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目的:评价肌酸激酶同工酶(CK-MB)与肌钙蛋白I(cTnI)在非ST段抬高型急性冠状动脉综合征(NSTE-ACS)患者早期危险分层及处理中的作用及二者结果一致性的意义。方法:1 074例NSTE-ACS患者,入院早期(<48 h)行冠状动脉造影检查并采集症状发作至入院36 h内cTnI和CK-MB检测结果。以>1×正常值上限(ULN)作为阳性结果,以≤1×ULN作为阴性结果,将入选患者分为4组:CK-MB、cTnI均阴性组(CK-MB-/cTnI-组),CK-MB阳性、cTnI阴性组(CK-MB+/cTnI-组),CK-MB阴性、cTnI阳性组(CK-MB-/cTnI+组),CK-MB、cTnI均阳性组(CK-MB+/cTnI+组)。评价组间结果一致与不一致的发生率及早期侵入性检查(<48 h)应用情况,统计各组院内主要不良心脏事件(MACE)。结果:1 074例NSTE-ACS患者在CK-MB-/cTnI-组、CK-MB+/cTnI-组、CK-MB-/cTnI+组、CK-MB+/cTnI+组中分别为664例、90例、54例、266例。cTnI+318例,CK-MB+356例;CK-MB与cTnI结果一致者共930例(CK-MB-/cTnI-组664例,CK-MB+/cTnI+组266例);CK-MB与cTnI结果不一致者144例(CK-MB+/cTnI-组90例,CK-MB-/cTnI+组54例)。CK-MB-/cT-nI+组与CK-MB+/cTnI-组在冠状动脉病变支数、SCAI分型及院内MACE比较差异无统计学意义(P>0.05)。Logistic回归分析结果显示:冠状动脉病变SCAI分型、cTnI是CK-MB升高的危险因素;冠状动脉病变SCAI分型、冠状动脉病变支数、CK-MB是cTnI升高的危险因素。同时发现,在4组间存在风险逐渐上升的倾向。与CK-MB-/cTnI-组院内MACE进行比较,CK-MB+/cTnI-组(OR=2.07,95%CI:1.04~4.84)、CK-MB-/cT-nI+组(OR=3.57,95%CI:2.41~6.14)、CK-MB+/cTnI+组(OR=4.12,95%CI:2.98~8.32)院内风险有逐级升高趋势。结论:在NSTE-ACS患者,cTnI升高能够独立预测患者院内风险,CK-MB+的预测价值与cTnI+比较无明显差异。
PURPOSE: To evaluate the role of CK-MB and cTnI in the early risk stratification and management of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) The significance of consistency between the two results. Methods: Totally 1 074 patients with NSTE-ACS underwent coronary angiography at early admission (<48 h) and the symptoms of cTnI and CK-MB were detected within 36 h after admission. Patients were divided into 4 groups: CK-MB, cTnI negative group (CK-MB- / cTnI-group), positive results of> 1 × ULN as the positive result and ≤1 × ULN as the negative result. CK-MB positive, CK-MB + / cTnI-positive group, CK-MB negative, cTnI positive group (CK-MB- / cTnI + group). The rate of agreement and inconsistency between the two groups was evaluated, and the application of early invasiveness examination (<48 h) was analyzed. The major adverse cardiac events (MACE) in each group were statistically analyzed. Results: A total of 1 074 cases of NSTE-ACS patients were 664 cases and 90 cases in CK-MB- / cTnI-, CK-MB + / cTnI-, CK-MB- / cTnI + 54 cases, 266 cases. There were 930 cases of CK-MB and cTnI (664 cases in CK-MB- / cTnI-group and 266 cases in CK-MB + / cTnI + group); CK-MB and cTnI The results were inconsistent in 144 cases (CK-MB + / cTnI-90 cases, CK-MB- / cTnI + 54 cases). There was no significant difference in the number of coronary lesions, SCAI classification and hospital MACE between CK-MB- / cT-nI + group and CK-MB + / cTnI- group (P> 0.05). Logistic regression analysis showed that SCAI type and cTnI were the risk factors of CK-MB in coronary artery disease. SCAI type, coronary lesion count and CK-MB in coronary artery disease were the risk factors for the increase of cTnI. At the same time, we found that there was a tendency that the risks gradually increased among the four groups. Compared with the MACE in the CK-MB- / cTnI- group, there was no significant difference in the CK-MB + / cTnI-group (OR = 2.07,95% CI: 1.04-4.84) % CI: 2.41 ~ 6.14). In the CK-MB + / cTnI + group (OR = 4.12, 95% CI: 2.98 ~ 8.32), the risks in the hospital increased step by step. CONCLUSIONS: In patients with NSTE-ACS, elevated cTnI independently predicts in-hospital risk and predictive value of CK-MB + has no significant difference from cTnI +.