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目的探讨经压力导丝指导冠状动脉临界病变PCI患者超敏肌钙蛋白(hs-cTnT)测定价值。方法选择2012年1月~2014年6月于江苏省苏北人民医院心内科资料完整的冠心病患者86例(其中包括稳定型心绞痛32例,不稳定型心绞痛54例),术前检测hs-cTnT,经冠状动脉造影检查明确至少有1支冠状动脉狭窄程度在40%~70%,所有患者皆行压力导丝检测血流储备分数(FFR)。根据FFR值将患者分为对照组和PCI组。对照组:FFR>0.75,药物保守治疗;PCI组:对FFR<0.75,行PCI治疗,其中PCI组根据hs-cTnT值又分为hs-cTnT升高组(≥0.034 ng/ml)和hs-cTnT正常组(<0.034 ng/ml)。计数PCI组中血管病变数及支架数,比较三组患者住院和随访期间发生心绞痛、非致死性心肌梗死、心源性猝死及靶血管重建等主要心脏事件(MACE)的发生率。结果与hs-cTnT正常PCI组比较,hs-cTnT升高PCI组在冠状动脉双支或三支病变血管数(46.90%vs.33.30%)、人均支架置入数(1.8 vs.1.1)均增高(P<0.05)。hs-cTnT升高(0.526±0.088 ng/m L)PCI组心血管事件发生率显著高于hs-cTnT正常PCI组和对照组(P<0.05);而hs-cTnT正常(0.019±0.011 ng/m L)PCI组与对照组比较差别无显著意义。结论 hscTnT检测联合FFR检查可以指导冠状动脉临界病变介入治疗,且可预测患者心血管事件发生率。
Objective To investigate the value of hs-cTnT in patients with critical coronary artery disease guided by pressure guidewire. Methods From January 2012 to June 2014, 86 patients with coronary heart disease (including 32 patients with stable angina pectoris and 54 patients with unstable angina pectoris) were enrolled in the Department of Cardiology, North Jiangsu Provincial People’s Hospital. Preoperative detection of hs- cTnT, confirmed by coronary angiography at least one coronary artery stenosis in 40% to 70%, all patients underwent pressure guide wire to detect flow reserve score (FFR). Patients were divided into control group and PCI group according to FFR value. Control group: FFR> 0.75, drug conservative treatment; PCI group: FFR <0.75, PCI treatment, PCI group was divided into hs-cTnT elevated group (≥0.034 ng / ml) and hs- Normal cTnT group (<0.034 ng / ml). The incidence of cardiovascular events and the number of stents in the PCI group were counted. The incidence of major cardiac events (MACE) such as angina pectoris, nonfatal myocardial infarction, sudden cardiac death and target vessel revascularization during hospitalization and follow-up were compared among the three groups. Results Compared with the normal hs-cTnT group, hs-cTnT increased the number of vessels in the double or triple coronary artery (46.90% vs.33.30%) and the average number of stents per patient (1.8 vs.1.1) (P <0.05). The incidence of cardiovascular events in PCI group was significantly higher than that of hs-cTnT normal PCI group and control group (0.526 ± 0.088 ng / m L) (p <0.05), while hs-cTnT was normal (0.019 ± 0.011 ng / m L) There was no significant difference between PCI group and control group. Conclusion hscTnT combined with FFR can guide the interventional treatment of critical coronary artery disease, and can predict the incidence of cardiovascular events in patients.