依据肌酸激酶同工酶分层对非ST段抬高心肌梗死患者危险评估和住院期间发生主要心血管不良事件的预测价值

摘要

Objective To investigate the prediction value of CK-MB stratification in in-hospital major adverse cardiovascular events (MACE)among patients with non-ST-segment-elevation myocardial infarction (NSTEMI), whose diagnosis standard was determined by cardiac troponin I.Methods The study enrolled consecutively NSTEMI patients diagnosed by cardiac troponin I within 48 hours from the onset.According to CK-MB level,the objects were divided into CK-MB elevated group and CK-MB normal group.CK-MB elevated group was defined as the higher one in two CK-MB detection results (the time interval of 6 to 1 2 hours )was more than 1 6 U/L.Moreover,CK-MB normal group was defined as the higher one was below 1 6 U/L.The value of TIMI scores and the modified TIMI (M-TIMI ) scores in prediction of in-hospital MACE coronary artery angiography results and clinical indexes were compared between two groups.The M-TIMI scores were defined as adding CK-MB to the TIMI score and giving elevated CK-MB level (≥1 6 U/L )1 point.Results Compared with CK-MB normal group,the inflammatory indicators (white blood cells,neutrophilic granulocyte percentage,hs-CRP),renal function (blood urea nitrogen)were higher in CK-MB elevated group during hospitalization (P<0.05).In addition,the criminal lesion in CK-MB elevated group was more serious than the CK-MB normal group (P<0.05).And the circumstance of heart function in CK-MB elevated group was lower (P<0.05).Furthermore,the proportion of major adverse cardiovascular events (cardiac death、acute heart failure)was higher in elevated group (P <0.05).Meanwhile,the ROC curve analysis showed that,compared with TIMI scores,M-TIMI scores was a better predictor of in-hospital MACE in patients with NSTEMI.Conclusion NSTEMI patients with elevated CK-MB had higher in-hospital MACE rate.Moreover,after CK-MB participating in the risk stratification score system,it is more accurate to assess risk stratification among patients with NSTEMI.%目的：探讨以肌钙蛋白 I(cardiac troponin I,cTnI)为基础诊断的非 ST 段抬高心肌梗死(non-ST-segment elevation acute myocardial infarction,NSTEMI)患者,依据肌酸激酶同工酶(CK-MB)对其进行危险评估和住院期间主要心血管不良事件(major adverse cardiovascular events,MACE)的预测价值。方法连续筛选就诊于我院发病48小时内以 cTnI为基础诊断的 NSTEMI患者,根据CK-MB水平分为：CK-MB升高组,定义为两次 CK-MB检测(时间间隔6~12小时)结果中数值均CK-MB≥16 U/L；CK-MB正常组,则定义为两次结果中数值较高的 CK-MB<16 U/L,对比分析冠状动脉造影结果以及 TIMI、M-TIMI 积分对于预测住院期间 MACE 的准确性。结果对比CK-MB正常组,CK-MB升高组入院期间外周血炎症指标(白细胞、中性粒细胞百分比、高敏C-反应蛋白)水平较高(P<0.05)；且罪犯病变程度更为严重(P<0.05)；同时CK-MB升高组的心功能较差(P <0.05)；且 MACE(急性心力衰竭、心源性死亡)发生率较高(P<0.05)；此外,在TIMI、M-TIMI积分系统预测住院期间 MACE准确性的 ROC曲线分析中,M-TIMI积分系统较TIMI积分系统更能准确预测住院期间MACE的发生。结论 CK-MB升高的NSTEMI患者住院期间 MACE发生率更高。M-TIMI积分对于 NSTEMI患者的风险评估较传统的TIMI积分更为准确。