cTnT与CK--MB在胸痛危险分层中的作用

目的评价心肌肌钙蛋白T(cTnT)与肌酸激酶同工酶-MB(CK-MB)蛋白量在胸痛危险分层中的作用。方法对所有病例进行12h床边动态监测，包括基线、4、8、12h的连续心律监测和12导联心电图(ECG)测试；与此同时分别于基线、4、8、12h对入选胸痛组的其中383例患者测定cTnT、CK-MB。结果383例CPU患者只有8例(2．1％)CK-MB阳性，39例cTnT阳性。cTnT状态与随访的结果表明，cTnT阳性明显早于CK-MB。89％cTnT阳性患者血管造影术显示发生冠状动脉疾病(CAD)及多支血管病。结论cTnT比CK-MB在评估伴心肌坏死和多支血管病的胸痛危险分层中具有更高的敏感性与特异性；常规测定cTnT更便于胸痛的危险分层与处理。     

血清肌钙蛋白T及血浆同型半胱氨酸在急性冠脉综合征中的作用

目的　探讨急性冠脉综合征时高同型半胱氨酸血症和心脏肌钙蛋白T的关系 ,评价高同型半胱氨酸血症是否能导致心肌损伤程度加重。方法　AMI 5 3例 ,UAP 5 5例 ,采用荧光标记免疫检测法测定血浆同型半胱氨酸 (Hcy) ,酶联免疫法 (ELISA)测定肌钙蛋白T(cTnT)。结果　AMI组Hcy明显升高时cTnT也明显升高 ,Hcy大于 16 0 μmol/L时cTnT明显高于Hcy小于 7 7μmol/L(P <0 0 1) ,Hcy分别为 7 7、9 0、11 3、14 3、16 0 μmol/L时cTnT分别为 4 6 3、4 6、4 8、6 2、7 8μg/L ;UAP组同样 ,Hcy分别为 9 8、11 0、12 1、12 8、15 4 μmol/L时cTnT分别为 0 0 3、0 0 3、0 0 2、0 0 4、0 15 μg/L ,最高浓度组与最低浓度组方差分析显示P <0 0 1。UAP组cTnT阳性者血浆Hcy浓度比阴性者显著升高 (P <0 0 0 1)。结论　血浆同型半胱氨酸浓度升高与ACS时心肌损伤有关。     

探讨Hcy、hs-CRP与急性冠脉综合征危险分层的相关性

目的探讨血清同型半胱氨酸（homocysteine,Hcy）、超敏c反应蛋白（high sensitivity—C reactiveprotein,hs—CRP）水平与急性冠脉综合征（acute coronary syndrome,ACS）危险分层的关系。方法选择2011年12月-2012年12月我院住院的ACS患者71例,根据ACS诊断标准分为不稳定型心绞痛（unstable angina peetoris,UAP）患者22例、非sT段抬高心肌梗死（non—ST—elevation myocardial infaretion,NSTEMI）患者17例和ST段抬高心肌梗死（ST—elevation myocardial infarction,STEMI）患者32例。根据GRACE评分标准将各组患者进行危险分层,分为低危组、中危组和高危组,对各组患者进行hs-CRP和Hcy水平检测,并对所有数据进行统计学分析。结果71例ACS患者一般资料分析结果显示,低危组、中危组和高危组患者间除年龄差异有统计学意义外（P〈0．05）,其余各指标差异均无统计学意义（P均〉0.05）。22例UAP患者和17例NSTEMI患者中,中危组和高危组的hs—CRP水平均显著高于低危组,差异均有统计学意义（P均〈0．05）,而在32例STEMI患者中,hs—CRP水平在低危组、中危组和高危组间差异均有统计学意义（P均〈0．05）;在三种类型的ACS患者中,Hcy水平在低危组、中危组和高危组中差异均无统计学意义（P均〉0．05）。结论ACS疾病的严重程度随着年龄的增长逐渐加重。hs—CRP水平可反映ACS患者的病程情况,对ACS的治疗和预后评估有一定价值;Hcy尚不能作为ACS危险分层的一个监测指标。     

