高敏心肌肌钙蛋白Ⅰ阳性患者的疾病谱特征分析
发布时间：2018-10-22 19:46
【摘要】：目的分析福建省立医院高敏心肌肌钙蛋白I(hs-c Tn I)阳性患者疾病谱,以期为临床工作提供回顾性调查和分析数据。方法回顾性收集2012年8月至2013年11月在福建省立医院住院期间连续检测hs-c Tn I的1017例患者,结合相关临床资料、实验室检查、临床诊断及住院转归,统计得出hs-c Tn I阳性患者疾病谱特征,比较hs-c Tn I阳性患者不同年龄、性别、季节、肾功能的疾病谱差异,以及hs-c Tn I水平不同程度升高的疾病谱差异。运用logistic回归分析住院死亡与住院死亡危险因素的关系。结果1.hs-c Tn I阳性患者中急性冠状动脉综合征(ACS)占51.7%,非ACS占48.3%;其中最常见的5种疾病分别为ST段抬高型心肌梗死(STEMI)、心律失常、非ST段抬高型心肌梗死(NSTEMI)、心力衰竭、稳定型冠心病,所占比例分别为28.2%、23.3%、17.4%、17.0%、10.4%。不同性别分析,男性和女性最常见的5种疾病均为STEMI、心律失常、NSTEMI、心力衰竭、稳定型冠心病。2.按不同年龄分组,hs-c Tn I阳性患者常见的5种疾病均为STEMI、心律失常、NSTEMI、心力衰竭、稳定型冠心病,各年龄段疾病的构成比略有不同;非心血管系统疾病中,60岁以下人群以严重创伤、心肺复苏术后、蛛网膜下腔出血多见,60岁以上人群以慢性肾衰竭、脑卒中、消化道出血为主,而脓毒血症在各年龄段的疾病谱中所占构成比大致相似。3.按估计的肾小球滤过率分为肾功能正常组、轻度肾功能不全组、中度肾功能不全组和重度肾功能不全组,肾功能正常组、轻度肾功能不全组、中度肾功能不全组最常见的5种疾病均为STEMI、心律失常、NSTEMI、心力衰竭、稳定型冠心病,构成比略有不同;而重度肾功能不全组最常见的5种疾病分别为心力衰竭、稳定型冠心病、心律失常、NSTEMI、脓毒血症。4.按hs-c Tn I界值的10倍分为轻度升高组、中度升高组、重度升高组和极重度升高组,结果显示最常见的5种疾病中,STEMI、NSTEMI见于中度以上升高组;稳定型冠心病、慢性肾衰竭、脓毒血症仅见于中度以下升高组;重度以下升高组可见心律失常、心力衰竭、心脏外科术后。非心血管系统疾病,消化道出血仅见于轻度升高组;心肺复苏术后、严重创伤仅见于重度升高组。5.hs-c Tn I阳性患者中ACS组住院病死率为7.0%,非ACS组住院病死率为12.6%,两组间差异有统计学意义(P0.05);二元logistic回归分析示中度以上肾功能不全组的住院死亡风险是轻度以下肾功能不全组的2.263倍(OR值为2.263,P0.05);而年龄、性别、hs-c Tn I、氨基末端脑钠肽前体均未增加ACS组患者与非ACS患者的住院死亡风险。结论hs-c Tn I阳性疾病谱中常见的5种疾病为STEMI、心律失常、NSTEMI、心力衰竭、稳定型冠心病;ACS占51.7%,非ACS占48.3%;ACS患者住院病死率为7.0%,非ACS患者住院病死率为12.6%。
[Abstract]:Objective to analyze the spectrum of cardiac troponin I (hs-c Tn I) positive patients in Fujian Provincial Hospital, so as to provide retrospective investigation and analysis data for clinical work. Methods 1017 patients with hs-c Tn I were collected from August 2012 to November 2013 in Fujian Provincial Hospital. Combined with clinical data, laboratory examination, clinical diagnosis and outcome of hospitalization, 1017 patients were enrolled in this study. The disease spectrum characteristics of hs-c Tn I positive patients were statistically analyzed, and the differences of disease spectrum of hs-c Tn I positive patients with different age, sex, season and renal function were compared, as well as the difference of disease spectrum with different degree of hs-c Tn I level. Logistic regression analysis was used to analyze the relationship between hospital mortality and risk factors of hospital death. Results among the patients with 1.hs-c Tn I positive, acute coronary syndrome (ACS) accounted for 51.7%, non-ACS for 48.3%, and ST segment elevation myocardial infarction (ST) (STEMI), arrhythmia, non-ST segment elevation myocardial infarction (NSTEMI),) heart failure, stable coronary heart disease (CHD), among which the most common diseases were ST segment elevation myocardial infarction (STEMI), arrhythmia, non-ST segment elevation myocardial infarction (NSTEMI), heart failure and stable coronary heart disease. The percentages were 28.2and 23.3and 17.4and 17.0and 10.4, respectively. By sex analysis, the five most common diseases in both men and women were STEMI, arrhythmia, NSTEMI, heart failure, and stable coronary heart disease. 2. 