高敏肌钙蛋白Ⅰ对疑诊急性冠状动脉综合征患者短期预后的预测价值  

Predictive value of hs-cTnI for short-term prognosis in patients with suspected acute coronary syndrome

作　　者：龚泽彬 梁岩[1] 蔺亚辉[2] 高东方 杨晴 冯广迅[1] 张涛[1] 朱俊[1] 周洲[2] Gong Zebin;Liang Yan;Lin Yahui;Gao Dongfang;Yang Qing;Feng Guangxun;Zhang Tao;Zhu Jun;Zhou Zhou(Cardiology Emergency and Critical Care Center,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing100037,China)

机构地区：[1]中国医学科学院北京协和医学院、国家心血管病中心阜外医院心内科急重症中心,100037 [2]中国医学科学院北京协和医学院、国家心血管病中心阜外医院实验诊断中心,100037

出　　处：《中华老年心脑血管病杂志》2024年第7期751-754,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的 探讨高敏肌钙蛋白I(hs-cTnI)对急诊就诊的疑诊急性冠状动脉综合征患者预后的预测价值。方法 本研究为一大型、前瞻性的观察性研究,连续入选2017年1月至2020年10月于中国医学科学院阜外医院就诊的怀疑急性冠状动脉综合征患者966例,在就诊时进行基线hs-cTnI检测,同时按常规诊疗流程进行诊治,收集相关数据。采用logistic回归分析hs-TnI浓度预测患者30 d内主要终点事件、次要终点事件发生风险的能力,并进行亚型分析。结果 966例患者中,从胸痛发作至就诊时间5.0(2.5,13.0)h, 30 d发生主要终点事件284例,其中首次就诊心肌梗死283例(99.6%),再发心肌梗死1例(0.4%),心血管死亡5例(1.8%),计划外血运重建1例(0.4%)。当hs-cTnI在最低检测限2 ng/L时,不良事件发生率为5.8%;70 ng/L时,不良事件发生率为49.2%;316 ng/L时,不良事件发生率可达100%。经计算该模型可对92.3%的患者进行正确分类。结论 hs-cTn序列对于中国人群短期内心血管不良事件发生风险有良好的预测作用。Objective To explore the prognostic value of hs-cTnI in patients with suspected acute coronary syndrome(ACS)in emergency department.Methods A large-scale,prospective observational study was conducted on totally 966patients with suspected ACS admitted in Fuwai Hospital from January 2017to October 2020.Their baseline serum/plasma hs-cTnI level was detected at admission,conventional treatment was performed,and relevant data were collected.Logistic regression analysis was used to predict the risk of primary and secondary endpoint events within 30dby hs-TnI concentration,and subgroup analysis was performed.Results Among the 966 patients,the time from chest pain to visit was 5.0(2.5,13.0)h,and 284patients had primary endpoint events within 30d,including 283cases of myocardial infarction(99.6%)at the first visit,1case of recurrent myocardial infarction(0.4%),5cases of cardiovascular death(1.8%),and 1 case of unplanned revascularization(0.4%).When hs-cTnI was at the minimum detection limit of 2ng/L,the incidence of adverse events was 5.8%,when the limit of 70ng/L,the incidence was 49.2%,and when of 316ng/L,the incidence reached 100%.The model could correctly classify 92.3%of the patients.Conclusion The hs-cTn sequence has a good predictive effect for the risk of short-term cardiovascular adverse events in Chinese population.

关 键 词：急性冠状动脉综合征 心肌肌钙蛋白I 预后 预测 LOGISTIC模型 前瞻性研究 

分 类 号：R541.4[医药卫生—心血管疾病]