肌钙蛋白I与CRP对经皮冠状动脉介入治疗患者预后评价的价值  

Prognostic value of cardiac troponin I and CRP in patients undergoing percutaneous coronary intervention

作　　者：陈增强[1] 杨德业[2] 程俊彦[3] 余方友[1] 王金果[1] 张海燕[3] 

机构地区：[1]温州医学院附属第一医院实验诊断中心,325000 [2]温州医学院附属第一医院心内科,325000 [3]温州医学院附属第一医院急诊科,325000

出　　处：《中华检验医学杂志》2009年第11期1242-1245,共4页Chinese Journal of Laboratory Medicine

基　　金：温州市科技局资助课题（Y2004A043）

摘　　要：目的探讨肌钙蛋白I（cTnI）和C反应蛋白（CRP）水平在急性冠状动脉综合征（ACS）患者经皮冠状动脉介入干预（PCI）术后危险分层与预后中的价值。方法留取335例ACS患者胸痛症状发作6～10h的PCI术前血标本。化学发光法测定cTnI，免疫法测定CRP，入选患者按cTnI（〈0．1、0．1～0．5、〉0．5仙g／L）和CRP（≤3、〉3mg／L）浓度进行分组。观察ACS患者PCI术后30d心源性死亡和主要心脏不良事件（MACE，包括心源性死亡、非致命性再次心肌梗死、继发心力衰竭及再入院的复合终点）发生率，并随访患者2年内发生的心源性死亡率。结果PCI患者检测数据经多变量logistic回归分析显示，cTnI独立于年龄、性别、高血压、高胆固醇、糖尿病、吸烟等冠心病危险因素，预测ACS患者PCI术后30d心源性死亡率的OR为3．5，95％C12．2～5．3（P〈0．01），再次心肌梗死发生率的OR为1．5，95％CI1．1～2．6（P〈0．05）。CRP独立于各因素，预测近期心源性死亡率的OR为1．6，95％CI 1．1～2．3（P〈0．05），而对再次心肌梗死发生率不具备预测价值。CRP≤3mg／L的PCI患者，不同cTnI浓度组（〈0．1、0．1～0．5、〉0．5μg／L）术后30d的MACE发生率分别为4．3％、11．7％、18．8％（，=4．829，P=0．028）；CRP〉3mg／L的PCI患者，不同cTnI浓度组术后30d的MACE发生率分别为5．5％、13．2％、21．1％（，=5．862，P=0．015）。所有PCI术后患者经2年随访，Kaplan—Meier曲线分析结果显示，不同cTnI浓度组心血管性疾病存活率分别为92．2％、89．1％、80．0％，3组间差异有统计学意义（X^2=7．571，P〈0．05）。结论ACS患者胸痛症状发作6～10h时的cTnI和CRP浓度能够较好地对行PCI治疗患者进行危险分层，且与PCI术后30d的MACE发生率密切相关，cTnI浓度对远期心源性死亡率具有预测价值。cTnI和CRP联合检测，对及时发现高风�Objective This study was designed to evaluate the predictive value of pre-procedure Cardiac troponin I （cTnI） and CRP levels in patients with acute coronary syndrome （ACS） undergoing percutaneous coronary intervention （PCI）. Methods cTnI and CRP were determined on admission in 335 consecutive patients with ACS who underwent primary PCI. Blood samples were obtained within 6-10 h after onset of symptom. The concentration of eTnI was determined by an automated chemiluminescence immunoassay, CRP was measured by immunoassay assay. According to the admission cTnI （ 〈 0. 1,0. 1- 0. 5, 〉0. 5 μg/L） and CRP （ ≤3, 〉 3 mg/L） divided into different groups. The pre-procedure eTnI and CRP status associated with 30 days cardiac mortality and major adverse cardiac events （MACE, including cardiac death, non-fatal recurrent MI, heart failure, readmission for any reason） were analyzed. The cardiac mortality at follow-up period of 2 years were analyzed. Results Multivariate logistic regression analyses revealed preoperative cTnI predicted 30 days cardiac mortality（ OR = 3.5, 95% CI 2.2-5.3, P 〈 0. 01 ） ,and recurrent MI rate （OR = 1.5, 95% CI 1.1-2. 6, P 〈 0.05）, independent of other known prognostic factors such as age, gender, hypertension, Hypercholesterolemia, diabetes and smoking. The pre-procedure CRP was independently related to 30 days cardiac mortality （ OR = 1.6, 95% CI 1.1-2. 3, P 〈 0. 05 ）, whereas there was no relationship to the MI rate. In ACS, levels of CRP ≤3 mg/L, the three different risk groups （cTnI 〈0. 1, 0. 1-0. 5, 〉 0. 5 μg/L ） with corresponding 30 days MACE rates of 4. 3%, 11.7%, 18.8% （X^2 = 4. 829, P = 0. 028 ）, CRP 〉 3 mg/L, the three groups with corresponding 30 days MACE rates of 5.5% ,13.2% ,21.1% （X^2 = 5. 862, P = 0. 015 ）, respectively. Patients were followed up for 2 years, Kaplan-Meier survival analysis demonstrated a significantly reduced survival at 2 years in patients with a cTnI 〉0. 5 μg/L （80. 0% versus 89. 1% for a

关 键 词：肌钙蛋白I C-反应蛋白 经皮冠状动脉介入干预 

分 类 号：R686[医药卫生—骨科学]