心肌钙蛋白T在急性冠状动脉综合征临床分型和危险分层中的应用

目的探讨血清心肌钙蛋白T（cTnT）在急性冠状动脉综合征（ACS）临床分型和危险分层中的作用,评价cTnT水平与ACS的危险程度、心脏事件的发生率及预后的相关性.方法应用电化学发光免疫分析法检测急性心肌梗死（AMI）患者血清cTnT水平,临床诊断性能（ROC）曲线确立cTnT在AMI诊断中的决定限.结果用cTnT升高与否来判断ACS患者是否发生AMI,其诊断敏感性为100%,特异性为95.3%,AMI患者cTnT水平与其危险性相关.结论根据cTnT水平进行ACS的临床分型,能快速、准确的诊断非ST段抬高的AMI,比采用传统分型更科学、可靠与实用,更符合疾病发生的病理生理和临床特征.     

心肌钙蛋白T在急性冠状动脉综合征临床分型和危险分层中的应用

目的探讨血清心肌钙蛋白T(cTnT)在急性冠状动脉综合征(ACS)临床分型和危险分层中的作用,评价cTnT水平与ACS的危险程度、心脏事件的发生率及预后的相关性。方法应用电化学发光免疫分析法检测急性心肌梗死(AMI)患者血清cTnT水平,临床诊断性能(ROC)曲线确立cTnT在AMI诊断中的决定限。结果用cTnT升高与否来判断ACS患者是否发生AMI,其诊断敏感性为100%,特异性为95.3%,AMI患者cTnT水平与其危险性相关。结论根据cTnT水平进行ACS的临床分型,能快速、准确的诊断非ST段抬高的AMI,比采用传统分型更科学、可靠与实用,更符合疾病发生的病理生理和临床特征。     

Myeloperoxidase level in patients with stable coronary artery disease and acute coronary syndromes

Background No studies have measured plasma myeloperoxidase (MPO) across the entire spectrum of patients with coronary artery disease (CAD). The aim of the study was to compare MPO level across the entire spectrum of CAD, to assess the accuracy of MPO in predicting acute coronary syndromes and to define independent correlates of MPO level. Design This case–control study included 874 patients with angiographically proven CAD. Cases included 680 patients with CAD (382 patients with stable CAD, 107 patients with non-ST-segment elevation acute coronary syndromes and 191 patients with ST-segment elevation acute myocardial infarction). Controls included 194 subjects with normal coronary angiograms. MPO was measured using an enzyme immunoassay before angiography and heparin administration. Results MPO level [median (25th–75th percentiles)] was 74·5 (52·5–135·3) µg L⁻¹ in cases vs. 61·2 (44·6–80·9), µg L⁻¹ in controls (P < 0·001). MPO level was 61·2 (47·5–85·8), µg L⁻¹ in patients with stable CAD, 99·2 (62·2–154·9), µg L⁻¹ in patients with non-ST-segment elevation acute coronary syndromes and 129·5 (72·2–216·0) µg L⁻¹ in patients with acute myocardial infarction (P < 0·001). Elevated MPO level was associated with acute coronary syndromes with an area under receiver operating characteristic (ROC) curve of 0·731 (95% confidence interval 0·692–0·770; P < 0·001). Independent correlates of MPO level were acute coronary syndrome (P < 0·001), high-sensitivity C-reactive protein (P = 0·007), creatinine (P = 0·026), left ventricular ejection fraction (P = 0·027, negative association) and smoking (P = 0·028). Conclusions MPO level is elevated in patients with CAD and higher levels of MPO were found with progression of CAD from stable CAD to non-ST-segment elevation acute coronary syndromes and to acute myocardial infarction.     

