C-反应蛋白、D-二聚体、肌钙蛋白I与急性胸痛患者预后关系

目的:研究C-反应蛋白(CRP)、D-二聚体(DD)、肌钙蛋白I(cTnI)水平与急性胸痛患者预后关系。方法:78例急性胸痛患者分别测定CRP、DD、cTnI水平后,随诊半年,随诊终点为心脏事件,依检查结果分为正常组和异常组。结果:随诊期间12例患者发生心脏事件,其中50%患者C-反应蛋白升高、75%的患者D-二聚体升高、83·3%的患者肌钙蛋白I水平升高,50%患者3项均升高。78例患者中,CRP升高者和正常组心脏事件发生率分别33·3%和10%(P<0·01),DD升高者和正常组为27·6%和8·2%(P<0·01),cTnI升高者和正常组为23·8%和5·6%(P<0·01)。结论:急性胸痛患者就诊时的CRP、DD、cTnI水平分别与预后有关。     

肌钙蛋白T、C反应蛋白、D-二聚体在判定不稳定型心绞痛预后中的价值

不稳定型心绞痛(UAP)是介于稳定型心绞痛(AP)和急性心肌梗死(AMI)之间的一种心肌缺血综合征。临床对UAP的诊断及预后评估，通常主要依据心电图及传统的心肌酶指标。UAP及非Q波AMI患者的心电图通常无特异性改变，而心肌酶的敏感性及特异性欠佳。近年来，我们检测了98例     

急性脑梗死患者C-反应蛋白和D-二聚体的关系

目的观察急性脑梗死患者C-反应蛋白(CRP)和D-二聚体(D-D)关系。方法测定25例急性脑梗死患者CRP和D-D，并与正常组相比较。结果25例急性脑梗死患者CRP和D-D明显升高。结论急性脑梗死时D-D升高和CRP有关。     

C-反应蛋白水平与急性心肌梗死预后的关系

目的探讨C-反应蛋白(CRP)水平与急性心肌梗死(AMI)预后的关系。方法测定120例患者的CRP。根据CRP水平分为CRP升高组和CRP正常组,随访6个月。比较两组急性期治疗后再发心绞痛、心律失常、心衰、再梗死和心源性猝死的发生率。结果CRP升高组心绞痛的再发生率45.1%(37/82),心律失常的发生率42.7%(35/82),心衰的发生率9.8%(8/82),再梗死的发生率22.0%(18/82),心源性猝死的发生率8.5%(7/82);CRP正常组心绞痛的再发生率13.2%(5/38),心律失常的发生率10.5%(4/38),心衰的发生率2.6%(1/38),再梗死的发生率5.3%(2/38),无心源性猝死的发生。两组比较有高度显着性差异(P<0.01)。结论CRP在急性心肌梗死的发病机制中起重要作用,而且使AMI后再发心绞痛、心律失常、心衰、再梗死和心源性猝死的发生率明显增高。     

血清尿酸、肌钙蛋白I和高敏C反应蛋白对急性冠状动脉综合征患者预后的预测价值

目的:观察急性冠状动脉综合征(ACS)患者血清尿酸(UA)、肌钙蛋白I(cTnI)和高敏C反应蛋白(hs-CRP)含量并探讨对其临床预后的预测价值。方法:入选确诊ACS的住院患者592例,收集入院24h内UA、cTnI和hs-CRP的数值,并对患者出院后的心血管事件进行随访,分为心血管事件组和无心血管事件组。结果:UA、cTnI和hs-CRP在2组之间的差异均有统计学意义;校正了年龄、职业、吸烟史、BMI、高血压、糖尿病等相关因素后,血清UA、cTnI和hs-CRP能独立预测ACS患者再发心血管事件。结论:血清UA、cTnI和hs-CRP水平升高与ACS患者的再发心血管事件显著相关,具有较强的预测价值。     

高敏C反应蛋白、心肌肌钙蛋白I与冠状动脉病变程度的关系

目的探讨高敏C反应蛋白(hs-CRP)和心肌肌钙蛋白I(cTnI)浓度变化与冠状动脉(冠脉)的病变程度之间的关系.方法冠脉造影患者按照造影结果分为阴性组、单支病变组、双支病变组和三支病变组,寻找hs-CRP和cTnI与冠脉病变的关系.结果 hs-CRP浓度按病变程度依次升高,双支病变组和三支病变组与阴性组比较差异有非常显著性(P<0.001),cTnI的阳性率依次升高,差异有非常显著性(χ2 =50.881,P<0.001).结论血中hs-CRP浓度的升高和cTnI阳性率的升高与冠脉病变的程度有着密切的联系,对冠心病的病变程度具有预测价值.     

