急性缺血性卒中患者血清肌钙蛋白T与其它生化标志物变化的临床意义

Clinical Significance of Changes of Cardiac Troponin T and Other Biochemical Markers in Acute Ischemic Stroke Patients

目的：旨在观察急性缺血性卒中患者血清中肌钙蛋白T水平及其它生化标志物如血清三碘甲状腺氨酸（triiodothyronine ,T3）、肿瘤坏死因子- （tumor necrosis factor- ,TNF- ）水平变化,以探讨其与近期预后、卒中严重程度的相关性.方法：观察急性缺血性卒中患者68例（男病人35例,平均年龄68±11.4岁;女病人33例,平均年龄69±10.3岁）.入院后空腹12小时抽静脉血测试： 肌钙蛋白T、T3、TNF- ;存活的卒中病人在急性期间和出院后以电话随访的形式记录1个月内死亡及突发其他事件.结果：根据肌钙蛋白T的检测水平分为两组,肌钙蛋白T正常组54例（79.4%）,肌钙蛋白T阳性组有14例（20.6%）.肌钙蛋白T阳性与美国国立卒中神经功能评分标准（National Institutes of Health Stroke Scale NIHSS）评分的神经功能缺损程度有统计学意义（P＜0.001）.肌钙蛋白T与T3的下降呈负相关（r=-0.324 ,P=0.021）.肌钙蛋白T与TNF- 呈正相关（r= 0.67,P=0.017）.经过年龄、NIHSS调整肌钙蛋白T仍为死亡的独立危险因素（RR=2.34,95%CI=1.22～5.02,P=0.0011）.结论：急性缺血性卒中后T3水平下降、TNF- 水平升高与肌钙蛋白T相关,提示卒中后应激和炎性反应两者可能参与了心脏的损害.肌钙蛋白T的异常升高影响短期预后,可作为急性缺血性卒中短期预后不良的临床观测指标.

Objective：Through observing the change of serum cardiac troponin T level and other biochemical markers such as triiodothyronine（T3） and tumor necrosis factor- （TNF-）in acute ischemic stroke patients, to investigate the correlation between the indictors change and short-term prog- nosis and stroke severity. Methods： 68 patients with acute ischemic stroke （male 35 eases ,mean age 68 ± 11.4 years; female 33 cases, mean age 69±10.3 years）were observed. All cases were collected fasting blood sample to test cardiac troponin T ,T3 and TNF- . Death and other unexpected events were recorded in the form of telephone follow-up within one month in survival patients during and discharge from hospital. Results：According to cardiac troponin T detection level, all eases were divided into two groups, normal group （54 eases, 79.4 %） and positive group（14 eases, 20.6 %）. There was statistical significance between positive cardiac troponin T and NIHSS score neurological deficits （P〈0. 001）. cardiac troponln T was negratively correlated with T3（r= -0. 324, P=0. 021） ,but positively with TNF- （r=0.67, P=0. 017）. After age, NIHSS adjustment cardiac troponin T remains an independent risk factor for death （RR=2.34,95%CI=1.22-5.02,P=0. 0011）. Conclusion ： After acute ischemic stroke , cardiac troponin T was correlated with dropping T3 level and increasing TNF- level,suggesting that both stress and inflammatory response may be involved in heart damage. Abnormal elevation of cardiac troponin T influenced short-term prognosis of acute ischemic stroke,which can be used as short-term indicators of poor prognosis in the clinlcal observations.