Rapid risk stratification in suspected acute coronary syndrome using serial multiple cardiac biomarkers: A pilot study

Objective: To determine the feasibility of using a biomarker panel of myoglobin, creatinine kinase MB (CK‐MB) and cardiac troponin I (cTnI) to identify patients with suspected acute coronary syndrome (ACS) who are suitable for discharge within 2 h. Methods: We took blood at presentation and at 2 h from patients with suspected ACS and non‐diagnostic electrocardiogram who were admitted to the ED short stay ward for serial electrocardiogram and troponin testing. We used a point‐of‐care device that gives rapid estimation of myoglobin, CK‐MB and cTnI (Triage cardiac panel). These results were compared with the results of our standard hospital cardiac troponin T assay. Patients were followed up by telephone at 30 days. Results: The study group comprised 100 patients (61 men) with mean age of 58 years. Six had a troponin‐positive ACS during their ED stay. One additional patient died of a myocardial infarction within the follow‐up period. The Triage panel at 2 h after presentation predicted 12‐h cardiac troponin T elevation (sensitivity 100%, negative predictive value 99%) and 30‐day events (sensitivity 86%, negative predictive value 97%). The majority of patients were ultimately suitable for discharge. Conclusion: Serial myoglobin, CK‐MB and cTnI have the potential to identify patients who are suitable for early discharge and outpatient work‐up. A large multicentre study is required.     

高敏心肌肌钙蛋白I与心肌肌钙蛋白T预测心血管事件的对比研究

目的比较高敏心肌肌钙蛋白(high-sensitivity cardiac troponin I,hs-cTnI)与心肌肌钙蛋白(cardiac troponin T,cTnT)对非ST段抬高型急性冠状动脉综合征(急性冠脉综合征)患者心血管事件的预测价值。方法采集103例连续的不稳定型心绞痛和非ST段抬高型急性心肌梗死患者的血浆样品,分别采用电化学发光免疫法和VITROS化学发光免疫分析法检测cTnT和hs-cTnI。采用工作者特征曲线评估心血管事件的发生率,确定hs-cTnI与cTnT的最佳预测值。结果 hs-cTnI与cTnT均能显著预测心血管事件,两者差异无统计学意义(P=0.75)。两种心脏标志物的最佳预测值分别为hs-cTnI>0.055μg/L和cTnT>0.010μg/L,敏感度均为90%,特异度均为52%;hs-cTnI阳性患者的心血管事件发生率为17%,而hs-cTnI阴性患者的心血管事件发生率为2%,两者差异有统计学意义(P=0.02)。结论 hs-cTnI与cTnT对非ST段抬高型急性冠脉综合征患者心血管事件有相似的预测诊断价值。     

Decreased patient charges following implementation of point-of-care cardiac troponin monitoring in acute coronary syndrome patients in a community hospital cardiology unit

