| 引用本文： |
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于萍,范列英,朱琛颖,等.血清超敏肌钙蛋白T轻度升高对老年急性冠脉综合征患者的临床意义[J].同济大学学报（医学版）,2014,35(3):73-77. [点击复制]
- YU Ping,FAN Lie-ying,ZHU Chen-ying,et al.Clinical implication of mildly elevated serum hs-TnT in elderly patients with acute coronary syndrome[J].同济大学学报（医学版）,2014,35(3):73-77. [点击复制]
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| 摘要: |
| 目的探讨血清超敏肌钙蛋白T（hs-cTnT）轻度升高对老年急性冠脉综合征（acute coronary syndrome,ACS）患者的临床应用意义。方法研究入选679例健康成年人的hs-cTnT依据不同时的分布情况;入选拟诊急性冠脉综合征并收治入院的老年患者（＞65岁）共250例,所有入选患者到院即刻测定hs-cTnT和cTnT的基线水平,住院期间均完成常规生化检查、心电图、冠状动脉造影（CAG）等检查。应用ROC曲线图比较hs-cTnT、cTnT对老年急性心肌梗死（AMI）患者早期诊断的敏感性、特异性,讨论首次hs-cTnT轻度升高而cTnT阴性老年患者的诊断及冠脉病变情况,探讨hs-cTnT升高程度与老年不稳定性心绞痛患者冠脉病变的关系。结果健康成年人的血清超敏肌钙蛋白T（hs-cTnT）分布频度与年龄有关,本研究中健康汉族人群hs-cTnT的99百分位值与文献报道一致为14 ng/L,对于AMI的早期诊断,hs-cTnT与cTnT的ROC曲线下面积分别为0.963、0.904,两者间有显著性差异（P=0.000）；hs-cTnT诊断AMI的敏感性为95.8%,特异性为69.5%,而cTnT分别为83.3%,88.1%。250例老年患者中有49例患者为入院首次检测cTnT〈100 ng/L而hs-cTnT〉14 ng/L;其中AMI为12例（24.49%）、UAP为30例（62.22%）;hs-cTnT水平与老年不稳定性心绞痛患者冠脉病变的支数无关（P>0.05）,而与冠脉Gensini积分呈正相关（P＜0.05）。结论老年ACS患者中,hs-cTnT轻度升高可帮助早期识别老年急性心肌梗死患者;hs-cTnT水平的高低可预测老年不稳定性心绞痛患者冠脉病变的严重程度。 |
| 关键词: 急性冠脉综合征 超敏肌钙蛋白 老年人 急性心肌梗死 诊断 |
| DOI：10.3969/j.issnl008-0392.2014.03.017 |
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| 基金项目:上海市浦东新区科技发展基金（PKJ-2010-Y34） |
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| Clinical implication of mildly elevated serum hs-TnT in elderly patients with acute coronary syndrome |
| YU Ping,FAN Lie-ying,ZHU Chen-ying,Cai Ying,SHENG Pei-chen,GU Yu-ying |
| (Dept. of Heart Failure Unit, East Hospital, Tongji University, Shanghai 200120, China) |
| Abstract: |
| Objective To evaluation of the clinical implication of mildly elevated serum highsensitivity cardiac troponins T（hs-cTnT） in elderly patients with acute coronary syndrome（ACS）.Methods Serum hs-cTnT levels were measured in 250 elderly patients with ACS and 679 healthy individuals.The conventional blood chemical tests,ECG and coronary angiography were also performed.The receiver operating characteristic curve（ROC） was used to evaluate the sensitivity and specificity of serum hs-cTnT and conventional cTnT levels in early diagnosis of acute myocardial infarction（AMI）.The correlation of serum hs-cTnT level with coronary stenosis was also analyzed.Results The area under ROC curve for early diagnosis of AMI was 0.963 and 0.904 for serum hs-cTnT and conventional cTnT,respectively（P=0.000）.The sensitivity,specificity of hs-cTnT（cut-off value14 ng/L） and conventional TnT（cut-off value 100 ng/L） in diagnosis of AMI was 95.8%,69.5% and83.3%,88.1% respectively.Forty nine patients with negative cTnT（<100 ng/L） and positive hs-cTnT（>14 ng/L） at admission,among whom 12 were diagnosed as AMI（24.49%） and 30 were diagnosed as unstable angina pectoris（UAP）.There was no correlation between serum hs-cTnT level and the number of stenosed coronary arteries（P>0.05）; but there was positive correlation between serum hs-cTnT level and Gensini score.Conclusion Serum hs-cTnT level can be used for early diagnosis of AMI with a high sensitivity and prediction of the severity and extent of coronary artery stenosis. |
| Key words: acute coronary syndrome high-sensitive troponin T elderly people acute myocardial infarction diagnosis |
