronary artery lesion group higher than mild-to-moderate coronary lesions, and the difference was statistically significant (P<0.05). There was no significant difference in mortality within 6 months after admission between the severe coronary artery disease group and the mild to moderate coronary artery disease group (P=0.934>0.05). Preoperative allergic Ⅰ troponin levels are positively related with Gensini score (r=0.391, P=0.005<0.05), no obvious correlation with mortality within six months after admission (P=0.138>0.05);There was no correlation between Gensini score and mortality within 6 months after admission (P=0.509>0.05). ROC curve prompt allergic troponin Ⅰ the best point of tangency to predict coronary severe lesions of 2.525 mμg/L, sensitivity of 0.5, 0.931. Conclusion Preoperative hypersensitive troponin I level was associated with the degree of coronary artery lesion in young male myocardial infarction.Hypersensitive troponin can be more than 2.525 μg/L to predict the presence of severe coronary lesions, poor sensitivity, excellent specificity. Hypersensitive troponin I and the severity of coronary artery lesions were not correlated with mortality within 6 months after admission.