2018 年第 5 期 第 13 卷

不稳定型心绞痛患者心电图变化与心肌肌钙蛋白I水平及预后的相关性研究

Correlation among electrocardiogram changes, cardiac troponin I level and prognosis of patients with unstable angina

作者：孙萍薛锋秦月华

英文作者：

单位：226001南通大学附属医院心电图室

英文单位：

关键词：不稳定型心绞痛；心电描记术；肌钙蛋白Ⅰ

英文关键词：

• 摘要：

• 目的    探讨不稳定型心绞痛患者心电图变化与心肌肌钙蛋白I（cTnI）水平及预后的关系。方法    选取南通大学附属医院急诊科2015年7月至2016年12月收治的不稳定型心绞痛患者156例为研究对象。患者入院立即抽血检测cTnI水平并迅速完成18导联心电图检查，依据血液检测结果分为cTnI阳性组（≥0.16 mg/L）和阴性组（＜0.16 mg/L），依据心电图特征分为ST段升高组、ST段压低组、单纯T波倒置组和心电图正常组。记录患者30 d内的主要不良心脏事件（MACE）发生情况。分析cTnI水平与心电图异常的相关性，以及二者与MACE发生的相关性。结果    cTnI阳性患者61例，心电图异常患者123例，共发生MACE 28例。cTnI阳性组的心电图异常率明显高于cTnI阴性组［95.1%（58/61）比68.4%（65/95）］，差异有统计学意义（χ2＝26.007，P＜0.001）。cTnI阳性组的MACE发生率明显高于cTnI阴性组［19.7%（14/61）比4.2%（4/95）］，差异有统计学意义（χ2＝12.781，P＜0.001）。ST段抬高组、ST段压低组、单纯T波倒置组及心电图正常组的MACE发生率分别为34.8%（8/23）、13.8%（4/29）、7.0%（5/71）、3.0%（1/33），组间差异有统计学意义（P＜0.001）。二项Logistic回归分析结果显示，cTnI阳性（比值比＝19.717，P＜0.001，95%置信区间：5.668～68.589）以及心电图异常（比值比＝0.036，P＝0.002，95%置信区间：0.004～0.302）是不稳定性心绞痛近期预后的独立危险因素。结论    不稳定性心绞痛患者cTnI水平与心电图异常有相关性，二者均是不稳定性心绞痛近期预后的独立危险因素。

• 【Abstract】Objective    To explore the correlation among electrocardiogram changes, cardiac troponin I (cTnI) level and prognosis of patients with unstable angina. Methods    Totally 156 patients with unstable angina were enrolled from July 2015 to December 2016 in Affiliated Hospital of Nantong University. Level of cTnI was tested and the patients were divided into cTnI≥0.16 mg/L group and cTnI＜0.16 mg/L group. According to electrocardiogram（ECG） characteristics, the patients were divided into ST-segment elevation group, ST-segment depression group, simple T wave inversion group and normal ECG group. Occurrence of major adverse cardiac events(MACE) was recorded in 30 d after admission. The correlation among cTnI level, electrocardiographic characteristics and MACE was analyzed. Results    There were 61 cases of cTnI≥0.16 mg/L and 123 cases of ECG abnormality. MACE occurred in 28 patients. Electrocardiographic abnormality rate in cTnI≥0.16 mg/L group was significantly higher than that in cTnI＜0.16 mg/L group［95.1%（58/61） vs 68.4%（65/95）］（χ2＝26.007, P＜0.001）. MACE rate in cTnI≥0.16 mg/L group was significantly higher than that in cTnI＜0.16 mg/L group［19.7%（14/61） vs 4.2%（4/95）］（χ2＝12.781, P＜0.001）. MACE rates in ST-segment elevation group, ST-segment depression group, simple T wave inversion group and normal ECG group were 34.8%（8/23）, 13.8%（4/29）, 7.0%（5/71） and 3.0%（1/33）, respectively; there were significant differences among groups（P＜0.001）. Binomial logistic regression analysis showed that cTnI≥0.16 mg/L（odds ratio＝19.717, P＜0.001, 95% confidence interval: 5.668-68.589） and ECG abnormality（odds ratio＝0.036, P＝0.002, 95% confidence interval: 0.004-0.302） were independent risk factors of early prognosis of unstable angina. Conclusion    The level of cTnI is related with ECG abnormality and both of them are independent risk factors of early prognosis of unstable angina.

  【Key words】Unstable angina pectoris;Electrocardiography;Troponin I