肌钙蛋白峰值与急性心肌梗死患者早期预后的关系探讨

目的 探讨急性心肌梗死( AMI)患者肌钙蛋白I(cTnI)峰值与早期预后的相关性.方法 收集2008年1月至2010年12月本院住院AMI患者162例的临床资料进行回顾性分析.根据cTnI峰值水平将患者分为A(cTnI ＜6 μg/L)、B( cTnI 6～60μg/L)、C(cTnI＞ 60 μg/L)3组,分别为48、96、18例.分析不同cTnI峰值水平与左心室射血分数(LVEF)、心源性休克发生率、新发心力衰竭发生率和院内死亡率之间的相关性.结果 A、B、C组cTnI峰值及LVEF分别为(2.4±1.6) μg/L、(55.5±4.3)％,(22.8士14.2)μg/L、(52.8±4.7)％,( 157.4±115.9) μg/L、(45.2±5.2)％.A组cTnI峰值最低,而LVEF值最高；C组cTnI峰值最高,而LVEF值则最低.A组与B组LVEF差异无统计学意义(P＞0.05),而C组与A组或B组差异均有统计学意义(P＜0.05).A组无死亡病例,心源性休克及新发心力衰竭的发生率最低分别为2.1％(1/48)、6.2％ (3/48)],B组院内死亡率为4.2％(4/96),心源性休克及新发心力衰竭的发生率分别是7.3％(7/96)和18.7％(18/96),与A组相比,差异均无统计学意义(P＞0.05).C组院内死亡率达27.8％(5/18),心源性休克发生率38.9％(7/18),新发心力衰竭发生率为55.6％ (10/18).C组与A组及B组比较,差异均有统计学意义(P＜0.05).结论 cTnI峰值与AMI的早期预后密切相关,cTnI峰值越高其早期预后越差,LVEF越低,新发心力衰竭、心源性休克发生率及院内死亡率越高.

Relationship of cardiac troponin I peak and short-term prognosis of acute myocardial infarction patients

Objective To observe the influence of cardiac troponin I (cTnI) peak on the patients with acute myocardial infarction(AMI) on the short-term prognosis and to investigate the relationship between different peak levels and prognosis.Methods According to cTnI peak level,162 cases of patients with AMI divided into 3 groups:Group A (cTnI ＜6 μg/L),Group B (cTnI 6 ～60 μg/L) and Group C (cTnI ＞60 μg/L).The relationship between different cTnI peak levels and left ventricular ejection fraction (LVEF),heart failure,heart source shock,rate of cardiac death were compared.Results Group A had no deaths,the rates of heart source shock and newly heart failure were the lowest.Mortality of group B was 4.16％,the rates of heart source shock and newly heart failure were respectively 7.29％ and 18.87％.In group C mortality was 27.77％,and the rate of heart source shock was 38.89％.The new heart failure rate was 55.56％,higher than group A and B.Conclusions The cTnI peak level is closely related to the short-term prognosis of AMI.The higher the cTnI peak level is,the worse the short-term prognosis is.Furthermore the lower the LVEF is,the higher incidence of heart failure,heart source shock and death there is.