摘要:
目的 探讨高敏心肌肌钙蛋白T(hs-cTnT)在非ST段抬高型急性冠状动脉综合征(NSTE-ACS)诊断中的临床应用.方法 回顾性分析2016年7月至2017年6月云南省第三人民医院急诊科收住心内科的126例NSTE-ACS患者的临床资料,其中非ST段抬高型心肌梗死(NSTEMI)组76例,不稳定型心绞痛(UA)组50例.收集两组患者入院时、入院4 h和12 h静脉血hs-cTnT及肌酸激酶同工酶(CK-MB)等临床资料,比较两组hs-cTnT和CK-MB水平的差异.结果 NSTEMI组随治疗时间延长hs-cTnT、CK-MB均逐渐升高,入院时、入院4 h、入院12 h hs-cTnT升高比例分别为88.2%(67例)、100.0%(76例)和100.0%(76例),CK-MB升高比例分别为60.0%(30例)、80%(40例)和96%(48例);UA组各时间点上述指标无明显变化.NSTEMI组入院时、入院4 h和12 h各时间点hs-cTnT、CK-MB水平均明显高于UA组〔hs-cTnT(μg/L)分别为0.182±0.052比0.010±0.001、2.421±0.084比0.011±0.012、5.647±0.012比0.110±0.012,CK-MB(U/L)分别为36.3±12.1比8.1±0.5、179.6±26.3比8.5±0.5、286.0±23.2比7.9±0.7,均P<0.05〕.结论 急性心肌梗死(AMI)患者hs-cTnT明显升高,可以作为鉴别NSTEMI与UA的依据.%Objective To investigate the clinical application of high-sensitivity cardiac troponin T (hs-cTnT) in the diagnosis of patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Methods The clinical data of 126 patients with NSTE-ACS admitted to the Department of Emergency of the Third People's Hospital in Yunnan Province from July 2016 to June 2017 were retrospectively analyzed, including 76 patients in non-ST-segment elevation myocardial infarction (NSTEMI) group and 50 patients in unstable angina (UA) group. Moreover, the clinical data of venous blood hs-cTnT and creatine kinase MB (CK-MB) were collected at immediate admission, 4 hours and 12 hours after admission to the hospital in the two groups. At last, the differences in levels of hs-cTnT and CK-MB were compared between the two groups. Results The hs-cTnT and CK-MB in NSTEMI group were gradually increased with the prolongation of therapeutic time, the elevation ratios of hs-cTnT were 88.2% (67 cases) and 100.0% (76 cases), 100.0% (76 cases) at admission and 4 hours, 12 hours after admission respectively; and the elevation ratios of CK-MB were 60.0% (30 cases), 80% (40 cases) and 96% (48 cases) respectively at the above time points; there were no significant differences in UA group. The levels of hs-cTnT and CK-MB in NSTEMI group were significantly higher compared to those of UA group at admission and 4 hours, 12 hours after admission [hs-cTnT (μg/L): the levels were respectively 0.182±0.052 vs. 0.010±0.001, 2.421±0.084 vs. 0.011±0.012, 5.647±0.012 vs. 0.11±0.012, CK-MB (U/L): the levels were respectively 36.3±12.1 vs. 8.1±0.5, 179.6±26.3 vs. 8.5±0.5, 286.0±23.2 vs. 7.9±0.7, all P < 0.05]. Conclusion The blood level of hs-cTnT in acute myocardial infarction (AMI) patients is obviously increased, which can be used as the basis to distinguish NSTEMI from UA.