血浆肌钙蛋白I对急性肺栓塞预后的评估

The value of cardiac tropnins I for the prognosis of patients with acute pulmonary embolization

目的探讨血浆肌钙蛋白(cTn1)水平对评估急性肺栓塞(PE)患者预后的价值。方法78例急性肺栓塞患者,通过肺核素扫描、螺旋CT、磁共振、肺动脉造影确诊,入院后均行cTn1、心电图(ECG)、超声心动图(UCG)、血气分析等检查,对怀疑冠心病者行冠状动脉造影。结果cTn1>0.05ng/ml共34例,其中大面积PE16例(47%),次大面积18例(53%);UCG均示右室功能障碍(100%),心电图示右室负荷过重28例(82%),低氧血症30例(88%),心源性休克9例(26%)。应用血管活性药物升压治疗11例(32%),行机械通气8例(24%),死亡7例(21%),行溶栓治疗26例(76%);cTn1<0.05ng/ml者44例,其中大面积PE3例(7%),次大面积12例(27%),小面积29例(66%);UCG示右室功能障碍15例(34%),心电图示右室负荷过重14例(32%),低氧血症24例(55%),心源性休克1例(2.3%);应用血管活性药物升压治疗2例(4.5%),行机械通气2例(4.5%),死亡1例(2.3%),行溶栓治疗10例(23%)。cTn1升高组与cTn1正常组比较右室功能障碍、低氧血症的发生率均有显著性差异,且cTn1升高组心源性休克发生率、应用机械通气、升压药物及住院期间死亡发生率、行溶栓治疗比率均明显高于cTn1正常组(P<0.05)。结论cTn1可作为急性肺栓塞患者独立的预后指标,可以帮助明确危险分层,指导治疗。

Objective To assess the value of cardiac troponin Ⅰ for the prognosis of acute pulmonary embolism. Methods This study observed 78 acute pulmonary embolism patients. The diagnosis was confirmed PE by ventilation-perfusion lung scan, spiral computed tomography（sCT）, magnetic resonance imaging（MRI）, pulmonary angiography and coronary heart disease （CAD） was excluded. Serum cTnl, electrocardiogram, echocardiography, blood gas analysis of these patients were taken after admission. The coronary angiography were taken for suspected CAD patients. Results Among these patients, 34 cases whose cTnl were higher than 0.05ng/ml were diagnosed as massive or sub-massive PE, 16 patients （47%） were diagnosed as massive PE, 18 patients （53%） were sub-massive PE. In theses patients, 34 cases （100%） showed right heart dysfunction in UCG, right ventricular 28 （82%） in ECG, 30 cases （88%） had hypexemia, 9 cases （26%） had cardiogenic shock, 11 cases （32%） were treated with vasoactive agents, 8 cases （24%） had mechanic ventilation, 7 cases （21%） died, and 26 cases （76%） were thrombolyzed. The cTnl was lower than 0.05ng/ml in 44 patients. In this group, 3 cases （7%） were massive PE, 12 cases （27%） were sub-massive PE, 29（66%） were small PE, 15 （34%） had right heart dysfunction in UCG, right ventricular in ECG in 14 cases （32%）, hypoxemia in 24 cases （55%）, cardiogenic shock in 1 case （2.3%）, vasoactive agent were wsedin 2 cases （4.5%） and mechanic ventilation were performed in 2 cases （4.5%）, one patient （2.3%） died and 10 （23%） were thrombolyzed. There was signigicant difference in the occurrence of right heart dysfunction and hypoxemia, High cTnl group tended to have mechanic ventilation, cardiogenic shock and death, meanwhile they had a tendency of using vasoactive agents and thrombolysis therapy（P〈0.05）. Conclusions Serum cTn1 can be used as independent parameter for PE, and can be used to stratify risk levels for severity and assess effectiveness of treatment.