血清肌钙蛋白Ⅰ判断急性肺血栓栓塞症危险分层临床价值研究

The clinical value of serum cardiac troponin Ⅰ in acute pulmonary thrombo-embolism.

目的探讨血清肌钙蛋白Ⅰ(cTnⅠ)对急性肺血栓栓塞症(APTE)危险分层及预后的临床价值。方法选择中国医科大学附属盛京医院第二呼吸内科2007年1月至2010年2月确诊APTE并行cTnⅠ检查42例患者,按照外周血cTnⅠ水平,分为cTnⅠ阳性组20例与阴性组22例。比较两组患者临床特点、高危及中危APTE发生率、右心功能障碍、心源性休克及病死率。结果阳性组高危APTE 7例(35.0%),中危APTE 13例(65.0%);阴性组高危APTE 2例(9.1%),中危APTE 4例(18.1%)。发生心源性休克分别为7例(35.0%)、1例(4.5%)。阳性组死亡2例(10%)。两组晕厥、低氧、大面积及次大面积肺栓塞、肺动脉高压、右室扩大右心功能不全、心源性休克经统计学处理差异具有统计学意义。结论cTnI可作为APTE患者独立的预后指标,指导APTE治疗。

Objective To assess the value of serum cardiac troponin I （cTnI） for risk stratification and prognosis evaluation in patients with acute pulmonary thrombo-embolism （APTE）. Methods Fourty-two patients with confirmed APTE undergoing test for serum cTnI were enrolled in this study. Patients were divided into cTnI positive group and cTnI negative group according to results of serum cTnI. We compared the clinical features, incidences of massive and sub-massive APTE, dysfunction of right ventricle, cardiogenic shock and short-term progno- sis of patients with APTE between the both groups. Results There were 7 cases （ 35.0% ） of high risk APTE and 13 cases （ 65. 0% ） of moderate risk APTE in cTnI positive group. There were 2 cases （ 9. 1% ） of high risk APTE and 4 cases （18. 1% ）of moderate risk APTE in cTnI negative group. Two patients （10%） in cTnI positive group but none in cTnI negative group died. There were significant differences between the two groups in occurrence of syncope,hypoxemia, massive and sub-massive pulmonary embolism, pulmonary hypertension, right ventricle enlargement, right heart dysfunction and cardiogenic shock. Conclusion Serum cTnI is important for risk stratification of patients with APTE, and may be used as an independent predictor for APTE prognosis, stratification of risk levels and in guiding the treatment of APTE.