经压力导丝指导冠状动脉临界病变PCI患者超敏肌钙蛋白测定价值  

Detective value of high sensitive cardiac troponin T in patients with coronary borderline lesion during percutaneous coronary intervention under pressure wire guide

作　　者：张晶[1] 何胜虎[1] 徐日新[1] 陈述[1] 谢勇[1] 刘晓东[1] 纪军[1] 廖清池[1] 徐冰[1] 王雪飞[1] 孔令才[1] 

机构地区：[1]江苏省苏北人民医院心内科,扬州225000

出　　处：《中国循证心血管医学杂志》2015年第6期770-772,共3页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的 探讨经压力导丝指导冠状动脉临界病变PCI患者超敏肌钙蛋白（hs-cTnT）测定价值。方法 选择2012年1月-2014年6月于江苏省苏北人民医院心内科资料完整的冠心病患者86例（其中包括稳定型心绞痛32例,不稳定型心绞痛54例）,术前检测hs-cTnT,经冠状动脉造影检查明确至少有1支冠状动脉狭窄程度在40%-70%,所有患者皆行压力导丝检测血流储备分数（FFR）。根据FFR值将患者分为对照组和PCI组。对照组：FFR〉0.75,药物保守治疗;PCI组：对FFR〈0.75,行PCI治疗,其中PCI组根据hs-cTnT值又分为hs-cTnT升高组（≥0.034 ng/ml）和hs-cTnT正常组（〈0.034 ng/ml）。计数PCI组中血管病变数及支架数,比较三组患者住院和随访期间发生心绞痛、非致死性心肌梗死、心源性猝死及靶血管重建等主要心脏事件（MACE）的发生率。结果 与hs-cTnT正常PCI组比较,hs-cTnT升高PCI组在冠状动脉双支或三支病变血管数（46.90%vs.33.30%）、人均支架置入数（1.8 vs.1.1）均增高（P〈0.05）。hs-cTnT升高（0.526±0.088 ng/m L）PCI组心血管事件发生率显著高于hs-cTnT正常PCI组和对照组（P〈0.05）;而hs-cTnT正常（0.019±0.011 ng/m L）PCI组与对照组比较差别无显著意义。结论 hscTnT检测联合FFR检查可以指导冠状动脉临界病变介入治疗,且可预测患者心血管事件发生率。Objective To investigate the detective value of high sensitive cardiac troponin T（hs-cTnT） in patients with coronary borderline lesion during percutaneous coronary intervention（PCI） under pressure wire guide. Methods The patients with coronary heart disease（CHD, n=86） were chosen from Jan. 2012 to Jun. 2014 [including 32 with stable angina pectoris（SAP） and 54 unstable angina pectoris（UAP）]. All patients were given detection of hs-cTnT and coronary angiography（CAG） for diagnosing with at least 1 coronary artery stenosis（from 40% to 70%） before PCI, and then given pressure wire for detecting fractional flow reserve（FFR）. The patients were divided into control group（FFR0.75 and treated with conservative drug therapy） and PCI group（FFR0.75 and treated with PCI） according to FFR values. PCI group was divided again into higher hs-cTnT group（≥0.034 ng/m L） and normal hscTnT group（0.034 ng/m L）. The numbers of disease vessels and stents were counted in PCI group, and incidence of major adverse cardiac events（MACE） including angina pectoris（AP）, nonfatal myocardial infarction（MI）, sudden cardiac death and target vessel revascularization（TVR） were compared in 3 groups during hospitalization and followup period. Results Compared with normal hs-cTnT group, the number of disease coronary arteries（46.90% vs. 33.30%） and average stenting number（1.8 vs. 1.1） increased in higher hs-cTnT group（P〈0.05）. The incidence of MACE was significantly higher in higher hs-cTnT group（0.526±0.088 ng/m L） than that in normal hs-cTnT group and control group（P〈0.05）, while the comparison between normal hs-cTnT group（0.019±0.011 ng/m L） and control group had no significant difference. Conclusion The detection of hs-cTnT combining FFR can direct the treatment of coronary borderline lesion during PCI, and predict the incidence of MACE.

关 键 词：血流储备分数 超敏肌钙蛋白 冠状动脉临界病变 心脏不良事件 

分 类 号：R816.21[医药卫生—放射医学]