目的 探讨慢性心力衰竭(CHF)患者血清心肌肌钙蛋白I浓度(cTnI)与心脏结构及功能关系,以及对预后的影响.方法 根据103例CHF患者入院时血清cTnI检测结果将其分为cTnI阳性组(51例)和cTnI阴性组(52例),对两组间心脏结构及功能指标进行比较.住院期间以主要不良心脏事件(MACE)为主要研究终点,随访3个月以死亡和再住院为主要研究终点.结果 与cTnI阴性组相比,cTnI阳性组的左心房内径(LAD)、左室舒张末期内径(LVEDD)、脑钠肽(BNP)及NYHA心功能Ⅲ~Ⅳ级比例显著升高(P<0.05),左室射血分数(LVEF)显著降低(P<0.05).相关分析显示,cTnI浓度与LVEDD、LAD、BNP呈正相关(P<0.05),与LVEF呈负相关(P<0.05).与cTnI阴性组相比,cTnI阳性组住院期间MACE复合终点发生率升高30.10%(P<0.05);随访3个月时cTnI阳性组死亡和再住院复合终点发生率升高30.17%(P<0.05).多变量Logistic回归分析显示,cTnI浓度是CHF患者10 rnd和3个月临床预后的一个独立危险因素.结论 cTnI浓度可作为CHF患者左心室重构及心功能的一个预测因子,也是反映CHF患者近期不良预后的一个独立危险因素.%Objective To investigate the association between cTnI and cardiac structure/functionin and its influence on the prognosis in patients with chronic heart failure( CHF ). Methods One hundred and three patients with decompensated CHF were divided into cTnI positive group ( n = 51 ) and cTnI negative group ( n = 52 ). Cardiac structure/function index was compared between two groups. Major adverse cardiac events( MACE ) in hospital and the composite end point( mortality,rehospitalization ) by 3 months was the primary study end point. Results LA, LVEDD, BNP, NYHA cardiac function Ⅲ~ Ⅳ ratio was significantly higher ( P <0. 05 ), LVEF was significantly lower ( P <0. 05 ) in cTnI positive group than that in cTnI negative group. Moreover, serum cTnI concentration was positively correlated with LA, LVEDD and BNP ( P < 0. 05 ), and negatively correlated with LVEF ( P <0. 05 ). The cumulative incidence of MACE in hospital increased by 30. 10% ( P <0. 05 ); the cumulative incidence of primary end point by 3 months increased by 30. 17% ( P <0. 05 ) in cTnI positive group than that in cTnI negative group. Multivariate logistic regression analysis showed that serum cTnI concentration in patients with CHF was an independent risk factor of clinical outcome by 10 d and 3 months. Conclusion Serum cTnI is a predictive factor of cardiac remodeling and cardiac function in patients with CHF, also an independent risk factor of recent poor prognosis in patients with CHF.
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