【摘要】 目的　探讨心脏肌钙蛋白T (cTnT)对不稳定心绞痛 (UA)危险分层的临床价值。方法用酶联免疫法测定 112例UA患者入院即刻、第 2、3日血浆cTnT水平 ,据cTnT≥ 0 1ng ml或 <0 1ng ml将患者分为cTnT升高组和cTnT正常组 ;观察住院期间两组急性心肌梗死 (AMI)、心脏性死亡和难治性心绞痛的发生率。结果　在 112例UA患者中 ,cTnT升高 44例 (39% ) ,cTnT正常 6 8例 (6 1% )。住院期间发生AMI 12例 (10 7% ) ,死亡 5例 (4 5 % ) ,非致死性心肌梗死及心脏性死亡 15例 (13 4% )。其中cTnT升高组的死亡率较cTnT正常组有升高趋势 ,但差异无显著性 ;而cTnT升高组AMI、非致死性心肌梗死及心脏性死亡的发生率显著高于cTnT正常组 (P <0 0 1)。校正年龄、性别、心绞痛分级、心电图改变等因素后 ,cTnT升高仍然是住院期间发生AMI、非致死性心肌梗死及心脏性死亡的独立危险因素 ,其相对危险度分别为 8 2 (P =0 0 113)和 9 3(P =0 0 0 71)。cTnT升高对UA住院期间发生非致死性心肌梗死及心脏性死亡的阳性预测值为 2 9 5 % ,阴性预测值为 97%。进一步将cTnT升高组分为cTnT≥ 0 1<1 0和≥ 1 0～ 2 5ng ml两个亚组 ,二者的临床特征和冠状动脉病变程度无差异 ,住院期间AMI、非致死性心肌梗死及心脏性死亡的发生率有升高趋势更多还原

【Abstract】 Objective To evaluate the value of cardiac troponin T (cTnT) in risk stratification in unstable angina. Methods The plasma cTnT levels in 112 patients with unstable angina were measured by ELISA. The patients were divided into cTnT elevated group (cTnT≥0 1 ng/ml) and cTnT normal group (cTnT<0 1 ng/ml). Acute myocardial infarction (AMI), cardiac death and refractory angina were observed in the two groups during hospitalization. Results 44 of 112 patients with unstable angina (39%) had an elevated cTnT level. During hospitalization, there were AMI 12 cases (10 7%), cardiac death 5 cases (4 5%), nonfatal myocardial infarction or cardiac death 15 cases (13 4%). The mortality in cTnT elevated group is mild higher than that of cTnT normal group, but there was no statistic difference. However, the incidence of AMI, nonfatal myocardial infarction or cardiac death in cTnT elevated group was significantly higher than those of cTnT normal group ( P < 0 01). Adjusted other risk factors, the relative risk for AMI and nonfatal myocardial infarction or cardiac death according to elevated cTnT was 8 2 ( P = 0 011 3) and 9 3 ( P = 0 007 1) respectively. Accordingly, the positive predictive value of cTnT elevation for nonfatal myocardial infarction and cardiac death was 29 5%, and the negative predictive value was 97%. The clinical features, coronary lesion and the incidence of cardiac events during hospitalization were not significantly different between ≤0 1 ng/ml cTnT <1 0 ng/ml and cTnT≥1 0 2 5 ng/ml group. Conclusion These data indicate that cTnT can evaluate the short term outcome and induct the treatment of patients with unstable angina, and could be used as a marker for risk stratification.更多还原