血清心肌肌钙蛋白T对危重病患者心肌损伤的诊断价值

The diagnostic value of cardiac troponin T in myocardial injury in critically ill patients

目的：探讨血清心肌肌钙蛋白Ｔ（ｃＴｎＴ）对危重病患者心肌损伤的诊断价值。方法：利用肌酸激酶同功酶（ＣＫＭＢ）和ｃＴｎＴ两指标，检测１５例ＡＰＡＣＨＥⅡ≥１６分的危重病患者、１０例ＡＰＡＣＨＥⅡ≤１０分的无胸部伤的多发伤患者和２０例健康献血员血清ｃＴｎＴ和ＣＫＭＢ，进行对比研究。结果：在危重病患者发病后４小时内、第２４小时、第１２０小时和第２４０小时，ｃＴｎＴ浓度分别为（０．７９±０．７４）μｇ／Ｌ、（１．６８±１．５０）μｇ／Ｌ、（３．０１±２．３２）μｇ／Ｌ和（３．０３±１．９６）μｇ／Ｌ，显著高于健康献血员〔（０．０５±０．０３）μｇ／Ｌ〕和多发伤患者发病后４小时内、第２４小时与第１２０小时水平〔（０．０８±０．０３）μｇ／Ｌ、（０．０６±０．０２）μｇ／Ｌ与（０．０６±０．０３）μｇ／Ｌ，Ｐ＜０．０５或Ｐ＜０．０１〕。危重病患者发病后４小时内、第２４小时、第１２０小时和第２４０小时ＣＫＭＢ浓度分别为（０．０９±０．０６）μｇ／Ｌ、（０．１２±０．０８）μｇ／Ｌ、（０．０６±０．０４）μｇ／Ｌ和（０．０７±０．０７）μｇ／Ｌ，发病后４小时内与第２４小时ＣＫＭＢ显著高于健康献血员〔（０．０２±０．０１）μ?

Objective:To evaluate the diagnostic value of cardiac troponin T (cTnT) in myocardial injury in critically ill patients.Methods:Serum cTnT and creatine kinase MB (CKMB) levels were determined in 15 critically ill patients (APACHEⅡ≥16),10 polytrauma patients without chest injuries (APACHEⅡ≤10),and 20 healthy volunteers.Results:Serum cTnT levels in critically ill patients were (079±074)μg/L,(168±150)μg/L,(301±232)μg/L and (303±196)μg/L at<4,24,120,240 hours after injuries respectively,which were significantly higher than those in polytrauma patients at<4,24,120 hours 〔respectively(008±003)μg/L,(006±002)μg/L,and (006±003)μg/L,P<005 or P<001〕 and in normal controls 〔(005±003)μg/L,all P<001〕.CKMB levels in critically ill patients at<4,24,120 and 240 hours were (009±006)μg/L,(012±008)μg/L,(006±004)μg/L and (007±007)μg/L,respectively.They were much higher than those in normal controls 〔(002±001)μg/L〕,but not markedly different from polytrauma patients at<4 and 24 hours 〔respectively (010±003)μg/L and (017±013)μg/L〕.Conclusions:Myocardial injury may occur in critically ill patients.cTnT and CKMB could serve as useful markers to reflect myocardial injury and judge the prognosis in critically ill patients,and cTnT appears to be superior to CKMB for clinical use.