摘要
目的:探讨非ST段抬高型心肌梗死(NSTEMI)患者发病24 h内人血清肌酸激酶同工酶(CK-MB)水平与NSTEMI后发生心室重构程度的相关性。方法:选择2017年1月—2020年6月贵港市人民医院心血管内科收治的经临床症状、18导联心电图及检验科血生化学检查诊断的110例NSTEMI患者作为NSTEMI组,另选110例同期体检者作为对照组。收集所有入选者的临床资料,检测所有入选者的血清CK-MB、肌钙蛋白I(cTnI)、肌红蛋白(Mb)、超敏C反应蛋白(hsCRP)以及N末端B型利钠肽前体(NT-proBNP)等生化指标。于入院后4 d内及随访12个月末采用心脏超声检查所有入选者的左心室舒张末期容积(LVEDV)、舒张末期心外膜容积(LVEDVepi)、左心室舒张末内径(LVEDD)、左心室射血分数(LVEF)等指标。结果:与对照组入选者相比,NSTEMI组患者的CK-MB、cTnI、Mb、hsCRP及NT-proBNP水平均明显升高,同时LVEDV和LVEDD增大,LVEF有所下降,差异有统计学意义(t=5.177、7.350、11.310、23.150、5.375、4.359、3.698、4.037,P<0.01)。CK-MB分别与hsCRP、NT-proBNP、Mb、cTnI、LVEDV及LVEDD呈正相关(r=0.38、0.42、0.76、0.73、0.64、0.52,P<0.01),与LVEF及LVRI呈负相关(r=-0.68、-0.61,P<0.01)。随访12个月末较入院后4 d内的心室重构特点是LVEDV、LVEDD及LVM均明显增加,以LVEDV增加为主,但LVEF及LVRI均明显减低,差异有统计学意义(t=4.624、3.953、3.755、4.112、4.132,P<0.01)。ROC曲线分析结果显示,CK-MB的曲线下面积是0.72(95%CI 0.56~0.91),CK-MB的最佳临界值为248.5μg/L,对心室重构诊断的灵敏度为85.9%,特异度为65.6%。结论:NSTEMI患者血清CK-MB水平升高,与其心室重构程度呈显著的、独立的相关性,提示血清CK-MB水平可能是一个预测NSTEMI患者发生心室重构的有效指标。
Objective:To investigate the correlation between human serum creatine kinase isoenzyme(CK-MB)levels within 24 h of onset and the degree of ventricular remodeling occurring after NSTEMI in patients with non-ST-segment elevation myocardial infarction(NSTEMI).Methods:110 NSTEMI patients diagnosed by clinical symptoms,18-lead electrocardiogram and blood biochemistry examination in the Laboratory Department admitted to the hospital from January 2017 to June 2020 were selected as the NSTEMI group,and another 110 patients with physical examination in the same period were selected as the control group.Clinical data were collected from all enrolled patients,and biochemical indices such as serum CK-MB,troponin I(cTnI),myoglobin(Mb),ultrasensitive C-reactive protein(hsCRP),and N-terminal B-type natriuretic peptide precursor(NT-proBNP)were tested in all enrolled patients.Left ventricular end-diastolic volume(LVEDV),end-diastolic epicardial volume(LVEDVepi),left ventricular end-diastolic internal diameter(LVEDD),and left ventricular ejection fraction(LVEF)were examined by cardiac ultrasonography for all enrollees within 4 d of admission and at the end of 12 months of follow-up.Results:Compared with the control group,the NSTEMI group had significantly higher levels of CK-MB,cTnI,Mb,hsCRP and NT-proBNP,increased LVEDV and LVEDD,and decreased LVEF,with statistically significant differences(t=5.177,7.350,11.310,23.150,5.375,4.359,3.698,4.037;P<0.01).CK-MB was positively correlated with hsCRP,NT-proBNP,Mb,cTnI,LVEDV,and LVEDD(r=0.38,0.42,0.76,0.73,0.64,0.52;P<0.01)and negatively correlated with LVEF and LVRI(r=-0.68,-0.61;P<0.01).Ventricular remodeling at the end of 12 months of follow-up compared with 4 d after admission was characterized by a significant increase in LVEDV,LVEDD,and LVM,but the increase in LVEDV was predominant,but the LVEF and LVRI were significantly reduced,with statistically significant differences(t=4.624,3.953,3.755,4.112,4.132;P<0.01).ROC curve analysis showed that the area under the curve for CK-MB was 0.72(95%CI 0.56 to 0.91),and the optimal threshold value for CK-MB was 248.5μg/L,with a sensitivity of 85.9%and a specificity of 65.6%for the diagnosis of ventricular remodeling.Conclusion:Elevated serum CK-MB levels in patients with NSTEMI showed a significant and independent correlation with the degree of their ventricular remodeling,suggesting that serum CK-MB levels may be a valid predictor of the occurrence of ventricular remodeling in patients with NSTEMI.
作者
刘海德
Liu Haide(Department of Cardiology,Guigang People’s Hospital,Guigang,Guangxi,537100,China)
出处
《黑龙江医学》
2024年第7期794-797,共4页
Heilongjiang Medical Journal
基金
贵港市自筹经费科研项目(贵科软2300030)。
关键词
肌酸激酶同工酶
非ST段抬高型心肌梗死
心室重构
Creatine kinase isoenzymes
Non-ST-segment elevation myocardial infarction
Ventricular remodeling
