择期冠状动脉介入治疗后CTnI与GLS、QTd的关系  

Correlation of troponin I with QT dispersion and left ventricular long-axis strain after elective percutaneous coronary intervention

作　　者：楼玉美[1] 葛晓颖 郑哲岚[3] LOU Yumei;GE Xiaoying;ZHENG Zhelan(Department of Cardiovascular Medicine,Li Huili Hospital of Ningbo Medical Center,Ningbo315000,China;Department of Cardiovascular Ultrasound,Li Huili Hospital of Ningbo Medical Center,Ningbo315000,China;Cardiovascular Ultrasound Center,the First Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou310003,China)

机构地区：[1]宁波市医疗中心李惠利医院心血管内科,浙江宁波315000 [2]宁波市医疗中心李惠利医院心血管超声科,浙江宁波315000 [3]浙江大学医学院附属第一医院心血管超声中心,浙江杭州310003

出　　处：《中国现代医生》2022年第7期13-16,共4页China Modern Doctor

基　　金：浙江省医院可持续发展扬子江研究项目(2020-ZHA-YZJ102);浙江省自然科学基金项目(2017A610203)。

摘　　要：目的探讨老年患者行择期冠状动脉介入治疗(PCI)后肌钙蛋白I(CTnI)与QT离散度(QTd)、左室长轴应变(GLS)的关系。方法选取2018年3月至2019年7月入住宁波市某公立三甲综合医院心血管内科且年龄≥60岁的冠心病患者为研究对象,检测PCI前后患者肌钙蛋白I(术前1 d及术后24 h)、QTd及GLS(均为术前及术后4个周)。根据PCI术后CTnI数值,分为两组:CTnI(+)组(n=26)及CTnI(-)组(n=104)。同时测定PCI前、后两组的QTd、GLS,分析两组PCI前后QTd、GLS的变化。结果CTnI(+)组手术前后QTd分别为(52.3±16.2)ms和(46.1±12.5)ms,组内比较,差异有统计学意义(P<0.01);CTnI(-)组手术前后的QTd分别为(53.5±15.9)ms和(41.3±12.9)ms,组内比较,差异有统计学意义(P<0.001),组间比较,差异有统计学意义(P<0.05)。CTnI(+)组PCI术前、后GLS分别为(-18.42±2.21)%和(-20.37±2.67)%,CTnI(-)组PCI术前、后GLS分别为(-19.38±2.88)%和(-22.21±2.63)%,PCI后组间比较,差异有统计学意义(P<0.05)。结论老年患者择期冠状动脉介入治疗(PCI)后出现CTnI阳性者,其QTd缩短幅度变小,GLS改善幅度较小,表明其存在亚临床心功能受损,提示可能增加患者择期冠状动脉介入治疗术后主要心脏不良事件发生。Objective To investigate the correlation of troponin I(CTnI)with QT dispersion(QTd)and left ventricular long-axis strain(global longitudinal strain,GLS)after elective percutaneous coronary intervention(PCI)in elderly patients.Methods Patients with coronary artery disease who were admitted to the department of cardiovascular medicine at a public tertiary general hospital in Ningbo from March 2018 to July 2019 and aged≥60 years were selected as study subjects.The CTnI levels(at 1 day before and 24 h after the surgery),QTd and GLS values(both before and at four weeks after the surgery)in patients before and after PCI were detected.These patients were divided into the CTnI(+)group(n=26)and the CTnI(-)group(n=104)according to the CTnI values after PCI.The QTd and GLS values of the two groups before and after PCI were also measured,and the changes of QTd and GLS values in the two groups before and after PCI were analyzed.Results The QTd values before and after PCI in the CTnI(+)group were(52.3±16.2)ms and(46.1±12.5)ms,respectively(P<0.01),while those in the CTnI(-)group were(53.5±15.9)ms and(41.3±12.9)ms,respectively(P<0.001),and there was a statistically significant difference between the two groups in QTd values after PCI(P<0.05).The GLS(%)before and after PCI in the CTnI(+)group were(-18.42±2.21)and(-20.37±2.67),respectively(P<0.01),while those in the CTnI(-)group were(-19.38±2.88)and(-22.21±2.63),respectively(P<0.01),and there was a statistically significant difference between the two groups in GLS(%)after PCI(P<0.05).Conclusion Smaller QTd shortening degree and less improvement in GLS are found in elderly patients who developed positive CTnI after elective PCI,indicating the presence of subclinical cardiac impairment,which suggests a possible increase in the occurrence of major adverse cardiac events(MACE)in such patients after PCI.

关 键 词：老年 肌钙蛋白 冠状动脉疾病 支架 QT离散度 左心室整体纵向应变 

分 类 号：R541.4[医药卫生—心血管疾病]