心肌肌钙蛋白I水平联合Tilburg量表对高龄心力衰竭患者预后的判断价值

曾文莉; 马红梅

doi:10.12125/j.chj.201912104

心肌肌钙蛋白I水平联合Tilburg量表对高龄心力衰竭患者预后的判断价值

Prognostic value of cTnI level combined with Tilburg scale in elderly patients with pneumonia and heart failure

摘要

摘要:
目的探讨心肌肌钙蛋白(cardiac troponin，cTn)I及Tilburg衰弱量表（tilburg frailty scale，TFI）对老年慢性心力衰竭（chronic heart failure，CHF）患者预后的评估价值。
方法选取2014年9月～2017年8月我院心内科收治的经确诊为老年CHF患者280例作为研究对象，根据NYHA心功能分级将患者分为四组，比较各组cTnI及TFI评分水平。再根据患者随访期间是否发生主要不良心血管事件(major adverse cardiovascular events，MACE)分为MACE组（n=92）和非MACE组（n=188），收集患者一般临床资料、入院第2天血液生化指标、cTnI及TFI评分，采用COX比例风险模型分析cTnI及TFI评分与MACE的关系，并根据ROC曲线下cTnI及TFI评分的最佳临界值对老年CHF患者进行危险分组，经Kaplan-Meier生存分析法分析各组间MACE平均发生时间的差异。
结果 cTnI及TFI评分水平随NYHA心功能分级的增高呈明显上升，差异有统计学意义（P<0.05）；与非MACE组比较，MACE组患者cTnI及TFI评分更高，差异均具有统计学意义（P<0.05）；cTnI及TFI评分的ROC曲线下面积分别为0.722、0.761，具有较高的诊断价值，最佳临界值分别为8.36ng/ml、8分；COX分析结果显示，cTnI>8.36ng/ml、TFI评分>8分是老年CHF患者发生MACE的独立危险因素；以cTnI及TFI评分的最佳临界值将患者分层，Kaplan-Meier生存曲线分析结果显示，低危组、中危组、高危组三组患者发生MACE的平均生存时间分别为14.37个月、9.39个月、7.29个月，差异有统计学意义（P<0.05）。
结论老年CHF患者cTnI、TFI评分随着心功能增加明显升高，同时二者是老年CHF患者发生MACE的独立预测因子，二者联用可提高老年CHF患者3年MACE发生的预测效率，具有潜在临床诊断价值。

Abstract:
AIM To evaluate the prognostic value of cardiac troponin I (cTnI) and Tilburg frailty scale (TFI) in elderly patients with chronic acute heart failure (CHF).
METHODS A total of 280 elderly CHF patients admitted to Renmin Hospital from September 2014 to August 2017 were divided into four groups according to NYHA cardiac function classification, and the cTnI and TFI scores of each group were compared. By adverse cardiovascular events occurrence during the follow-up period, the patients were divided into major adverse cardiovascular events (MACE) group (n = 92) and non-MACE group (n = 188). The patients’ general clinical data, their blood biochemical indexes the day after admittance to hospital and cTnI and TFI scores were collected. COX proportional hazards models were used to analyze the relationship between cTnI and TFI scores and MACE. According to the cTnI under ROC curve and the best threshold TFI scores, the elderly CHF patients were stratified and Kaplan-meier survival analysis was used to analyze the difference of mean time of MACE occurrence between the stratified groups.
RESULTS The scores of cTnI and TFI increased significantly with the increase of NYHA cardiac function grading (P < 0.05). Compared with those in non-MACE group, cTnI and TFI scores in the MACE group were higher, with statistically significant differences (P < 0.05). The area under the ROC curve of cTnI and TFI scores were 0.722 and 0.761, respectively, which had a high diagnostic value. The optimal threshold values were 8.36 ng/mL and 8 points, respectively. COX analysis results showed that cTnI > 8.36 ng/mL and TFI score > 8 were independent risk factors for MACE in elderly CHF patients. Patients were stratified with the optimal critical values of cTnI and TFI scores. Kaplan-meier survival curve analysis showed that the mean survival time of patients with MACE in the low risk group, the middle risk group and the high-risk group was 14.37 months, 9.39 months and 7.29 months, respectively, with statistically significant differences (P < 0.05).
CONCLUSION CTnI and TFI scores of elderly CHF patients increase significantly with increase of cardiac function and they are independent predictors of MACE in elderly CHF patients, with high diagnostic value. The combination of the two could potentially improve 3-year prediction efficiency of MACE in elderly CHF patients, which would have significant clinical importance.

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