肌钙蛋白I对不稳定型心绞痛患者预后评价

目的观察不稳定型心绞痛（UAP）患者入院后血清肌钙蛋白I（cTnI）的变化，探讨其与ECG改变、心绞痛分级、冠状动脉病变的关系及对心脏事件的短期预报价值。方法34例UAP患者分别在入院时，入院后12h、24h、48h、10d各采血一次。用免疫发光法测定cTnI浓度，并分析其与临床状况、冠状动脉病变以及心脏事件的关系。结果在30d内，UAP患者中cTnI≥0.4μg/L者46.67%发生心脏事件；cTnI＜0.4μg/L者10.53%发生心脏事件（P＜0.05）。心绞痛Ⅲ级cTnI阳性率高，cTnI有否升高与心电图改变及冠状动脉造影、冠状动脉病变支数、狭窄部位无关（P>0.05）。cTnI对预测发生心脏事件的敏感性77.8%、特异性68%、阳性预测值46.7%、阴性预测值89.5%、准确性70.6%。结论cTnI定量测定对判断UAP患者短期内发生心脏事件有重要的预报价值。

The prognostic value of serum troponin I in patients with unstable angina pectoris

Objective:To observe the changes of serum troponin I(cTnI) inpatients with unstable angina pectoris (UAP),and to evaluate the relationships between the levels of serum cTnI and changes of ECG,classification of UAP,the characteristics of coronary lesion and to evaluate its short-term predictive value for cardiac events.Method:Blood samples were obtained at admission,12,24,48 hours and 10 days later from 34 consecutive UAP patients .Serum concentrations of cTnI were simultaneously measured using the solid-phase two-site chemiluminescent immunometric assay by IMMULITE systems.The relations between the changes of cTnI and clinical conditions ,the characteristics of coronary lesion and the cardiac events, including AMI, sudden death and refractory angina pectoris were analysed.Result:The incidence of cardiac events within 30 days were significantly higher in group with increased cTnI (≥0.4 μg/L) than that with normal cTnI (<0.4 μg/L ),(46.67% vs 10.53%, P<0.05).Although the positive rate of cTnI was higher in the group of Braunwald Ⅲ grade ,we found that there was no relations between cTnI levels and ECG changes ,the number of diseased vessal ,and the location of stenosis (P>0.05).For the prediction of cardiac events with cTnI,its sensitivity, specificity, positive predictive value,negative predictive value,and accuracy were 77.8%,68.0%,46.7%,89.5 and 70.6%,respectively.Conclusion:The present study suggests that serum cTnI level shows very important predictive value for short-term cardiac events in patients with unstable angina pectoris.