摘要
目的探讨以肌钙蛋白I(cardiac troponin I,cTnI)为基础诊断的非ST段抬高心肌梗死(non-STsegment elevation acute myocardial infarction,NSTEMI)患者,依据肌酸激酶同工酶(CK-MB)对其进行危险评估和住院期间主要心血管不良事件(major adverse cardiovascular events,MACE)的预测价值。方法连续筛选就诊于我院发病48小时内以cTnI为基础诊断的NSTEMI患者,根据CK-MB水平分为:CK-MB升高组,定义为两次CK-MB检测(时间间隔6~12小时)结果中数值均CK-MB≥16U/L;CK-MB正常组,则定义为两次结果中数值较高的CK-MB<16U/L,对比分析冠状动脉造影结果以及TIMI、M-TIMI积分对于预测住院期间MACE的准确性。结果对比CK-MB正常组,CK-MB升高组入院期间外周血炎症指标(白细胞、中性粒细胞百分比、高敏C-反应蛋白)水平较高(P<0.05);且罪犯病变程度更为严重(P<0.05);同时CK-MB升高组的心功能较差(P<0.05);且MACE(急性心力衰竭、心源性死亡)发生率较高(P<0.05);此外,在TIMI、M-TIMI积分系统预测住院期间MACE准确性的ROC曲线分析中,M-TIMI积分系统较TIMI积分系统更能准确预测住院期间MACE的发生。结论 CK-MB升高的NSTEMI患者住院期间MACE发生率更高。M-TIMI积分对于NSTEMI患者的风险评估较传统的TIMI积分更为准确。
Objective To investigate the prediction value of CK-MB stratification in in-hospital major adverse cardiovascular events（MACE）among patients with non-ST-segment-elevation myocardial infarction（NSTEMI）,whose diagnosis standard was determined by cardiac troponin I.Methods The study enrolled consecutively NSTEMI patients diagnosed by cardiac troponin I within 48 hours from the onset.According to CK-MB level,the objects were divided into CK-MB elevated group and CK-MB normal group.CK-MB elevated group was defined as the higher one in two CK-MB detection results（the time interval of 6to 12hours）was more than 16U/L.Moreover,CK-MB normal group was defined as the higher one was below 16U/L.The value of TIMI scores and the modified TIMI（M-TIMI）scores in prediction of in-hospital MACE coronary artery angiography results and clinical indexes were compared between two groups.The M-TIMI scores were defined as adding CK-MB to the TIMI score and giving elevated CK-MB level（≥16U/L）1point.Results Compared with CK-MB normal group,the inflammatory indicators（white blood cells,neutrophilic granulocyte percentage,hs-CRP）,renal function（blood urea nitrogen）were higher in CK-MB elevated group during hospitalization（P〈0.05）.In addition,the criminal lesion in CK-MB elevated group was more serious than the CK-MB normal group（P〈0.05）.And the circumstance of heart function in CK-MB elevated group was lower（P〈0.05）.Furthermore,the proportion of major adverse cardiovascular events（cardiac death、acute heart failure）was higher in elevated group（P〈0.05）.Meanwhile,the ROC curve analysis showed that,compared with TIMI scores,M-TIMI scores was a better predictor of in-hospital MACE in patients with NSTEMI.ConclusionNSTEMI patients with elevated CK-MB had higher in-hospital MACE rate.Moreover,after CK-MB participating in the risk stratification score system,it is more accurate to assess risk stratification among patients with NSTEMI.
出处
《临床荟萃》
CAS
2017年第1期54-58,共5页
Clinical Focus
