肌钙蛋白Ⅰ对老年不稳定型心绞痛患者危险分层的判断价值

目的探讨心脏肌钙蛋白Ⅰ（cTnⅠ）对老年不稳定型心绞痛（UAP）患者危险分层的价值。方法对72例老年UAP患者、27例稳定型心绞痛（SAP）患者及22例健康对照者分别进行血清cTnⅠ测定，并观察住院1个月内心脏事件发生情况。结果UAP组血清cTnⅠ值为（1．96±0．61）μg／L，明显高于sAP组的（0．68±0．19）μg／L及对照组的（0．46±0．10）μg/L（P均〈0．01）。UAP组内，随着Braunwald临床分级增高，Ⅰ～Ⅲ级血清cTnⅠ值相应增高[分别为（1．25±0．38）μg/L、（2．12±0．34）μg/L及（3．06±0．72）μg/L]（P〈0．05）。对照组、SAP组及BraunwaldⅠ级UAP患者无一例发生心脏事件；18例Ⅱ级患者中，1例（其血清cTnⅠ≥1．5μg／L）发生非致命性心肌梗死（MI）；33例Ⅲ级UAP患者中，21例血清cTnⅠ≥1．5μg/L患者中的9例发生心脏事件（6例非致命性心肌梗死、3例心脏猝死），总心脏事件发生率16．7％；16例血清cTnⅠ〈1．5μg／L者仅1例发生非致命性MI，其总心脏事件发生率6．3％。血清cTnⅠ≥1．5μg/L者心脏事件发生率明显高于cTnⅠ〈1．5μg/L者（P〈0．05），比数比（OR）为2．05（16．7％／6．3％），95％可信限为1．02～9．78。血清cTnⅠ≥1．5μg／L时判断心脏事件的阳性预测值为44．3％，阴性预测值为84．8％。结论血清cTnⅠ检测对老年UAP患者危险分层有一定的临床价值。

The value of cardiac troponin I in risk stratification of elderly patients with unstable angina pectoris

Objective To study the value of serum troponin Ⅰ（cTnⅠ） in risk stratification of elderly patients with unstable angina peetoris （UAP）. Methods Serum cTnI levels were measured in 22 healthy subjects （ control group）, 27 stable angina peetoris （SAP） and 72 UAP elderly patients, respectively. Cardiac events （non fatal myocardial infarction, cardiac sudden death ）were observed within 1 month of hospitalization. Serum cTnⅠ≥ 1.5 μg/L was considered as the cutoff level for myocardial damage. Results Serum cTnⅠ levels in the UAP group were higher than those in the SAP and control group [ （ 1.96 ± 0.61 ） μg/L, （0.68 ± 0.19 ） μg/L and （ 0.46 ± 0.10 ） μg/L, respectively ] （ P 〈 0.01 ）. In the UAP group, s＇erum cTnI levels increased with increase of Braunwald classification class [ （ 1.25± 0.38） μg/L, （2. 12± 0.34） μg/L and （3. 06 ±0.72） μg/L, respectively ] （ P 〈 0.05 ）. In Braunwald class Ⅱ patients, the rate of eardiae events in patients with serum cTnⅠ ≥ 1.5 μg/L was much higher than that in those with cTnI 〈 1.5 μg/L （ 16.7% vs 6.3%, P 〈 0.05 ）, risk ratio 2.05 （ 95 % confidence limit 1.02 - 9.78 ）. The positive predictive value of serum cTnⅠ≥ 1.5 μg/L for cardiac events was 44. 3% and the negative predictive value was 84.8%. Conclusions Detection of serum cTnⅠ has clinical value in risk stratification of elderly patients with UAP.