心肌损伤标志物联合AECC对HHD患者MACE的预测价值研究  

Study on the Predictive Value of Myocardial Injury Markers Combined With AECC for MACE in HHD Patients

作　　者：蔡雪芬 武桂云[1] 周瑜 CAI Xuefen;WU Guiyun;ZHOU Yu(Department of Cardiac Function,the First People's Hospital of Tianmen in Hubei Province,Tianmen Hubei 431700,China)

机构地区：[1]湖北省天门市第一人民医院心功能科,湖北天门431700

出　　处：《中国卫生标准管理》2024年第16期102-105,共4页China Health Standard Management

摘　　要：目的探讨心肌损伤标志物联合动态心电图(ambulatory electrocardiography,AECC)对高血压性心脏病(hypertensive heart disease,HHD)患者主要不良心脏事件(major adverse cardiac events,MACE)的预测价值。方法回顾性分析2020年1月—2023年12月湖北省天门市第一人民医院收治的88例HHD患者为研究对象。按照患者1年内是否发生MACE分为研究组(发生MACE,n=18)与对照组(未发生MACE,n=70)。比较2组AECC结果、心肌损伤标志物水平。绘制受试者工作特征(receiver operating characteristic,ROC)曲线。结果研究组碎裂型波(fragmented QRS complexes,fQRS)发生率为66.67%,高于对照组的24.29%,差异有统计学意义(P<0.05)。研究组微伏级T波电交替(microvolt T-wave alternans,MTWA)、肌酸激酶同工酶(creatine kinase-MB,CK-MB)、心肌肌钙蛋白I(cardiac troponin I,cTnI)和N端脑钠肽前体(N-terminal pro-B-type natriuretic peptide,NT-proBNP)分别为(62.35±6.25)μV、(14.26±1.07)U/L、(101.25±5.36)ng/mL和(4022.35±151.36)pg/mL,均高于对照组的(47.98±4.06)μV、(10.89±0.79)U/L、(75.36±2.16)ng/mL和(3625.35±121.35)pg/mL,差异有统计学意义(P<0.05)。ROC曲线显示,联合预测的ROC曲线下面积最大,AUC=0.933(95%CI 0.879~0.986)。总体模型质量结果分析显示,联合指标的模型值最大为0.88。结论使用AECC对MTWA波和fQRS波的实时监测分析同时联合对NT-proBNP、CK-MB、cTnI 3种标志物的检测在预测HHD患者MACE方面有较高敏感度和实用效能,能够在临床实践中更真实地评测MACE风险程度,能够为临床实践提供重要的参考指导依据。Objective To explore the predictive value of myocardial injury markers combined with dynamic electrocardiography(AECC)for major adverse cardiac events(MACE)in patients with hypertensive heart disease(HHD).Methods A retrospective analysis of 88 HHD patients admitted to the First People's Hospital of Tianmen in Hubei Province from January 2020 to December 2023 was conducted.Patients were grouped according to whether they developed MACE within 1 year,and were divided into study group(with MACE,n=18)and control group(without MACE,n=70).The AECC results and levels of myocardial injury markers between two groups were compared.The receiver operating characteristic(ROC)curve was plotted.Results The incidence of fragmented QRS complexes(fQRS)in the study group was 66.67%,higher than 24.29%in the control group,the difference was statistically significant(P<0.05).The microvolt T-wave alternans(MTWA),creatine kinase-MB(CK-MB),cardiac troponin I(cTnI)and N-terminal pro-B-type natriuretic peptide(NT-proBNP)of the study group were(62.35±6.25)μV,(14.26±1.07)U/L,(101.25±5.36)ng/mL and(4022.35±151.36)pg/mL,respectively.They were higher than(47.98±4.06)μV,(10.89±0.79)U/L,(75.36±2.16)ng/mL and(3625.35±121.35)pg/mL in the control group,and the difference was statistically significant(P<0.05).The ROC curve shows that the area under the joint prediction ROC curve was the largest,with AUC=0.933(95%CI 0.879-0.986).The analysis of the overall model quality results shows that the maximum model value for the joint indicator was 0.88.Conclusion The use of AECC for real-time monitoring and analysis of MTWA and fQRS waves,combined with the detection of NT-proBNP,CKMB,and cTnI biomarkers,has high sensitivity and practical efficacy in predicting MACE in HHD patients.It can more accurately evaluate the risk of MACE in clinical practice and provide important reference and guidance for clinical practice.

关 键 词：心肌损伤标志物 动态心电图 高血压性心脏病 不良心脏事件 预测价值 效能验证 

分 类 号：R541[医药卫生—心血管疾病]