C-反应蛋白水平与老年急性冠状动脉综合征预后的关系

目的探讨C-反应蛋白(CRP)水平与老年急性冠状动脉综合征(ACS)预后的关系。方法测定60例老年ACS患者的CRP,再根据CRP水平分为CRP升高组和CRP正常组,随访6个月。比较两组治疗后再发心绞痛、心律失常、心力衰竭、再梗死和心脏性猝死的发生率。结果CRP升高组心绞痛的再发生率46.3%(19/41),心律失常的发生率43.9%(18/41),心力衰竭的发生率9.76%(4/41),再梗死的发生率22.0%(9/41),心脏性猝死的发生率7.32%(3/41);CRP正常组心绞痛的再发生率15.8%(3/19),心律失常的发生率10.5%(2/19)心力衰竭的发生率5.3%(1/19),再梗死的发生率5.3%(1/19),无心脏性猝死的发生。两组各发生率比较均有统计学意义(P<0.01)。结论CRP在ACS的发病机制中起重要作用,而且使ACS后再发心绞痛、心律失常、心力衰竭、再梗死和心脏性猝死的发生率明显增高。     

急性脑梗死患者的血超敏C-反应蛋白和D-二聚体测定

目的探讨急性脑梗死患者血超敏C-反应蛋白(hs-CRP)和D-二聚体(D-Dimer)含量的变化及其意义。方法分别于发病后24小时、15天测定42例急性脑梗死患者血清hs-CRP和血浆D-Dimer含量,并与正常对照组进行比较;分析血清hs-CRP与血浆D-Dimer含量及其与神经功能缺损程度评分(NIHSS)、脑梗死面积的关系。结果急性脑梗死组血hs-CRP和D-Dimer含量均明显高于正常对照组(P<0.05);脑梗死患者血清hs-CRP和血浆D-二聚体含量分别与脑梗死面积、神经功能缺损程度有关,脑梗死面积越大血hs-CRP和D-Dimer含量越高,神经功能缺损中重度组明显高于轻度组(均P<0.05)。结论急性脑梗死患者血hs-CRP及D-Dimer含量明显增高。观察血hs-CRP及D-Dimer水平的改变对于判断脑梗死病情轻重具有重要的意义。     

急性冠状动脉综合征患者血清超敏C-反应蛋白水平变化及其影响因素

目的 探讨急性冠状动脉综合征(ACS)患者血清超敏C-反应蛋白(hsCRP)和心肌肌钙蛋白I(cTnI)变化及其影响因素.方法 ①采用化学发光免疫分析法检测50例ACS患者、20例OMI患者和20名健康人的hsCRP和cTnI含量.②以hsCRP为因变量,以年龄、性别、高血压史、糖尿病史、吸烟史、cTnI、甘油三酯(TG)、胆固醇(CHO)、载脂蛋白A(APOA)、载脂蛋白B(APOB)、血糖(GLU)、高密度脂蛋白胆固醇(HDL-C)、尿酸(URI)为自变量进行多元逐步回归分析.结果 ①ACS组的hsCRP、cTnI均高于OMI组和对照组(P＜0.05);OMI组的hsCRP、cTnI水平与对照组相比有升高趋势,但差别无统计学意义(P＞0.05).②以hsCRP作为因变量的多元逐步回归方程式为:hsCRP=-3.362 0.02446X7 1.097X9(X7为cTnI,X9为CHO,X7、X9显著性均为P＜0.01).结论 ACS患者血清hsCRP、cTnI水平明显升高;血清hsCRP水平和cTnI、CHO呈正相关.     