BACKGROUND: The need to rapidly evaluate patients presenting to emergency departments and cardiology services for ruling in and ruling out acute myocardial infarction (AMI) is widely recognized as a clinical challenge. We determined the impact of incorporating point-of-care (POC) cardiac troponin I (cTnI) testing into a cardiology service regarding assay turn around time (TAT), patient length of stay (LOS), financial matrixes and patient outcomes compared to central laboratory cTnI testing. METHODS: Patients presenting with symptoms suggestive of acute coronary syndrome (ACS) were enrolled pre-POC (PreCS, n=271) and post-POC (PostCS, n=274). POC cTnI determinations were performed at the bedside on the Dade Behring Stratus CS by nursing staff. Routine cTnI determinations were performed in the central laboratory (Dade Behring Dimension) by laboratory staff. Data were collected and analyzed on each patient per hospital stay by review of electronic medical and financial records. In addition, risk stratification outcomes for all cause death were determined at 30 days and 1 y following baseline sampling based on the 99th percentile cutoff concentrations of <0.1 microg/l for both assays. RESULTS: There was a decrease in time from blood draw to result to healthcare provider (PreCS mean 76 min; PostCS mean 19.5 min; p<0.001) as well as a decrease trend in charge per patient admission (4281 dollars savings) following implementation of POC testing. Total charges per patient admission decreased by 25% PostCS vs. PreCS (17,163 dollars vs. 12,882 dollars); a composite of lower charges for: boarding (-21%), other departments (-58%), pharmacy (-28%), labs (-22%), non-cardiac procedures (-28%), cardiac procedures (-14%). The mean LOS also decreased 8% (p=0.05) from PreCS (2.36 days) to PostCS (2.19 days). cTnI reagents charges to the laboratory were higher for the POC assay, 10.54 dollars, vs. the central lab assay, 3.83 dollars. One year survival was greater in the <0.1 microg/l patients (PreCS 96.2%, PostCS 97.2%) compared to the >0.1 microg/l patients (PreCS 77.7%, PostCS 75.5%); both p<0.001. Kaplan-Meier survival curves showed early separation by 30 days in each group. CONCLUSIONS: Our study demonstrates the cost effectiveness and clinical effectiveness of implementation of POC whole blood, cTnI testing for assisting clinicians with diagnostic and risk assessment of ACS patients.     

Prospective evaluation of emergency department patients with potential coronary syndromes using initial absolute CK-MB vs. CK-MB relative index

We compared the predictive properties of an initial absolute creatine kinase-MB (CK-MB) to creatine kinase-MB relative index (CK-MB RI) for detecting acute myocardial infarction (AMI), acute coronary syndromes (ACS), and serious cardiac events (SCE). Consecutive patients > 24 years of age with chest pain who received an electrocardiogram (EKG) as part of their Emergency Department (ED) evaluation had CK and CK-MB drawn at presentation. Patients were followed prospectively during their hospital course. The main outcome was AMI, ACS or SCE (death, AMI, dysrhythmias, CHF, PTCA/stent, CABG) within 30 days. The sensitivity, specificity, PPV and NPV of CK-MB and CK-MB RI to predict AMI, ACS, and SCE were calculated with 95% CIs. We enrolled 2028 patients. There were 105 patients (5.2%) with AMI, 266 (13.1%) with ACS, and 150 with SCE (7.4%). Absolute CK-MB had a higher sensitivity than CK-MB RI for AMI (52.0 vs. 46.9, respectively), ACS (23.5 vs. 20.8, respectively), and SCE (39.6 vs. 36.0, respectively), but a lower specificity than CK-MB RI for AMI (93.2 vs. 96.1, respectively), ACS (93.1 vs. 96.1, respectively) and SCE (93.3 vs. 96.3, respectively); and lower PPV for AMI (35.7 vs. 46.5, respectively), ACS (42.0 vs. 53.4, respectively) and SCE (38.5 vs. 50.5, respectively). The negative predictive values were similar for all outcomes. We conclude that the risk stratification of ED chest pain patients by absolute CK-MB has higher sensitivity, similar NPV, but a lower specificity and PPV than CK-MB relative index for detection of AMI, ACS, and SCE. The optimal test depends upon the relative importance of the sensitivity or specificity for clinical decision-making in an individual patient.     

延长应用低分子肝素治疗急性冠脉综合征

目的本文应用法安明（低分子肝素）治疗急性冠脉综合征病人,观察应用5—7d和14d的疗效及副作用。方法急性冠脉综合征病人120例,应用法安明14d,皮下注射,每Et2次（实验组）;对照组120例,应用法安明5—7d,其他治疗均同,观察半年内两组发生心血管事件的次数及出血、血小板减少等不良事件的发生率。结果实验组心血管事件发牛率为16．67％,对照组发生率为24．17％,两组比较差异有统计学意义（P〈0．01）。不良事件发生率两者比较差异无统计’学意义（P〉0．05）。结论低分子肝素延长应用至14d,较应用5—7d,能更好的减少心血管事件,同时副作用不增加,尤其为择期手术病人创造了机会。     

