GRACE评分联合超敏肌钙蛋白T在急性心源性胸痛筛查和预后评估中的应用价值

Clinical Value of GRACE Score combined with High-sensitivity Cardiac Troponin T in Screening and Prognostic Evaluation of Acute Cardiogenic Chest Pain

目的探讨全球急性冠状动脉事件注册评分(GRACE)联合超敏肌钙蛋白T筛查急性心源性胸痛,预测其预后的价值。方法选择2018年3月1日-2020年2月1日某院诊治的206例急性胸痛患者,其中心源性胸痛117例为观察组,非心源性胸痛89例为对照组。患者入院后24h内均行血清肌红蛋白、肌酸激酶同工酶、hsTnT水平检测和GRACE评分,受试者工作特征曲线分析GRACE评分、hsTnT在急性心源性胸痛鉴别及预后预测的效能。结果观察组血清Mb(125.36±26.35)μg/L、CK-MB(56.35±13.97)ng/ml、hsTnT(352.35±61.29)ng/l、GRACE评分(129.35±38.16)分高于对照组的(41.05±12.02)μg/L、(4.21±1.32)ng/ml、(12.01±4.69)ng/l、(65.13±19.85)分(P<0.001)。高危组血清Mb、CK-MB、hsTnT水平高于中危组和低危组(P<0.001),中危组血清Mb、CK-MB、hsTnT水平高于低危组(P<0.001)。死亡组血清Mb、CK-MB、hsTnT水平、GRACE评分均高于存活组(P<0.001)。hsTnT、GRACE评分鉴别急性心源性胸痛、预测急性心源性胸痛患者出院1个月内死亡的AUC分别为0.830、0.821,0.718、0.683,高于Mb、CK-MB(P<0.05),联合hsTnT和GRACE评分鉴别急性心源性胸痛,预测急性心源性胸痛患者出院1个月内死亡的的AUC为0.926、0.949,高于单独hsTnT和GRACE评分(P<0.05)。结论急性心源性胸痛患者血清hsTnT水平明显升高,且hsTnT水平与GRACE评分以及急性心源性胸痛患者预后密切相关。GRACE评分联合hsTnT在急性心源性胸痛筛查以及预后预测方面均有较高应用价值。

Objectives To investigate the prognostic value of global registry of acute coronary events(GRACE)score combined with high-sensitivity cardiac troponin T(hsTnT) in screening, and predict its prognostic value for acute cardiogenic chest pain. Methods To select 206 patients with acute chest pain who were diagnosed and treated in a hospital from March 1 st, 2018 to February 1 st, 2020. Among them, 117 cases had cardiogenic chest pain(observation group) and 89 cases had non-cardiogenic chest pain(control group). Within 24 hours after admission, all patients were tested for serum Mb, creatine kinase isoenzyme(CK-MB), hsTnT levels and GRACE score. Receiver-operating characteristic curve(ROC) was used to analyze the efficacy of GRACE score and hsTnT in the identification and prognostic prediction of acute cardiogenic chest pain. Results The Serum Mb(125.36±26.35) μg/L, CK-MB(56.35±13.97) ng/ml, hsTnT(352.35±61.29) ng/l levels and GRACE score(129.35±38.16) of the observation group were higher than those of the control group [( 41.05±12.02) μg/L,(4.21±1.32) ng/ml,(12.01±4.69) ng/l,(65.13±19.85) minutes](P<0.001). The serum levels of Mb, CK-MB and hsTnT in the high-risk group were higher than those in the medium-risk group and the low-risk group(P<0.001),and the serum levels of Mb, CK-MB and hsTnT in the medium-risk group were higher than those in the low-risk group(P<0.001). The levels of serum Mb, CK-MB, hsTnT and GRACE score in the death group were higher than those in the survival group(P<0.001). The AUC of hsTnT and GRACE scores to identify acute cardiogenic chest pain, and predicting death in patients with acute cardiogenic chest pain within 1 month after discharge were 0.830, 0.821, 0.718 and 0.683, respectively, which were higher than that of Mb and CK-MB(P< 0.05).The AUC of hsTnT combined with GRACE score to identify acute cardiogenic chest pain, and predicting death in patients with acute cardiogenic chest pain within 1 month after discharge were 0.926 and 0.949, respectively,which were higher than that of hsTnT and GRACE score alone(P<0.05). Conclusions Serum hsTnT level was significantly increased in patients with acute cardiogenic chest pain, and it was closely correlated with GRACE score and prognosis of patients with acute cardiogenic chest pain. Grace score combined with hsTnT had high application value in the screening and prognosis of acute cardiogenic chest pain.