非ST段抬高型急性冠状动脉综合征患者胸痛时间、肌钙蛋白水平及心电图ST段下移的诊断价值

目的:探讨非ST段抬高型急性冠状动脉综合征(ACS)患者胸痛时间、肌钙蛋白水平及心电图ST段下移的临床诊断价值。方法:收集自2008-06—2008-12,在急诊科因急性胸痛拟诊不稳定性心绞痛(UA)及非ST段抬高心肌梗死(NSTEMI)收入院且记录资料完整的54例患者。仔细询问病史、体检,据胸痛持续时间分成3组(0.5h,0.5～2h,≥2h),并完成常规18导联心电图检查,将患者入院时心电图ST段下移幅度分成3组(1mV,1～2mV,≥2mV),同时抽静脉血做肌钙蛋白I(TnI)检测。据TnI水平将患者分成3组(TnI0.02μg/L,0.02μg/L～0.04μg/L,≥0.04μg/L),根据冠状动脉造影结果诊断急性心肌梗死。结果:随着胸痛发生时间延长或肌钙蛋白水平升高,心肌梗死的发病率显著升高。随着ST段下移幅度加深,心肌梗死的发病率没有升高。结论:胸痛时间及TnI水平对非ST段抬高的ACS患者的预测均有重要价值,但心电图的ST段变化对于非ST段抬高的ACS患者的预测价值有待进一步探讨。

The diagnostic value of chest pain duration,ST-segment depression and troponin I in patients with non-ST elevation acute coronary syndromes

Objective：To investigate the diagnostic value of chest pain duration,ST-segment depression and plasma levels of troponin I in patients with non ST elevation acute coronary syndromes（NSTE-ACS）.Method：54 patients diagnosed with NSTE-ACS from June 2008 to December 2008 were enrolled in this study.Details of the history and physical examination were collected,and 18 leads of ECG test was performed on all cases.The patients were divided into 3 groupsaccording to the duration of chest pain（〈0.5 hour,0.5～2 hour,≥2 hour）or ST segment depression（〈1 mV,1～2 mV,≥2 mV）.Meanwhile,the plasma levels of cardiac troponin I（TnI）was determined and the patients were divided into 3 groups according to the levels of TnI（〈0.02 μg/L,0.02 μg/L～0.04 μg/L,≥0.04 μg/L）.Myocardial infarction was diagnosed according to the results of coronary angiography.Results：The incidence of myocardial infarction increased significantly with the prolonged chest pain and elevated level of TnI.The incidence of myocardial infarction was not associated with the depression of ST segment..Conclusion：The durations of chest pain and plasma levels of TnI have a significant valve for predicting the myocardial infarction in patients with NSTEACS.The prognostic value of ST segment depression need to be further explored.