浙江中西医结合杂志

李开军,吴聪聪,肖礼民,徐剑,季思媛,杨凯超,叶丽.心肌损伤标志物及HEART评分在急性冠脉综合征中的临床运用研究[J].浙江中西医结合杂志,2021,31(8):

心肌损伤标志物及HEART评分在急性冠脉综合征中的临床运用研究

Clinical study of myocardial injury markers and HEART score in emergency patients with acute coronary syndrome

投稿时间：2021-02-15 修订日期：2021-04-02

DOI：

英文关键词:Markers of myocardial injury, HEART score, Chest pain

基金项目:浙江省中医药科学研究基金项目 2020ZB301

作者	单位	E-mail
李开军^*	浙江省丽水市中心医院	likaijunmail@sina.com
吴聪聪	丽水市中心医院
肖礼民
徐剑
季思媛
杨凯超
叶丽

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中文摘要:

目的观察心肌损伤标志物及HEART评分与急性胸痛冠脉病变程度相关性,探讨其可能的临床意义。方法选取2020年1月至 2020年12月在我院急诊科诊断为急性胸痛并收住心血管内科行冠状动脉造影术的患者共计171例为受试对象。根据冠状动脉造影术中根据冠状动脉造影术中Gensini 评分的结果是否＞41将其分为Gensini评分≤41组(n=51),Gensini评分＞41组(n=120)。记录HEART评分,同时检测CK、CKMB、cTnI、α-HBDH、DD、FIB、CRP等相关生化指标。结果比较Gensini评分≤41组,Gensini评分＞41组各个心肌损伤标志物,通过对各项检验结果进行单因素方差分析组间差异结果显示：造影组与支架组中的α-HBDH(F=10.67, p=0)、CKMB(F=23.84, p=0)D-Dimer(F=4.99, p= 0.03)、FIB(F=27.35, p=0)、CK(F=24.19, p=0)、CRP (F=15.30, p=0)、cTnI (F=37.72, p=0)、HEART(F=116.25, p=0)等相关指标进行比较,差异均有统计学意义(P均＜0.05)。进一步将这些相关因素进行 Logistic多因素回归分析结果显示,将Gensini评分＞41作为因变量,进行 Logistic多因素回归分析表明：α-HBDH(OR=0.99、p=0.27)、CKMB(OR=1.10、p=0.03)、DD(OR=0.48、p=0.17)、FIB(OR=0.99、p=0.57)、CK(OR=1.11、p=0.19)、CRP(OR=1.50、p=0.36)、HEART(OR=2.30、p=0)。分别将年龄、性别等混杂因素纳入调整变量,结果显示：α-HBDH(OR=0.99、p=0.22)、CKMB(OR=1.11、p=0.03)、DD(OR=0.51、p=0.22)、FIB(OR=0.99、p=0.41)、CK(OR=1.10、p=0.20)、CRP(OR=1.56、p=0.31)、HEART(OR=2.33、p=0)。分别将年龄、性别、吸烟史、糖尿病史、高血压史等混杂因素纳入调整变量,结果显示：α-HBDH(OR=0.99、p=0.18)、CKMB(OR=1.11、p=0.04)、DD(OR=0.53、p=0.25)、FIB(OR=0.99、p=0.45)、CK(OR=1.11、p=0.19)、CRP(OR=1.49、p=0.42)、HEART(OR=2.30、p=0)。结论 HEART 评分模型评分结果可靠,能为急诊鉴别ACS提供有力的诊断依据,适用于急性胸痛患者处理。

英文摘要:

Objective To observe the correlation between myocardial injury markers and HEART scores and the degree of coronary artery disease in acute chest pain, and to explore its possible clinical significance. Methods A total of 171 patients who were diagnosed with acute chest pain in the emergency department of our hospital from January 2020 to December 2020, were admitted to the cardiovascular department for coronary angiography were selected as subjects. According to whether the results of the Genini score during coronary angiography during coronary angiography were greater than 41, they were divided into two groups with Gensini scores≤ 41 (n=51), and groups with Gensini scores> 41 (n=120). Record HEART scores, CK, CKMB, cTnI, α-HBDH, DD, FIB, CRP and other related biochemical indicators. Results Comparison of Gensini scores ≤ 41 groups, Gensini scores> 41 groups of each myocardial injury marker, the difference between the groups through a one-way analysis of variance on the test results showed that: α-HBDH in the contrast group and the stent group (F=10.67 , P=0), CKMB (F=23.84, p=0), D-Dimer (F=4.99, p= 0.03), FIB (F=27.35, p=0), CK (F=24.19, p=0) , CRP (F=15.30, p=0), cTnI (F=37.72, p=0), HEART (F=116.25, p=0) and other related indexes were compared, the differences were all statistically significant (p<0.05 ). The logistic multivariate regression analysis of these related factors showed that the Gensini score>41 was used as the dependent variable, and the logistic multivariate regression analysis showed that: α-HBDH (OR=0.99, p=0.27), CKMB (OR=1.10, p=0.03), DD (OR=0.48, p=0.17), FIB (OR=0.99, p=0.57), CK (OR=1.11, p=0.19), CRP (OR=1.50, p=0.36), HEART (OR=2.30, p=0). Confounding factors such as age and gender were included in the adjustment variables, and the results showed: α-HBDH (OR=0.99, p=0.22), CKMB (OR=1.11, p=0.03), DD (OR=0.51, p=0.22), FIB (OR=0.99, p=0.41), CK (OR=1.10, p=0.20), CRP (OR=1.56, p=0.31), HEART (OR=2.33, p=0). Confounding factors such as age, gender, history of smoking, history of diabetes, history of hypertension were included in the adjusted variables, and the results showed: α-HBDH (OR=0.99, p=0.18), CKMB (OR=1.11, p=0.04), DD (OR=0.53, p=0.25), FIB (OR=0.99, p=0.45), CK (OR=1.11, p=0.19), CRP (OR=1.49, p=0.42), HEART (OR=2.30, p =0). Conclusion The HEART scoring model has reliable scoring results, which can provide a strong diagnostic basis for the identification of ACS in the emergency department. It is suitable for the treatment of patients with acute chest pain.

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