非急性心肌梗死患者高敏心肌肌钙蛋白T升高的病因研究
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摘要
目的分析非急性心肌梗死(AMI)住院患者高敏心肌肌钙蛋白T(hs-cTnT)升高的病因。方法纳入2017年1-12月该院胸痛且hs-cTnT>100ng/L的住院患者8 743例为研究对象,收集患者的临床资料和实验室数据,计算各种病因所占比例及hs-cTnT水平,分析hs-cTnT增高的病因。结果住院患者hs-cTnT水平升高的病因包括AMI(2 448例,28.0%)和非AMI(6 295例,72.0%)。其中,非AMI病因包括冠心病(1 748例,20.0%)、器质性心脏病(437例,5.0%)、肾功能不全(786例,9.0%)、脑卒中(699例,8.0%)、感染(786例,9.0%)、慢性阻塞性肺疾病急性发作(AECOPD)(262例,3.0%)、心力衰竭(524例,6.0%)、心肌病(262例,3.0%)、糖尿病并发症(349例,4.0%)、术后(107例,1.2%)、严重创伤(67例,0.8%)、主动脉夹层(77例,0.9%)、其他(184例,2.1%)。结论 hs-cTnT是心肌细胞损伤的标志物,在多种非AMI患者中出现水平升高,临床工作中应分析其具体病因,从而采取针对性治疗。
Objective To analyze the causes of high-sensitivity cardiac troponin T(hs-cTnT)increase in the inpatients with non-acute myocardial infarction(non-AMI).Methods A total of 8 743 inpatients with chest pain and hs-cTnT>100 ng/L in West China Hospital from January 2017 to December 2017 served as the study subjects.The clinical data and laboratory data were collected,the proportion of various causes and hscTnT levels were calculated,and the causes of hs-cTnT increase were analyzed.Results The causes of hs-cTnT level increase in hospitalized patients included acute myocardial infarction(AMI,2 448 cases,28.0%)and non-AMI(6 295 cases,72.0%).Among them,the non-AMI causes included coronary heart disease(1 748 cases,20.0%),organic heart disease(437 cases,5.0%),renal function insufficiency(786 cases,9.0%),stroke(699 cases,8.0%),infection(786 cases,9.0%),acute exacerbations of chronic obstructive pulmonary disease(AECOPD,262 cases,3.0%),heart failure(524 cases,6.0%),cardiomyopathy(262 cases,3.0%),diabetic complications(349 cases,4.0%),postoperation(107 cases,1.2%),severe trauma(67 cases,0.8%),aortic dissection(77 cases,0.9%),and others(184 cases,2.1%).Conclusion hs-cTnT is a marker of myocardial cell injury and its level is increased in multiple non-AMI.In the clinical work,its specific causes should be analyzed,thus the targeted treatment is adopted.
Objective To analyze the causes of high-sensitivity cardiac troponin T(hs-cTnT)increase in the inpatients with non-acute myocardial infarction(non-AMI).Methods A total of 8 743 inpatients with chest pain and hs-cTnT>100 ng/L in West China Hospital from January 2017 to December 2017 served as the study subjects.The clinical data and laboratory data were collected,the proportion of various causes and hscTnT levels were calculated,and the causes of hs-cTnT increase were analyzed.Results The causes of hs-cTnT level increase in hospitalized patients included acute myocardial infarction(AMI,2 448 cases,28.0%)and non-AMI(6 295 cases,72.0%).Among them,the non-AMI causes included coronary heart disease(1 748 cases,20.0%),organic heart disease(437 cases,5.0%),renal function insufficiency(786 cases,9.0%),stroke(699 cases,8.0%),infection(786 cases,9.0%),acute exacerbations of chronic obstructive pulmonary disease(AECOPD,262 cases,3.0%),heart failure(524 cases,6.0%),cardiomyopathy(262 cases,3.0%),diabetic complications(349 cases,4.0%),postoperation(107 cases,1.2%),severe trauma(67 cases,0.8%),aortic dissection(77 cases,0.9%),and others(184 cases,2.1%).Conclusion hs-cTnT is a marker of myocardial cell injury and its level is increased in multiple non-AMI.In the clinical work,its specific causes should be analyzed,thus the targeted treatment is adopted.
