急诊科首次肌钙蛋白I联合GRACE评分对急性心肌梗死的预测价值分析  

Analysis of the predictive value of emergency department's first detection of cardiac troponin I combined with GRACE score in acute myocardial infarction

作　　者：张玲玲 ZHANG Ling-ling(Emergency Department,The 73rd Group Military Hospital of the Chinese People's Liberation Army,Xiamen 361000,China)

机构地区：[1]中国人民解放军陆军第七十三集团军医院急诊科,361000

出　　处：《中国现代药物应用》2025年第4期74-77,共4页Chinese Journal of Modern Drug Application

摘　　要：目的分析急诊科首次心肌肌钙蛋白I(cTnI)联合全球急性冠状动脉事件注册(GRACE)评分对急性心肌梗死(AMI)的预测价值。方法以胸痛为主诉的就诊患者132例,其中58例患者最终确诊AMI,其余74例为非AMI。比较AMI患者与非AMI患者的年龄、性别、体质量指数(BMI)、胸痛发作至入院就诊时间、吸烟史、高血压史、糖尿病史、血浆cTnI水平、GRACE评分,采用Logistic回归筛选AMI预测指标,采用受试者工作曲线(ROC曲线)分析预测效能。结果AMI组高血压史占比74.1%、GRACE评分(141.6±32.0)分、血浆cTnI(3.0±1.6)ng/ml均高于非AMI患者的35.1%、(101.6±30.4)分、(1.0±0.5)ng/ml,有统计学差异(P<0.05)。Logistic回归分析显示,高血压史、GRACE评分、血浆cTnI是AMI早期预测的影响因素(P<0.05)。ROC曲线分析结果显示,GRACE评分预测AMI的曲线下面积(AUC)=0.816[95%CI=(0.744,0.887)],截断值(cut-off值)为127分,取cut-off值时敏感度与特异度分别为0.690、0.811,约登指数为0.501。cTnI预测AMI的AUC=0.871[95%CI=(0.800,0.942)],cut-off值为1.84 ng/ml,取cut-off值时敏感度与特异度分别为0.724、0.973,约登指数为0.697。GRACE评分与cTnI联合预测AMI的AUC=0.944[95%CI=(0.909,0.979)],cut-off值分别为121分、1.50 ng/ml,取cut-off值时敏感度与特异度分别为0.845、0.892,约登指数为0.737。结论cTnI联合GRACE评分对AMI早期预测具备较高的临床价值,急诊科首次cTnI联合GRACE评分预测AMI的效能满意,显著优于单独指标预测,具备较高的推广应用价值。Objective To analyze the predictive value of emergency department's first detection of cardiac troponin I(cTnI)combined with global registry of acute coronary events(GRACE)score in acute myocardial infarction.Methods There were 132 patients with the main complaint of chest pain,of whom 58 patients were finally diagnosed with AMI and the remaining 74 patients with non-AMI.The general and clinical data of the two groups of patients were compared.Logistic regression was used to screen for predictive indicators of AMI,and receiver operating characteristic(ROC)curve was used to analyze the predictive performance.Age,gender,body mass index(BMI),time from onset of chest pain to hospital admission,smoking history,hypertension history,diabetes history,plasma cTnI level and GRACE score were compared between AMI patients and non-AMI patients.The predictive indicators of AMI were screened by Logistic regression,and the predictive efficacy was analyzed by ROC curve.Results In AMI group,hypertension history accounted for 74.1%,GRACE score was(141.6±32.0)points and plasma cTnI was(3.0±1.6)ng/ml,which were higher than 35.1%,(101.6±30.4)points and(1.0±0.5)ng/ml in non-AMI patients;there was statistical difference(P<0.05).Logistic regression analysis showed that hypertension history,GRACE score and plasma cTnI were influencing factors for the early prediction of AMI(P<0.05).ROC curve analysis showed that the GRACE score predicted AMI with an AUC=0.816[95%CI=(0.744,0.887)],a cut-off value of 127 points,and a sensitivity and specificity of 0.690 and 0.811,a Youden's index of 0.501 when taking the cut-off value;cTnI predicted AMI with an AUC=0.871[95%CI=(0.800,0.942)],a cut-off value of 1.84 ng/ml,and a sensitivity and specificity of 0.724 and 0.973,a Yoden's index of 0.697 when taking the cut-off value;GRACE score combined with cTnI predicted AMI with an area under the curve(AUC)=0.944[95%CI=(0.909,0.979)],a cut-off value of 121 points and 1.50 ng/ml,and a sensitivity and specificity of 0.845 and 0.892,a Youden's index of 0.737

关 键 词：急性心肌梗死 急诊科 全球急性冠状动脉事件注册评分 心肌肌钙蛋白Ⅰ 

分 类 号：R542.22[医药卫生—心血管疾病]