肌钙蛋白Ⅰ对非心源性危重患者的预后价值

Cardiac troponin Ⅰ testing for the prognosis of non-cardiogenic critically ill patients

目的探讨肌钙蛋白Ⅰ（CTNⅠ）能否预测非心源性危重患者的28d病死率。方法选取2006年10月20日至2007年10月20日北京朝阳医院431例急诊室非心源性危重患者，测量血中CTNⅠ浓度，记录各项生化指标并计算APACHEⅡ评分。随访28d，记录患者是否存活，进一步分析人选时CTNⅠ水平与28d病死率的关系。结果共200例患者CTNⅠ水平升高，与CTNⅠ水平正常组比较，CTNⅠ升高组患者的28d病死率更高。CTNⅠ水平预测28d死亡率的ROC曲线下面积是0．733，预测患者死亡率的最佳界值点是0．05ng／L。多因素回归分析表明CTNⅠ升高〉0．05ng／L（HR1．979，95％CI1．398～2．802，P〈0．001）、APACHE Ⅱ评分升高〉16（HR4．428，95％CI 3．019～6．494，P〈0．001）、血浆白蛋白水平降低〈25g／L（HR1．812，95％CI 1．276～2．573，P=0．001）是预测患者28d死亡率的独立危险因素。进一步分析表明，CTNⅠ与APACHEⅡ评分均升高的患者28d病死率最高。结论急诊非心源性危重患者的CTNⅠ水平升高是其28d病死率的独立预测因子，同时CTNⅠ联合APACHEⅡ评分对于此类患者的预后有协同作用。

Objective To investigate the role of cardiac troponin Ⅰ （ CTN Ⅰ ） for predicting 28- day mortality of non-cardiogenic critically ill patients at emergency department （ED）. Methods A total of 431 non-cardiogenic critically ill patients at ED were prospectively enrolled and blood samples obtained for CTN Ⅰ measurements. A variety of laboratory variables and the Acute Physiology and Chronic Health Evaluation （APACHE） Ⅱ scores were recorded. At Day 28, the survival status of each patient was ascertained and the association between CTN Ⅰ at presentation and mortality assessed. Results Two hundred patients had elevated CTN Ⅰ levels and 231 had normal levels. Compared with those with normal levels, the patients with elevated CTN Ⅰ levels had a higher 28-day mortality. The CTN Ⅰ concentration alone had an area under the receiver operating characteristic curve （AUC） of 0. 733 for mortality prediction. The optimal CTN Ⅰ cut-off point for predicting the 28-day mortality was 0. 05 ng/L. By multivariate analysis, an elevated CTN Ⅰ level（ 〉0. 05 ng/L, HR 1. 979,95% CI 1. 398-2. 802, P 〈0. 001 ）, a high APACHE Ⅱ score （ 〉 16, HR 4. 428,95% CI 3.019-6. 494, P 〈 0. 001 ） and hypoalbuminemia （ 〈 25 g/L, HR 1. 812, 95% CI 1. 276-2. 573 ,P =0. 001 ）were the three most important independent predictors for a shorter survival. Combination analysis showed a shorter survival in patients with a high APACHE Ⅱ score plus elevated CTN Ⅰ levels than those with a high APACHE Ⅱ score or an elevated CTN Ⅰ level alone. Conclusion An elevated serum CTN Ⅰ level is a independent predictor of 28-day mortality in non- cardiogenic critically ill patients. And CTN Ⅰ level and APACHE Ⅱ score have an additive effect in outcome prediction.