引文
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[11]FAN Y,JIANG M L,GONG D D,et al.Cardiac troponin for predicting all-cause mortality in patients with acute ischemic stroke:a meta-analysis[J/OL].Biosci Rep,2018,38(2):[2018-09-15].http://www.ncbi.nlm.nih.gov/pubmed.
[12]AHN S H,LEE J S,KIM Y H,et al.Prognostic significance of troponin elevation for Long-Term mortality after ischemic stroke[J].J Stroke,2017,19(3):312-322.
[13]BISO S M,LU M,DE VENECIA T A,et al.Clinical characteristics,management,and outcomes of suspected poststroke acute coronary syndrome[J].Cardiol Res Pract,2017,2017:3762149.
[14]BURAK M F,INOUYE K E,WHITE A,et al.Development of a therapeutic monoclonal antibody that targets secreted fatty acid-binding protein aP2to treat type 2diabetes[J].Sci Transl Med,2015,7(319):319ra205.
[15]李天艺,李华.老年2型糖尿病患者血清心肌肌钙蛋白水平与心血管事件的相关性研究[J].中华老年医学杂志,2016,35(8):843-845.
[2]SAAD Y M,MCEWAN J,SHUGMAN I M,et al.Use of a high-sensitivity troponin T assay in the assessment and disposition of patients attending a tertiary Australian emergency department:a cross-sectional pilot study[J].Emerg Med Australas,2015,27(5):405-411.
[3]LINDNER G,PFORTMUELLER C A,BRAUN C T,et al.Non-acute myocardial infarction-related causes of elevated high-sensitive troponin T in the emergency room:a cross-sectional analysis[J].Intern Emerg Med,2014,9(3):335-339.
[4]ZHELEV Z,HYDE C,YOUNGMAN E,et al.Diagnostic accuracy of single baseline measurement of Elecsys Troponin T high-sensitive assay for diagnosis of acute myocardial infarction in emergency department:systematic review and meta-analysis[J].BMJ,2015,350:h15-h20.
[5]DAMMAN P,VAN′T HOF A W,TEN BERG J M,et al.2015ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation:comments from the Dutch ACSworking group[J].Neth Heart J,2017,25(3):181-185.
[6]KOESTERS A,ENGISCH K L,RICH M M.Decreased cardiac excitability secondary to reduction of sodium current may be a significant contributor to reduced contractility in a rat model of sepsis[J].Crit Care,2014,18(2):R54-R58.
[7]WALLEY K R.Deeper understanding of mechanisms contributing to sepsis-induced myocardial dysfunction[J].Crit Care,2014,18(3):137-141.
[8]DUBIN R F,LI YONG-MEI,HE JIANG,et al.Predictors of high sensitivity cardiac troponin T in chronic kidney disease patients:a cross-sectional study in the chronic renal insufficiency cohort(CRIC)[J].BMC Nephrol,2013,14(1):229-233.
[9]CERASOLA G,NARDI E,MULG,et al.Left ventricular mass in hypertensive patients with mild-to-moderate reduction of renal function[J].Nephrology(Carlton),2010,15(2):203-210.
[10]RYSZ J,GLUBA-BRZOZKA A,FRANCZYK B,et al.Novel biomarkers in the diagnosis of chronic kidney disease and the prediction of its outcome[J].Int J Mol Sci,2017,18(8):1702-1706.
[11]FAN Y,JIANG M L,GONG D D,et al.Cardiac troponin for predicting all-cause mortality in patients with acute ischemic stroke:a meta-analysis[J/OL].Biosci Rep,2018,38(2):[2018-09-15].http://www.ncbi.nlm.nih.gov/pubmed.
[12]AHN S H,LEE J S,KIM Y H,et al.Prognostic significance of troponin elevation for Long-Term mortality after ischemic stroke[J].J Stroke,2017,19(3):312-322.
[13]BISO S M,LU M,DE VENECIA T A,et al.Clinical characteristics,management,and outcomes of suspected poststroke acute coronary syndrome[J].Cardiol Res Pract,2017,2017:3762149.
[14]BURAK M F,INOUYE K E,WHITE A,et al.Development of a therapeutic monoclonal antibody that targets secreted fatty acid-binding protein aP2to treat type 2diabetes[J].Sci Transl Med,2015,7(319):319ra205.
[15]李天艺,李华.老年2型糖尿病患者血清心肌肌钙蛋白水平与心血管事件的相关性研究[J].中华老年医学杂志,2016,35(8):843-845.