GRACE评分及血清CKMB、CTnI、Mb在急诊胸痛患者急诊科危险分层及短期预后评估中的应用  

Application of GRACE score and serum CKMB,CTnI,and Mb in risk stratification and short-term prognosis assessment of patients with chest pain in the emergency department

作　　者：魏茜 王嘉川 方凯 WEI Qian;WANG Jiachuan;FANG Kai(Department of Emergency Medicine,the Second Affiliated Hospital of Chengdu Medical College-Nuclear Industry 416 Hospital,Chengdu Sichuan 610000,China)

机构地区：[1]成都医学院第二附属医院·核工业四一六医院急诊科,四川成都610000 [2]成都医学院第二附属医院·核工业四一六医院感染科,四川成都610000

出　　处：《中国急救复苏与灾害医学杂志》2024年第5期648-652,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：2017年四川省卫生和计划生育科研课题(编号:17PJ026)。

摘　　要：目的探讨全球急性冠状动脉事件注册(GRACE)评分及血清肌酸激酶同工酶(CKMB)、肌钙蛋白I(CTnI)、肌红蛋白(Mb)在急诊胸痛患者急诊科危险分层及短期预后评估的应用价值。方法回顾性收集2020年8月—2023年8月成都医学院第二附属医院收治的110例急诊胸痛患者的临床资料。根据30 d内是否发生主要心血管不良事件(MACE)进行分组,MACE组(21例)和非MACE组(89例)。比较两组患者GRACE评分及CKMB、CTnI、Mb水平,分析GRACE评分及CKMB、CTnI、Mb水平与急诊胸痛患者发生MACE的关系及预测效能。结果高危患者为23例(20.91%),中危患者为48例(43.64%),低危患者为39例(35.45%)。不同危险分层患者CKMB、CTnI和Mb水平存在显著差异,高危组高于中危组,中危组高于低危组,且差异均有统计学意义(P<0.05)。MACE组患者GRACE评分、CKMB水平显著高于非MACE组(P<0.05)。logistic回归分析结果显示,GRACE评分增大、CKMB水平升高是急性胸痛患者发生MACE的独立危险因素(P<0.05)。Pearson法分析结果显示,GRACE评分、CKMB水平与急性胸痛患者发生MACE呈明显正相关(P<0.05)。GRACE评分、CKMB水平预测急性胸痛患者发生MACE的曲线下面积(AUC)分别为0.777、0.862,联合预测因子AUC为0.950,敏感度为80.95%,特异度为95.51%,联合预测因子AUC显著高于单独指标(Z=4.169、7.269,P<0.001、<0.001)。结论GRACE评分及血清中CKMB、CTnI、Mb可用于急诊胸痛患者危险分层。GRACE评分、CKMB水平与急诊胸痛患者发生MACE密切相关,可用于评估其短期预后,二者联合可提高预测效能。Objective To study the application value of the global registry of acute coronary events(GRACE)score and serum creatine kinase isoenzyme(CKMB),troponin I(CTnI)and myoglobin(Mb)in risk stratification of emergency room(ER)and short-term prognosis assessment of patients with chest pain.Methods A retrospective analysis was conducted on 110 patients with chest pain who admitted to the ER of the second affiliated hospital of Chengdu medical college-nuclear industry 416 hospital from August 2020 to August 2023.All patients were divided into MACE group(21 cases)and the non-MACE group(89 cases)according to the presence or absence of major adverse cardiovascular event(MACE)within 30 days.The GRACE scores and the levels of CKMB,CTnI and Mb were compared between the two groups.The predictive efficacy of the GRACE score and the levels of CKMB,CTnI and Mb for the occurrence of MACE in patients with chest pain was analyzed.Results There were 23 patients(20.91%)with GRACE scores>140;48 patients(43.64%)with GRACE scores between 109 and 140;and 39 patients(35.45%)with GRACE scores≤108.There were significant differences in the levels of CKMB,CTnI and Mb among the three different GRACE score groups(P<0.05).There were significant differences in the levels of CKMB,CTnI and Mb among the three different GRACE score groups(P<0.05).The GRACE score and CKMB level in the MACE group were significantly higher than those in the non-MACE group(P<0.05).Logistic regression analysis showed that increased GRACE score and elevated CKMB level were independent risk factors for MACE in patients with acute chest pain(P<0.05).Pearson analysis showed that the GRACE score and CK-MB level were positively correlated with the occurrence of MACE in patients with acute chest pain(P<0.05)The area under curve(AUC)values of the GRACE score and CKMB level for predicting MACE in patients with acute chest pain were 0.777 and 0.862.The AUC,sensitivity and specificity of joint prediction were 0.950,80.95%and 95.51%.The AUC of joint prediction was significantly larger

关 键 词：全球急性冠状动脉事件注册评分 肌酸激酶同功酶 肌钙蛋白I 肌红蛋白 急诊胸痛 危险分层 预后评估 

分 类 号：R56[医药卫生—呼吸系统]