急诊经皮冠状动脉介入治疗术后围术期心肌肌钙蛋白T水平对心肌内出血的预测价值

Predictive value of perioperative cardiac troponin T level for myocardial hemorrhage after primary percutaneous coronary intervention

目的探讨心肌内出血(IMH)对ST段抬高型心肌梗死患者再灌注后围术期心肌肌钙蛋白T(cTnT)水平的影响以及cTnT对IMH的预测价值。方法连续性纳入复旦大学附属中山医院2018年1月至2019年8月共计70例急性心肌梗死患者。在经皮冠状动脉介入治疗(PCI)术后4~7 d接受心脏磁共振成像(CMR)检查,根据CMR表现分为IMH组(45例)和非IMH组(19例)。采用受试者工作特征(ROC)曲线评估不同时间点cTnT水平对IMH的预测价值。结果基于不同时间点的cTnT相关性分析显示,术后即刻cTnT水平、峰值cTnT水平与CMR各参数的Spearman秩相关性最强。其中术后即刻cTnT及峰值cTnT与IMH容积呈正相关,秩相关系数分别为0.76和0.74(均P<0.001);与IMH T2*值呈负相关,秩相关系数分别为–0.68和–0.65(均P<0.001);与梗死容积呈正相关,秩相关系数分别为0.55和0.50(均P<0.001);与LVEF呈负相关,秩相关系数分别为–0.66和–0.59(均P<0.001)。ROC曲线分析显示:术后即刻cTnT预测心肌梗死患者PCI术后发生IMH具有最大的AUC为0.95(P<0.001),敏感度、特异度及准确度分别为75.6%、100.0%和82.8%,截断值为4.71 ng/ml。术后即刻cTnT预测IMH的AUC与峰值cTnT的AUC差异无统计学意义(P=0.191),而与术后1 d(P=0.025)、术后3 d(P=0.034)及术后5~7 d(P=0.018)的差异均有统计学意义。进一步进行多变量回归分析显示,术后即刻cTnT(OR 2.40,95%CI 1.44~4.00,P=0.001)仍是STEMI患者发生IMH的独立危险因素。结论术后cTnT水平可作为患者发生IMH的有效预测因子。

Objective To investigate the effect of intramyocardial hemorrhage(IMH)on perioperative cTnT levels in patients with STEMI after reperfusion and its predictive value.Methods From January 2018 to August 2019,a total of 70 patients with acute myocardial infarction underwent cardiac magnetic resonance(MR)examination 4–7 days after PCI were consecutively enrolled.They were divided into IMH group and non IMH group according to cardiac MR findings.Linear regression analysis was used to evaluate the relationship between IMH and cTnT level at each time point.ROC curve was used to evaluate the predictive value of cTnT level on IMH formation at different time points.Results Patients with IMH had larger infarct area and higher cTnT level.In the correlation analysis,IMH volume,IMH T2*value and infarct volume were significantly correlated with cTnT level.cTnT levels at each time point have the value of effectively predicting IMH.The AUC values of IMH immediately after operation are the highest(0.95),and the best cutoff values are 4.71 ng/ml.Conclusions Postoperative cTnT level is an effective predictor of IMH.