探讨血清肌钙蛋白I（cTnI）对于2型糖尿病并发冠状动脉粥样硬化性心脏病（CHD）患者的诊治价值。

选取2017年1月至2019年6月期间在浙江萧山医院诊治的122例2型糖尿病患者，根据冠状动脉造影术的检查结果分为糖尿病组（54例）和糖尿病合并CHD组（68例）；同期选取我院体检的健康人群50例，设为健康对照组。对3组人群常规检测糖化血红蛋白（HbA1c）、肌酸激酶同工酶（CK-MB）及cTnI，并进行比较。采用Pearson相关分析对糖尿病合并CHD患者心肌损伤标志物（CK-MB及cTnI）与冠状动脉病变程度（Gensini评分）进行相关性分析。采用受试者工作特征（ROC）曲线判断CK-MB及cTnI对2型糖尿病患者是否合并CHD的预测价值。

3组患者间HbA1c、CK-MB及cTnI比较，差异均有统计学意义（F = 26.820、14.011、93.287，P均<0.05）。进一步两两比较发现，糖尿病组及糖尿病合并CHD组患者的HbA1c[（6.5 ± 0.7）%、（6.7 ± 0.9）%、（5.8 ± 0.5）%]、CK-MB[（21 ± 6）、（23 ± 7）、（17 ± 4）U/L]及cTnI[（22 ± 6）、（28 ± 7）、（13 ± 4）ng/L]水平均显著高于健康对照组患者，且HbA1c及cTnI水平在糖尿病合并CHD组患者中更高（P均<0.05）。同时，对于2型糖尿病合并CHD患者，其血清cTnI水平与Gensini评分呈正相关（r = 0.547，P<0.001），而CK-MB与Gensini评分无明显相关性（r = 0.059，P>0.05）。ROC曲线分析显示，血清cTnI对2型糖尿病患者合并CHD具有较好的预测价值，其曲线下面积为0.765，且以血清cTnI水平>23.5 ng/L作为预测界点，其敏感度为72.1%，特异度为70.4%。

对于2型糖尿病患者，血清cTnI水平对于预测这类患者是否合并CHD具有明确的临床价值，其往往呈现低水平或微量升高。

To investigate the value of serum cardiac troponin I (cTnI) in the diagnosis and treatment of patients with type 2 diabetes mellitus and coronary heart disease (CHD).

A total of 122 patients with type 2 diabetes mellitus admitted to the Xiaoshan Hospital of Zhejiang from January 2017 to June 2019 were enrolled and divided into a diabetes mellitus group (54 cases) and a diabetes mellitus combined with CHD group (68 cases) according to the coronary arteriography; 50 healthy people during the same period in our hospital were selected as the healthy control group. Hemoglobin A1c (HbA1c), creatine kinase-MB (CK-MB) and cTnI were tested and compared among the three groups. The correlation between markers of myocardial injury (CK-MB, cTnI) and the degree of coronary artery disease (Gensini score) was analyzed by Pearson correlation analysis. The receiver operating characteristic (ROC) curve was used to assess the value of CK-MB and cTnI for predicting whether patients with type 2 diabetes mellitus have CHD.

The levels of HbA1c, CK-MB and cTnI all showed significant differences among 3 groups (F = 26.820, 14.011, 93.287; all P<0.05). Further pairwise comparison showed that the levels of HbA1c [(6.5 ± 0.7)%, (6.7 ± 0.9)%, (5.8 ± 0.5)%], CK-MB [(21 ± 6), (23 ± 7), (17 ± 4) U/L] and cTnI [(22 ± 6), (28 ± 7), (13 ± 4) ng/L] in the diabetes mellitus group and diabetes mellitus combined with CHD group were much higher than those in the healthy control group, and the levels of HbA1c and cTnI were highest in the diabetes mellitus combined with CHD group (all P<0.05). Meanwhile, the cTnI was positively correlated with Gensini score (r = 0.547, P<0.001), but there was no correlation between CK-MB and Gensini score (r = 0.059, P>0.05) in the patients with type 2 diabetes mellitus and CHD. The ROC curve showed that cTnI was valuable for predicting whether patients with type 2 diabetes mellitus have CHD, and the area under the curve was 0.765. With the optimal cTnI cut-off point > 23.5 ng/L, the sensitivity and specificity were 72.1% and 70.4%, respectively.

Serum cTnI isclinically valuable for predicting whether patients with type 2 diabetes mellitus have CHD, which is often in a low level or slight increase.