血清肌钙蛋白I轻度升高在初诊为非ST段抬高型急性冠状动脉综合征患者中的临床意义

目的：探讨血清肌钙蛋白 I（cTnI）轻度升高在初诊为非 ST 段抬高型急性冠状动脉综合征（NSTE-ACS）的患者诊治中的临床意义。方法选取2012年7月至2013年7月于天津医科大学第二医院心脏内科初诊为NSTE-ACS,血清cTnI水平在0.02～1 ng/ml的患者80例,为cTnI轻度升高组;血清cTnI正常的患者60例,为cTnI正常组。所有患者在院期间均行冠状动脉造影术。据冠状动脉造影结果计算Gensini积分评价冠状动脉病变严重程度,分析其与cTnI水平的关系。结果（1）与cTnI正常组相比,cTnI轻度升高组患者肌酸激酶、肌酸激酶同工酶水平更高,病变支数更多,最大病变程度更严重（P＜0.05）;（2）以全部观察对象作为整体,Gensini 积分、病变支数均与cTnI 水平呈正相关（r＝0.365,r＆#39;＝0.343,P＜0.01）;（3）cTnI 轻度升高组患者超声心动图显示室壁节段性运动异常及瓣膜钙化的比例显著高于正常组（P＜0.05）;（4）cTnI轻度升高组的谷草转氨酶及尿素氮均显著高于cTnI正常组（P＜0.05）,而白蛋白和二氧化碳结合力均显著低于cTnI正常组（P＜0.05）。结论对于初诊NSTE-ACS患者,cTnI轻度升高有重要的临床意义,提示冠状动脉病变范围较大、程度较重,且同时合并更复杂的临床情况。     

B型钠尿肽、心肌肌钙蛋白I和高敏C反应蛋白在急性冠状动脉综合征中联合应用的研究

目的 探讨B型钠尿肽(BNP)、心肌肌钙蛋白I (cTnI)、高敏C反应蛋白(hs-CRP)三者的联合应用对于评估急性冠状动脉综合征(ACS)患者不良心血管事件(MACE)发生及预后的价值.方法 检测131例ACS患者血浆BNP、hs-CRP及cTnI水平,并对出院患者随访1年,将其分为MACE发生组[MACE (+)]与未发生组[MACE(-)],观察3项指标与MACE发生的关系.按3项指标不同升高数将患者分为0、1、2和3个指标升高4组,用Kaplan-Meier法做生存曲线分析,以了解指标升高数与生存率的关系.并对患者年龄、性别、左室射血分数(LVEF)、是否吸烟、糖尿病、高血压、高血脂等因素做多因素Cox比例风险回归模型分析.结果 131例ACS患者中,随访1年内MACE (+)患者BNP、hs-CRP水平显著高于MACE(-)的患者(P<0.01);cTnI阳性率在MACE(+)和MACE(-)间无差异.按指标不同升高数分组的4组其生存曲线间生存率的差异有统计学意义(P<0.01).多因素Cox比例风险模型发现LVEF[P=0.004,比值比(OR)=0.939]与hs-CRP(P=0.012,OR=1.026)是患者预后生存的危险因素.结论 BNP、 hs-CRP与ACS患者1年内MACE发生有关,而cTnI阳性率与MACE发生无关.3个指标升高数目不同的4组ACS患者间生存率不同,因此三者联合检测对ACS患者1年内MACE的发生与否及1年内的生存率的评估有更好的预测价值.     