2. According to different age groups, five common diseases of hs-c Tn I positive patients were STEMI, arrhythmia, NSTEMI, heart failure, stable coronary heart disease. After cardiopulmonary resuscitation, subarachnoid hemorrhage was more common. Chronic renal failure, cerebral apoplexy and gastrointestinal hemorrhage were the main causes in patients over 60 years old. According to the estimated glomerular filtration rate, they were divided into normal renal function group, mild renal insufficiency group, moderate renal insufficiency group and severe renal insufficiency group, normal renal function group, mild renal insufficiency group, and mild renal insufficiency group. The five most common diseases in moderate renal insufficiency group were STEMI, arrhythmia, NSTEMI, heart failure, stable coronary heart disease, and the composition ratio was slightly different, while the most common five diseases in severe renal insufficiency group were heart failure and stable coronary heart disease. Arrhythmia, NSTEMI, sepsis. According to the 10 times of the hs-c Tn I threshold, the patients were divided into three groups: mild elevated group, moderate elevated group, severe elevated group and extremely severe elevated group. The results showed that among the five most common diseases, STEMI,NSTEMI was found in moderate elevation group, stable coronary heart disease group, chronic renal failure group, stable coronary heart disease group, chronic renal failure group, stable coronary heart disease group, chronic renal failure group, Sepsis was only found in patients below moderate elevation, and arrhythmia, heart failure and cardiac surgery were found in patients below severe elevation. Non-cardiovascular diseases, gastrointestinal bleeding only seen in mild elevated group; after cardiopulmonary resuscitation, Severe trauma was found only in severe elevated group. The mortality of ACS group was 7.0, and that of non-ACS group was 12.6 in 5.hs-c Tn I positive group, there was significant difference between the two groups (P0.05). Binary logistic regression analysis showed moderate renal insufficiency group. The risk of death in hospital was 2.263 times as high as that in patients with mild renal insufficiency (OR = 2.263, P 0.05); age, however, was significantly higher than that in patients with mild renal insufficiency (P < 0.05). Sex, hs-c Tn I, and amino terminal brain natriuretic peptide precursors did not increase the risk of hospital death in ACS patients and non-ACS patients. Conclusion STEMI, arrhythmia, NSTEMI, heart failure and stable coronary heart disease are common diseases in hs-c Tn I positive disease spectrum, ACS is 51.7%, non-ACS is 48.3%, hospital mortality is 7.0 and non-ACS is 12.6%.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R54
本文编号：2288129
[Abstract]:Objective to analyze the spectrum of cardiac troponin I (hs-c Tn I) positive patients in Fujian Provincial Hospital, so as to provide retrospective investigation and analysis data for clinical work. Methods 1017 patients with hs-c Tn I were collected from August 2012 to November 2013 in Fujian Provincial Hospital. Combined with clinical data, laboratory examination, clinical diagnosis and outcome of hospitalization, 1017 patients were enrolled in this study. The disease spectrum characteristics of hs-c Tn I positive patients were statistically analyzed, and the differences of disease spectrum of hs-c Tn I positive patients with different age, sex, season and renal function were compared, as well as the difference of disease spectrum with different degree of hs-c Tn I level. Logistic regression analysis was used to analyze the relationship between hospital mortality and risk factors of hospital death. Results among the patients with 1.hs-c Tn I positive, acute coronary syndrome (ACS) accounted for 51.7%, non-ACS for 48.3%, and ST segment elevation myocardial infarction (ST) (STEMI), arrhythmia, non-ST segment elevation myocardial infarction (NSTEMI),) heart failure, stable coronary heart disease (CHD), among which the most common diseases were ST segment elevation myocardial infarction (STEMI), arrhythmia, non-ST segment elevation myocardial infarction (NSTEMI), heart failure and stable coronary heart disease. The percentages were 28.2and 23.3and 17.4and 17.0and 10.4, respectively. By sex analysis, the five most common diseases in both men and women were STEMI, arrhythmia, NSTEMI, heart failure, and stable coronary heart disease. 