心肌肌钙蛋白I升高和STAF评分对心源性脑梗死的预测价值

Study on the predictive value of elevated cardiac troponin I and STAF scores in diagnosis of cardiogenic cerebral infarction

目的本研究旨在分析并比较心肌肌钙蛋白I(cardiac troponin I,cTnI)升高及STAF评分(Score for the Targeting of Atrial Fibrillation)对心源性脑梗死诊断的预测价值。方法本研究纳入223例急性缺血性脑卒中患者,心源性脑梗死38例,非心源性脑梗死185例。收集患者详细的临床资料后,检测血清cTnI的浓度,计算STAF评分。比较两组临床基线资料,采用ROC曲线确定cTnI和STAF评分对心源性脑梗死诊断的界值,并对比分析其预测价值。结果心源性脑梗死组患者相比于非心源性脑梗死组,年龄更大,心房颤动、缺血性心脏病史更多,NIHSS评分、cTnI 值以及STAF评分明显更高(P<0.05)。STAF的ROC曲线下面积为0.954,其95%CI为0.924~0.985。cTnI值的ROC曲线下面积为0.852,其95%CI为0.788~0.916。STAF评分截点为4分,此时灵敏度为92.1%,特异度为89.2%。cTnI值截点为0.0085 ng/mL,此时灵敏度为73.7%,特异度为84.9%。结论本研究中STAF评分和cTnI 值均对心源性脑梗死有良好的预测价值,且STAF评分对心源性脑梗死诊断的预测价值高于cTnI。血清cTnI 值和STAF评分对急性缺血性脑卒中患者的病因分型具有一定的临床运用价值。

Objective The purpose of this study was to examine the predictive value of elevated cardiac troponin I (cTnI) and Score for the Targeting of Atrial Fibrillation (STAF) in the diagnosis of cardiogenic cerebral infarction. Methods Two hundred twenty-three patients with acute ischemic stroke were recruited in the study including 38 patients in cardiogenic cerebral infarction (CCI) group and 185 in non-cardiac cerebral infarction (NCCI) group. Clinical data were collected. Chemiluminescence immunoassay was used to detect serum cTnI concentrations in patients and STAF scores were calculated. The clinical baseline data of the two groups were compared. A receiver operating characteristic (ROC) curve was used to determine the boundary value of cTnI and STAF scores in diagnosing CCI and in analyzing their predictive value. Results In the CCI group, the patients were older with higher frequency in atrial fibrillation and ischemic heart disease. Moreover, the NIHSS scores, the value of cTnI and STAF scores were significantly higher in CCI group than in the NCCI group (P<0.05). The area under the ROC curve of STAF scores was 0.954, and its 95%CI was between 0.924 and 0.985. The area under the ROC curve of the cTnI value was 0.852, and its 95%CI was between 0.788 and 0.916. The cutoff of STAF scores was 4 points, with a sensitivity of 92.1% and a specificity of 89.2%. The cutoff of cTnI value was 0.0085ng/ml, with a sensitivity of 73.7% and a specificity of 84.9%. Conclusion Serum cTnI value and STAF score have a good predictive value for CCI, and STAF score have a higher value than serum cTnI in predicting the diagnosis of CCI. Clinically, serum cTnI and STAF score may be helpful for etiology classification of acute ischemic stroke.