急性冠状动脉综合征患者血栓前体蛋白和心肌肌钙蛋白Ⅰ联合检测的意义

目的:了解血浆血栓前体蛋白和心肌肌钙蛋白I联合检测对急性冠状动脉综合征的临床价值。方法:利用酶联免疫分析法测定58例急性冠状动脉综合征患者,根据临床症状分为不稳定型心绞痛组(UAP组)和急性心肌梗死组(AM I组),并测定胸痛发作6 h内和24 h血浆血栓前体蛋白含量,免疫化学发光法测定其心肌肌钙蛋白I含量,同时检测相关指标CK-M B含量。结果:胸痛发作6 h内血栓前体蛋白AM I组为(11.73±4.38)μg/mL,UAP组为(3.20±2.10)μg/mL,AM I组明显高于UAP组,两组比较差异有统计学意义(P<0.01);心肌肌钙蛋白I:AM I组为(32.7±5.74)μg/L,UAP组为(24.8±2.72)μg/L,AM I组高于UAP组(P<0.05)。24 h时两组心肌肌钙蛋白I含量均持续升高,而血栓前体蛋白已基本趋于正常。结论:血栓前体蛋白可提示急性心肌梗死患者血栓形成于早期阶段,而心肌肌钙蛋白I对急性心肌梗死的诊断具有显著的特异性。两者联合检测可提高早期鉴别诊断的价值。     

肌钙蛋白联合血气分析对肺栓塞诊断及危险分层的探讨

目的:通过联合检测血浆肌钙蛋白I(cTnI)和血气分析,探讨其结果对急性肺栓塞(APE)患者进行诊断及危险分层的意义。方法:根据cTnI水平和血气分析阳性结果将61例APE患者分为3组:A组(12例):cTnI<0.05μg/L且血气分析结果为阴性;B组(27例):cTnI≥0.05μg/L或血气分析结果为阳性;C组(22例):cTnI≥0.05μg/L且血气分析结果为阳性。分析cTnI和血气分析阳性结果与APE患者诊断与危险分层的关系。结果:3组中D-二聚体阳性率C组、B组较A组升高(P<0.05)。其中C组,其右心室扩大及肺动脉高压的发生率明显高于A组(P<0.01),较B组发生率增高,但差异无统计学意义。B组较A组右心室扩大及肺动脉高压的发生率明显增高(P<0.05)。病死率及心源性休克的发生率C组明显高于A组(P<0.01),B组高于A组(P<0.05)。C组大面积APE的发生率较A组、B组明显增高,差异有统计学意义(P<0.01或P<0.05)。结论:联合检测cTnI和血气分析在APE的诊断和分层中具有重要意义。     

心型脂肪酸结合蛋白和缺血修饰白蛋白在肌钙蛋白T未增高的急性冠状动脉综合征患者中联合检测的价值

目的探讨心肌损伤标志物——心型脂肪酸结合蛋白（H-FABP）和心肌缺血标志物——缺血修饰白蛋白（IMA）联合检测能否提高冠状动脉综合征（ACS）的诊断效率。方法测定108例胸痛患者[包括82例ACS患者及26例非缺血性胸痛（NICP）患者]血清IMA及H-FABP水平。血清IMA检测采用白蛋白钴结合（ACB）法,H-FABP采用免疫层析法检测。结果ACS组ACB水平[64（61-67）U/mL]明显低于NICP组[75（71-78）U/mL]（P〈0.05）。通过受试者工作特征（ROC）曲线分析,ACB水平的合适诊断界值为70.5 U/mL。ACB水平〈71.0 U/mL时敏感性和特异性分别为89.0%和80.8%,ROC曲线下面积（AUC）为0.876[95%可信区间（CI）：0.783-0.970],阳性预测值和阴性预测值分别为93.6%和70.0%。H-FABP的诊断敏感性和特异性分别为82.9%[95%C：I 74.8%-91.0%]和80.8%[95%CI：65.7%-95.9%],诊断准确性为82.4%[95%CI：75.2%-89.6%]。IMA与H-FABP联合检测的敏感性及特异性分别为96.3%[95%C：I 96.2%-100%]和80.8%[95%C：I 65.7%-95.9%],诊断的准确性为92.6%[95%C：I 87.7%-97.5%]。与IMA及H-FABP单独检测相比,二者联合检测的敏感性及诊断的准确性明显提高（P〈0.05）,阳性预测值与阴性预测值分别为94.0%和87.5%。结论胸痛发生后联合检测IMA和H-FABP可能提高肌钙蛋白T未增高的ACS患者的诊断效率。     