2. 2. According to different age groups, five common diseases of hs-c Tn I positive patients were STEMI, arrhythmia, NSTEMI, heart failure, stable coronary heart disease. After cardiopulmonary resuscitation, subarachnoid hemorrhage was more common. Chronic renal failure, cerebral apoplexy and gastrointestinal hemorrhage were the main causes in patients over 60 years old. According to the estimated glomerular filtration rate, they were divided into normal renal function group, mild renal insufficiency group, moderate renal insufficiency group and severe renal insufficiency group, normal renal function group, mild renal insufficiency group, and mild renal insufficiency group. The five most common diseases in moderate renal insufficiency group were STEMI, arrhythmia, NSTEMI, heart failure, stable coronary heart disease, and the composition ratio was slightly different, while the most common five diseases in severe renal insufficiency group were heart failure and stable coronary heart disease. Arrhythmia, NSTEMI, sepsis. According to the 10 times of the hs-c Tn I threshold, the patients were divided into three groups: mild elevated group, moderate elevated group, severe elevated group and extremely severe elevated group. The results showed that among the five most common diseases, STEMI,NSTEMI was found in moderate elevation group, stable coronary heart disease group, chronic renal failure group, stable coronary heart disease group, chronic renal failure group, stable coronary heart disease group, chronic renal failure group, Sepsis was only found in patients below moderate elevation, and arrhythmia, heart failure and cardiac surgery were found in patients below severe elevation. Non-cardiovascular diseases, gastrointestinal bleeding only seen in mild elevated group; after cardiopulmonary resuscitation, Severe trauma was found only in severe elevated group. The mortality of ACS group was 7.0, and that of non-ACS group was 12.6 in 5.hs-c Tn I positive group, there was significant difference between the two groups (P0.05). Binary logistic regression analysis showed moderate renal insufficiency group. The risk of death in hospital was 2.263 times as high as that in patients with mild renal insufficiency (OR = 2.263, P 0.05); age, however, was significantly higher than that in patients with mild renal insufficiency (P < 0.05). Sex, hs-c Tn I, and amino terminal brain natriuretic peptide precursors did not increase the risk of hospital death in ACS patients and non-ACS patients. Conclusion STEMI, arrhythmia, NSTEMI, heart failure and stable coronary heart disease are common diseases in hs-c Tn I positive disease spectrum, ACS is 51.7%, non-ACS is 48.3%, hospital mortality is 7.0 and non-ACS is 12.6%.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R54
【参考文献】
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1 姜红;葛均波;;心力衰竭流行病学特点[J];中国医学前沿杂志(电子版);2010年01期
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