心电图变化及肌钙蛋白水平对无ST段抬高的急性冠状动脉综合征患者的危险分层与预后预测的价值  

The predicting value of electrocardiography deviation and plasma levels of troponin on risk stratification and prognosis in patients with non-ST elevation acute coronary syndrome

作　　者：赵明中[1] 胡大一[1] 许玉韵[2] 马志敏[3] 刘如辉[1] 

机构地区：[1]北京大学人民医院心内科,100044 [2]北京大学第一医院心内科 [3]首都医科大学北京同仁医院心血管病诊疗中心

出　　处：《中华心血管病杂志》2003年第8期568-572,共5页Chinese Journal of Cardiology

基　　金：北京市科技项目基金资助 (H 0 1 0 2 1 0 330 1 1 3)

摘　　要：目的　探讨心电图变化及肌钙蛋白水平对无ST段抬高的急性冠状动脉综合征患者的危险分层与预后预测的价值。方法　自 2 0 0 0年 7月～ 2 0 0 1年 6月 ,在急诊室因急性胸痛拟诊不稳定性心绞痛及无ST段抬高心肌梗死而收入住院且记录资料完整的连续 2 56例患者。入急诊室后仔细询问病史、查体 ,并在 10min内完成常规 18导联心电图检查 ,将患者入院时心电图的改变分为ST段压低组 (包括伴有T波倒置者 )、单纯T波倒置组、尚不能诊断的心电图组及正常心电图组 ,同时床旁抽静脉血做肌钙蛋白I(TnI)检测。并据TnI水平将患者分成TnI阳性组 (TnI定量检测≥ 0 1μg/L)和TnI阴性组 (TnI <0 1μg/L )。观察各组住院期主要心血管事件 (心脏性死亡、非致命性心肌梗死、反复缺血性心绞痛发作 ) ,并随访 1～ 12 (7 2± 3 8)个月主要心血管事件变化。结果　与正常心电图组比较 ,ST段压低组的反复心绞痛发作及复合心血管事件明显增多。 3 2 1%的不稳定性心绞痛及所有无ST段抬高心肌梗死患者的TnI阳性 ,TnI阳性组有明确冠心病诊断者较TnI阴性组多 ,TnI阳性组较TnI阴性组的住院期非致命性心肌梗死发生率增高 ,住院期与随访期反复心绞痛发作增加 ,总心脏性病死率也上升 ,且复合心血管事件显著增多。对复合心血管事件的预测 。Objective To investigate the predicting value of electrocardiography(ECG) deviation and plasma levels of troponin on risk stratification and prognosis in patients with non-ST elevation acute coronary syndromes(ACS) Methods Two hundred and fifty six patients with acute chest pain were admitted to hospital consecutively with the diagnosis of unstable angina pectoris or non-ST elevation myocardial infarction from July 2000 to June 2001 The case history was collected and the physical examination and 18 leads of ECG test within 10 min after hospitalization were performed All patients were assigned to ST depression group (including accompanied T wave inversion), solely T wave inversion group, nondiagnostic ECG group and normal ECG group respectively according to the ECG deviation at admission Meanwhile, cardiac troponin I (TnI) was determined at bedside and the patients were re-divided into TnIpositive group (TnI≥0 1μg/L) and TnI-negative group (TnI<0 1μg/L ) according to TnI level The major adverse cardiovascular events (MACE), including cardiac death, nonfatal myocardial infarction and recurrent ischemia angina, were analyzed in each group in-hospital and follow-up period Results The incidences of recurrent angina and combined cardiovascular events increased significantly in ST depression group than in normal ECG group Thirty two percent patients with unstable angina pectoris and all patients with non-ST elevation myocardial infarction showed TnI-positive The proportion of documented coronary disease was higher in TnI-positive group than that in TnI-negative group Compared with TnI-negative group, the incidences of nonfatal myocardial infarction during the period in-hospital and recurrent episodes of angina during the period in-hospital or follow-up increased significantly, meanwhile, total cardiac mortality and combined cardiovascular events were higher in TnI-positive group TnI-positive had a higher sensitivity (92 7% vs 58 5%, P<0 01) and increased negative predicting value (97 9%

关 键 词：心电图 肌钙蛋白 ST段 急性冠状动脉综合征 心血管疾病 不稳定性心绞痛 ACS UAP NSTEMI 

分 类 号：R541.4[医药卫生—心血管疾病] R540.41[医药卫生—内科学]