肌钙蛋白峰值超过检测上限在急性心肌梗死中的临床意义及其早期预测指标

Clinical significance and early predictive indicators of peak troponin levels exceeding the upper detection limit in acute myocardial infarction(AMI)

目的探讨急性心肌梗死(AMI)时心肌肌钙蛋白I(cTnI)峰值超出检测范围的临床意义及预测指标。方法回顾2013年4月至2017年4月在北京友谊医院心内科监护室住院的129例cTnI>50 ng/ml和1533例cTnI≤50 ng/ml的AMI患者。记录基线资料、实验室指标、冠状动脉特征、主要心血管事件。应用logistic回归分析和ROC曲线分析cTnI超出检测范围的相关因素和早期预测指标。结果cTnI超峰值的患者多为男性、心率偏快、中性粒细胞与淋巴细胞比值(NLR)高、ST段抬高型心肌梗死(STEMI)比例高、左前降支(LAD)闭塞率高,多为早期经皮冠状动脉介入治疗(PCI),院内左心室射血分数低,主要心血管事件(MACE)高,住院时间长。Logistics回归分析显示,NLR高和cTnI超峰值有关(OR=1.125,95%CI 1.060~1.200,P=0.000)。ROC曲线显示,NLR取截断值5.794时,预测敏感度58.41%,特异度70.34%。结论TnI超过检测范围的AMI患者男性比例高、心率快、NLR高、STEMI和LAD闭塞比例高,多为早期PCI术,院内心脏功能差,MACE事件高,住院时间长。NLR高于5.794可作为cTnI超出检测范围的早期预测指标之一。

Objective To explore the clinical significance and predictive indicators of peak cardiac troponin I(cTnI)levels exceeding the detection range in patients with acute myocardial infarction(AMI).Methods A retrospective analysis was conducted in 129 AMI patients with cTnI>50 ng/ml and 1533 AMI patients with cTnI≤50 ng/ml admitted to the Cardiology Intensive Care Unit of Beijing Friendship Hospital from April 2013 to April 2017.The baseline characteristics,laboratory indicators,coronary artery features and major cardiovascular events were recorded.Logistic regression analysis and ROC curve analysis were used to identify the factors associated with cTnI exceeding the detection range and early predictive indicators.Results The patients with cTnI exceeding the peak value were predominantly male and had a faster heart rate,a higher neutrophil-tolymphocyte ratio(NLR),a higher proportion of ST-segment elevation myocardial infarction(STEMI),a higher proportion of left anterior descending(LAD)artery occlusion and a shorter time from onset to intervention.The patients had a lower left ventricular ejection fraction,higher incidence of major cardiovascular events(MACE)in hospital and longer hospital stay.Logistic regression analysis showed a significant association between higher NLR and cTnI exceeding the peak value(OR=1.125,95%CI 1.060-1.200,P=0.000).ROC curve analysis revealed that when the NLR cutoff value was set at 5.794,the predictive sensitivity was 58.41%and the specificity was 70.34%.Conclusion The AMI patients with cTnI levels exceeding the detection range have a higher proportion of male,faster heart rate,higher NLR,higher proportions of STEMI and LAD artery occlusion,poorer cardiac function,higher incidence of MACE during hospitalization and longer hospital stays.The NLR greater than 5.794 upon admission can serve as an early predictive indicator for cTnI levels exceeding the detection range.