肌钙蛋白及心电图对非ST段抬高急性冠脉综合征患者预后预测的意义

目的评估肌钙蛋白测定及心电图变化对非ST段抬高急性冠脉综合征患者预后预测的价值。方法收集资料完整的非ST段抬高的急性冠状动脉综合征患者238例,入院后即刻行12导联心电图检查及抽取静脉血做血清肌钙蛋白Ⅰ(TnⅠ)检测,并根据心电图变化及TnⅠ水平分组,观察各组住院期间主要心血管事件,并随访1个月￣6个月。结果ST段压低组的反复心绞痛发作及复合心血管事件较正常心电图组明显增多。所有非ST段抬高心肌梗死及31.9%不稳定性心绞痛患者的TnⅠ阳性,TnⅠ阳性组有明确冠心病诊断者较TnⅠ阴性组多,非致命性心肌梗死发生率增高,反复心绞痛发作增加,心血管事件增多。对复合心血管事件的预测,TnⅠ阳性因素较ST段压低因素的敏感性高(P<0.01)。多因素Logistic回归分析显示,TnⅠ阳性较ST段压低因素对患者复合心血管事件有较高的独立预测价值。结论肌钙蛋白测定及心电图变化对非ST段抬高的急性冠脉综合征患者预后预测具有重要意义,而且TnⅠ阳性因素可能具有更高的独立预测性。

The predicting value of troponin Ⅰ and ECG on prognosis of patients with non-ST elevation coronary syndrome

Objective To evaluate the predicting value of troponin I(TnI)and ECG on prognosis in patients with non-ST elevation coronary syndrome(ACS).Metheds 238 patients were admitted to hospital with the diagnosis of unstable angina pectoris or non-ST elevation myocardial infarction.12 leads of ECG test after admission. All patients were divided by the results of ECG and plasma levels of TnI. The major adverse cardiovascular events(MACE),including cardiac death,nonfatal myocardial infarction and recurrent ischemia angina, were analyzed in each group in hospital and follow-up period. Results The incidences of recurrent angina and combined cardiovascular events increased significantly in ST depression group than in normal ECG group. 31.9% patients with unstable angina pectoris and all patients with non-ST elevation myocardial infarction showed TnI-positive.The proportion of documented coronary disease was higher in TnI-positive group than in TnI-negative group.Total cardial mortality and combined cardiovascular events were higher in TnI-positive group. TnI-positive had a higher sensitivity and increased negative predicting value than ST depression.Multivariable logistic regression analysis revealed that TnI-positive was of higher independently prediction value for combined cardiovascular events at follow-up than ST depression.Conclusion ECG and TnI level play a important role on prediction of cardiovascular events in patients with non-ST elevation ACS,but TnI level may demanstrate a more strong pronostic discriminatory capacity.