Comparison of two clinical scoring systems for emergency department risk stratification of suspected acute coronary syndrome

Objective: To compare two methods of risk stratification for suspected acute coronary syndrome (ACS) in the ED. Methods: A prospective observational multicentre study was undertaken of patients undergoing evaluation in the ED for possible ACS. We compared the National Heart Foundation of Australia/Cardiac Society of Australia and New Zealand (NHF/CSANZ) guideline and the Thrombolysis in Myocardial Infarction (TIMI) risk score for differentiating high‐ and low‐risk patients. Composite outcome was all cause death, myocardial infarction or coronary revascularisation within 30 days. Results: Of 1758 enrolments, 223 (13%) reached the study outcome. Area under the receiver operator characteristic (ROC) curve was 0.79 (95% CI 0.76–0.81) for the NHF/CSANZ group and 0.71 (0.68–0.75) for TIMI score based on initial troponin result (P < 0.001), and 0.82 (95% CI 0.80–0.84) and 0.76 (0.73–0.79) respectively when the 8–12 h troponin result is included (P = 0.001). Thirty day event rates were 33% for NHF/CSANZ high‐risk vs 1.5% for combined low/intermediate risk (P < 0.001). For TIMI score, 30 day event rates were 23% for a score ≥2 and 4.8% for TIMI < 2 (P < 0.001). The NHF/CSANZ guideline identified more patients as low risk compared with the TIMI risk score (61% vs 48%, P < 0.001). Conclusions: The NHF/CSANZ guideline is superior to the TIMI risk score for risk stratification of suspected ACS in the ED.     

P-选择素、C-反应蛋白和心肌肌钙蛋白I对急性冠状动脉综合征的预后价值

目的探讨P-选择素、C-反应蛋白(CRP)和心肌肌钙蛋白I(cTnI)对急性冠状动脉综合征(ACS)患者短期预后评估的作用。方法分别测定70例ACS患者入院时外周血的P-选择素、CRP和cTnI水平。随诊1个月,终点为心脏事件。同时测定18例健康成人的P-选择素作对照。结果ACS组的P-选择素水平较对照组明显增高(P<0.01),在70例ACS患者中P-选择素升高27例,CPR升高23例,cTnI升高38例。随诊期共发生心脏事件14例,各因子增高组的心脏事件率均较正常组高(均为P<0.05)。其与ACS预后关系的相对危险度分别是5.74、6.83和3.94(均为P<0.05)。阳性预测值分别是37%、34%和28%。这三种因子的联合试验对心脏事件的阳性预测值是42.9%。结论P-选择素与ACS发生有关;P-选择素、CRP和cTnI分别与ACS短期预后有关,可作为危险分层的指标之一;联合检测意义更大。     

降低低密度脂蛋白水平与急性冠脉综合征预后的关系

目的探讨应用他汀类药物降低低密度胆固醇（LDL—C）与急性冠脉综合征（ACS）患者严重心血管事件发生率的关系。方法115例PCI术后急性冠脉综合征患者,规则服用他汀类和其他药物,根据LDL—C水平分组：2．07～3．36mmol／L为正常组,〈2．07mmol／L为低水平组。然后再将低水平组分为两组：1．55～2．07mmoL／L为较低水平组,〈1．55mmol／L为极低水平组。结果LDL—C低水平组严重心血管事件发生率较正常组低（χ^2=4．68,P〈0．05）,而较低水平组与极低水平组相比,差异无统计学意义（χ^2=0．06,P〉0．05）。结论〈2．07mmol／L的LDL—C低水平对严重心血管事件的发生率无明显影响。