社区老年高血压人群中高敏肌钙蛋白T对不良心血管事件的独立预测作用

Independent role of hs-TnT in predicting MACE in community elderly hypertensive patents

目的探讨在社区老年高血压人群中高敏肌钙蛋白T(hs-TnT)对主要不良心血管事件(MACE)的预测作用。方法纳入北京石景山区苹果园社区参加健康调查的老年高血压人群463例,根据基线hs-TnT水平四分位数将受试者分为A组(hs-TnT<3.00 ng/L)119例,B组(hs-TnT 3.00~5.75 ng/L)113例,C组(hs-TnT 5.76~9.90 ng/L)114例和D组(hs-TnT≥9.91 ng/L)117例。随访4.5~5.2(4.8±0.9)年,记录MACE和全因死亡情况,采用Cox比例风险回归分析及ROC曲线评估hs-TnT预测价值。结果D组年龄、吸烟比例、尿酸、同型半胱氨酸和高敏C反应蛋白水平高于A、B、C组(P<0.05)。随访期间,发生MACE 50例(10.8%),全因死亡23例(5.0%)。Cox比例风险回归分析显示,D组患者发生MACE和全因死亡风险明显高于其他3组(HR=5.483,95%CI:1.537~18.571;HR=3.783,95%CI:1.118~16.852,P<0.05)。ROC曲线分析显示,hs-TnT对于MACE和全因死亡预测的曲线下面积为0.661(95%CI:0.603~0.740)和0.631(95%CI:0.510~0.751)。结论在社区高血压人群中,血清hs-TnT水平是MACE及全因死亡的强而独立的预测指标。

Objective To study the independent role of hs-TnT in predicting MACE in community elderly hypertensive patients.Methods 463 elderly hypertensive patients from Beijing Shijinshan Pingguoyuan Community were divided into group A(n=119,hs-TnT<3.00 ng/L),group B(n=113,hs-TnT=3.00-5.75 ng/L),group C(n=114,hs-TnT=5.76-9.90 ng/L)and group D(n=117,hs-TnT≥9.91 ng/L).The patients were followed up for 4.5-5.2(4.8±0.9)years,during which the incidence of MACE and all-cause deaths was recorded.The value of hs-TnT in predicting MACE in community elderly hypertensive patients was analyzed by Cox regression analysis and ROC curve analysis respectively.Results MACE occurred in 50 patients(10.8%)and all-cause deaths occurred in 23 patients(5.0%)during the follow-up period.Cox regression analysis showed that the risk of MACE and all-cause deaths predicted according to the hs-TnT was significantly higher in group D than in groups A-C after adjustment for age,sex,BP,blood lipids and other traditional risk factors(HR=5.483,95%CI:1.537-18.571,HR=3.783,95%CI:1.118-16.852,P<0.05).ROC curve analysis displayed that the area under the ROC curve for MACE and all-cause deaths was 0.661 and 0.631 respectively(95%CI:0.603-0.740,95%CI:0.510-0.751).Conclusion Serum hs-TnT level is a strong and independent factor for predicting all-cause deaths and MACE in community elderly hypertensive patients.