肌钙蛋白I峰值预测心肌梗死后心力衰竭的研究  

Study on Using Troponin I Peak Value to Predict Heart Failure after Acute Myocardial Infarction

作　　者：刘锐锋 高翔宇[1] 范继红 赵慧强[1] LIU Ruifeng;GAO Xiangyu;FAN Jihong(Department of Cardiology,Beijing Friendship Hospital Affiliated to Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院心内科,100050

出　　处：《医学研究杂志》2025年第1期122-128,共7页Journal of Medical Research

基　　金：首都医科大学附属北京友谊医院院启动项目(ZX2020-2)。

摘　　要：目的 本研究旨在探讨入院时肌钙蛋白I (troponin I,TnI)峰值水平对急性心肌梗死(acute myocardial infarction,AMI)患者恢复期左心室射血分数(left ventricular ejection fraction,LVEF)是否小于50%的预测价值。方法 回顾性分析北京友谊医院2018年1月~2023年12月收治的220例AMI患者。将患者按照TnI峰值三分位数分为3组,比较基线资料,随后通过纳入不同的混杂因素构建3个逐步复杂的回归模型,评估TnI与恢复期LVEF<50%的关系,并通过限制性立方样条和平滑曲线分析确定最佳截断值。此外,还进行了亚组分析,探讨TnI的预测价值在不同人群中的差异。结果 TnI峰值水平与急诊经皮冠状动脉介入治疗比例、中性粒细胞与淋巴细胞比值、白细胞计数、中性粒细胞、主动脉内球囊反搏使用情况、N末端前体脑钠肽峰值等指标显著相关(P<0.05);3个模型均显示TnI峰值水平升高与LVEF<50%的风险增加显著相关(P<0.05);限制性立方样条和平滑曲线分析确定了TnI峰值和LVEF值为线性关系,TnI峰值的最佳截断值在3个模型中均为29.80ng/mL;亚组分析显示,TnI峰值对LVEF<50%的预测价值在男性、高BMI、高血压、高BMI、急性介入治疗,以及不同年龄、是否糖尿病、是否吸烟、是否饮酒等亚组中存在差异。结论 入院时TnI峰值水平超过29.80ng/ml是预测AMI患者恢复期LVEF<50%的独立危险因素,可用于识别心力衰竭的高危人群,为行早期积极干预提供依据。Objective To explore the predictive value of troponin I(TnI) peak value upon admission for predicting left ventricular ejection fraction(LVEF) <50% in patients with acute myocardial infarction(AMI) during the recovery period.Methods A retrospective analysis was carried out on 220 AMI patients admitted to Beijing Friendship Hospital from 2018 to the present.The patients were divided into three groups based on the peak value of TnI during their stay in hospital,and the baseline data were compared.Subsequently,three progressively complex regression models were constructed to evaluate the relationship between TnI and LVEF<50%.The optimal cutoff value was determined through restricted cubic spline and smooth curve analysis.Additionally,subgroup analysis was carried out to explore differences in the predictive value of TnI in different populations.Results TnI peak value was significantly associated(P<0.05) with the ratio of emergency percutaneous coronary intervention(PCI),neutrophil-to-lymphocyte ratio,white blood cell count,neutrophils,intra-aortic balloon pump usage,N-terminal pro-brain natriuretic peptide peak value,and so on.All three models showed a significant increase in the risk of LVEF<50% with higher TnI peak value(P<0.05).Restricted cubic spline and smooth curve analysis revealed a linear relationship between TnI peak value and LVEF values,with the optimal cutoff value for TnI peak value consistently at 29.80ng/ml across the three models.Subgroup analysis showed that the predictive value of peak TnI for LVEF<50% demonstrated statistically significant differences across the following subgroups:male patients,those with high BMI,hypertension,acute interventional treatment,as well as different age groups,and whether patients had diabetes,smoked,or consumed alcohol.Conclusion An admission TnI peak value exceeding 29.80ng/ml is an independent risk factor for predicting LVEF<50% during the recovery period in AMI patients.It can be used to identify high-risk individuals and provide a basis for early aggressive inte

关 键 词：急性心肌梗死 肌钙蛋白I 左心室射血分数 预测价值 风险分层 

分 类 号：R54[医药卫生—心血管疾病]