冠心病患者血浆超敏C-反应蛋白、D-二聚体水平测定及分析

目的 观察超敏-C反应蛋白（hs-CRP）和D-二聚体（D—D）水平在冠心病发生、发展中的作用。方法选择冠心病患者120例（观察组）和健康体检者50例（对照组）,分别采用免疫比浊法和自身红细胞凝集法检测血浆hs-CRP和D—D水平,并进行相关性分析。结果观察组血浆hs—CRP、D-D水平明显高于对照组（P〈0．01）,且急性心肌梗死（AMI）〉不稳定型心绞痛（UAP）〉稳定型心绞痛（SAP）,P均〈0．01。结论hs—CRP和D-D与冠心病的发生、发展密切相关;联合检测两者有利于冠心病的早期诊断、临床分型及疗效观察。     

床边快速肌钙蛋白T测定对急性胸痛患者诊断的价值

目的评价床边快速心肌肌钙蛋白T(cTnT)检测对以急性胸痛症状住院或转科的患者诊断的价值。方法采用床边快速心肌肌钙蛋白T测定仪(CARDIACREADER)测定502例以急性胸痛症状入院或转入心内科的患者入院即刻、6h、12h的cTnT水平,同时测定患者的心肌肌钙蛋白I(cTnI)、肌酸磷酸激酶(CK)及其同功酶(CK-MB)水平。以心电图出现急性心肌梗死(AMI)的动态改变和(或)CK-MB和TnI同时升高诊断为心肌梗死,计算床边快速cTnT诊断急性心肌梗死的特异性、敏感性、阴性预测价值和阳性预测价值。结果502例急性胸痛患者,cTnT阳性160例(31.9%),cTnT阴性323例(64.3%),19例弱阳性。139例cTnT阳性患者发生AMI,7例cTnT阴性的患者发生AMI。床边快速cTnT对以急性胸痛症状住院或转科的患者诊断AMI的特异性为93.8%、敏感性为95.2%、阳性预测价值为86.9%、阴性预测价值为97.8%。结论床边快速肌钙蛋白T测定可以迅速准确地在急性胸痛患者中识别或排除AMI患者,具有重要的诊断价值。     

非特异性胸痛患者运动试验前后血清心肌肌钙蛋白I水平的变化

目的探讨以非特异性胸痛(ACP)患者运动负荷前、后血清心肌肌钙蛋白I(cTnI)值的变化,间接推断其是否存在心脏微血管病变的可能性.方法冠状动脉造影结果正常的ACP患者33例,健康正常人17例和冠心病心绞痛患者16例,均进行运动平板试验,并分别于运动前,运动后1小时、24小时进行血清cTnI浓度、CK值和LDH值的测定.结果ACP组中运动试验阳性者及冠心病心绞痛组患者运动后1小时及24小时血清cTnI浓度明显升高(P<0.01及 P<0.05),提示ACP组运动试验阳性者可能存在心脏微血管病变;ACP组中运动试验阴性者运动前、后血清cTnI浓度的变化无显著性差异.在冠心病心绞痛组患者中,运动试验后1小时血清cTnI浓度随患者病变程度的加重而逐渐增加,且变化有显著性差异(P<0.05).结论ACP患者运动负荷前后血清cTnI值的检测有助于间接推断患者是否存在心脏微血管病变,且其升高程度可以间接反映冠状动脉的病变程度.     

A modified HEART risk score in chest pain patients with suspected non-ST-segment elevation acute coronary syndrome

Objective To validate a modified HEART [History, Electrocardiograph (ECG), Age, Risk factors and Troponin] risk score in chest pain patients with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in the emergency department (ED). Methods This retrospective cohort study used a prospectively acquired database and chest pain patients admitted to the emergency department with suspected NSTE-ACS were enrolled. Data recorded on arrival at the ED were used. The serum sample of high-sensitivity cardiac Troponin I other than conventional cardiac Troponin I used in the HEART risk score was tested. The modified HEART risk score was calculated. The end point was the occurrence of major adverse cardiac events (MACE) defined as a composite of acute myocardial infarction (AMI), percutaneous intervention (PCI), coronary artery bypass graft (CABG), or all-cause death, within three months after initial presentation. Results A total of 1,300 patients were enrolled. A total of 606 patients (46.6%) had a MACE within three months: 205 patients (15.8%) were diagnosed with AMI, 465 patients (35.8%) underwent PCI, and 119 patients (9.2%) underwent CABG. There were 10 (0.8%) deaths. A progressive, significant pattern of increasing event rate was observed as the score increased (P < 0.001 by χ² for trend). The area under the receiver operating characteristic curve was 0.84. All patients were classified into three groups: low risk (score 0–2), intermediate risk (score 3–4), and high risk (score 5–10). Event rates were 1.1%, 18.5%, and 67.0%, respectively (P < 0.001). Conclusions The modified HEART risk score was validated in chest pain patients with suspected NSTE-ACS and may complement MACE risk assessment and patients triage in the ED. A prospective study of the score is warranted.     

冠脉CT血管造影对疑难胸痛患者的诊断价值

目的：探讨冠脉CT血管造影（CCTA）对疑难胸痛患者的诊断价值。方法：对于经过包括心电图、心脏彩超、运动试验、心肌坏死标志物等检查的胸痛筛查流程,仍难以确诊的93例胸痛患者,先后进行64排螺旋CT的cCTA和冠脉造影检查,以明确诊断,了解临床拟诊和CCTA对冠心病诊断的敏感性,特异性和诊断的准确性。结果：以冠脉造影检查对冠心病的诊断为标准,临床拟诊对冠心病诊断的敏感性,特异性和准确性,分别是70．70%（53／75）,40．4％（8／18）和84．1％（53／63）;CCTA对冠心病诊断的敏感性,特异性和准确性,分别是97．3％（73／75）,85．7％（12／14）,和92．4％（73／79）。结论：对于疑难胸痛患者的诊断,冠脉CT血管造影有重要价值,又是无创的,可优先采用。     

The predictive value of the bedside troponin T test for patients with acute chest pain

BACKGROUND: The evaluation of patients with acute chest pain is time consuming and complicated. In the present study, the role of the bedside troponin T (TnT) test was prospectively investigated for predicting the risk of death and acute heart failure (AHF) in patients with acute chest pain. METHODS: Five hundred two consecutive patients admitted in the 24 h after the onset of chest pain were enrolled in the study. Tests of bedside TnT, qualitative troponin I, myoglobin, creatine kinase and creatine kinase (muscle-brain), and electrocardiography were performed on these patients. RESULTS: For the bedside TnT test, 160 (31.9%) patients had positive results and 323 (64.3%) patients had negative results. During 30 days of follow-up, the differences between TnT-positive and TnT-negative patients were as follows: 139 (86.9%) positive patients and seven (2.2%) negative patients were diagnosed with acute myocardial infarction (AMI) (OR=298.8 for AMI in positive versus negative patients); 51 (31.9%) positive patients and 37 (11.5%) negative patients had AHF (OR=3.6 for AHF in positive versus negative patients); 39 (24.4%) positive patients and 15 (4.6%) negative patients died (OR=6.7 for all-cause death in positive versus negative patients); 31 (19.4%) positive patients and five (1.5%) negative patients died due to a cardiac event (OR=15.8 for cardiac death in positive versus negative patients). The sensitivity and specificity of the bedside TnT test for diagnosing AMI were 95.2% and 93.8%, respectively. CONCLUSIONS: The bedside TnT test is a powerful, independent and valuable tool for risk stratification in patients with acute chest pain.     

Profile of patients with acute heart failure and elevated troponin I levels

BACKGROUND: Elevation of troponin I (TnI), a sensitive marker of myocardial cell injury, has been described in a portion of patients with chronic heart failure and acute decompensated heart failure. The proportion and characteristics of patients with TnI elevation in an unselected population with acute left heart failure (AHF) are, however, not known. PATIENTS AND METHODS: One hundred five consecutive patients with AHF as the leading diagnosis were included in the present study. TnI was routinely assessed at admission and 12 h to 24 h later. Patients with TnI 0.5 mug/L or greater (TnI+ group) and TnI less than 0.5 mug/L (TnI- group) were compared from demographic and clinical points of view. RESULTS: TnI elevation was detected in a total of 28 patients with AHF (26.7%). The TnI+ patients had a significantly higher entry Killip stage (P<0.0001), lower time from onset of symptoms (P=0.002), higher baseline heart rate (P=0.003) and creatinine level (P=0.002), and lower body mass index (P=0.03). On the other hand, the TnI+ group did not differ from TnI- patients in demographic and some clinical parameters, such as age, sex, blood pressure, history of coronary artery disease, major electrocardiograph parameters and left ventricular ejection fraction. CONCLUSIONS: TnI elevation was present in a substantial portion of unselected patients with AHF as the leading clinical diagnosis. Moreover, TnI+ patients differed from those with normal TnI in several clinical parameters.