急性有机磷农药中毒患者血清心肌肌钙蛋白I与高敏C反应蛋白及肿瘤坏死因子α的关系及其临床意义

The relationship between serum cardiac troponin I and high sensitivity C-reactive protein, tumornecrosis factor-alpha in patients with acute organophosphorus pesticide poisoning and theirclinical significance

目的探讨急性有机磷农药中毒（AOPP）患者血清心肌肌钙蛋白I（cTnI）与高敏C反应蛋白（hs-CRP）及肿瘤坏死因子α（TNF-α）之间的关系及其临床意义。方法选取无猝死AOPP患者112例（AOPP组），同时选取健康体检者112例（对照组），比较两组血清cTnI、hs-CRP及TNF-α水平，分析血清cTnI与hs-CRP及TNF-α的关系；观察AOPP组患者阿托品化时间、胆碱酯酶活性恢复时间及住院时间，比较不同血清cTnI水平AOPP患者的疗效。结果AOPP组血清cTnI、hs-CRP及TNF-α水平[0．75（0．26，0．99）μg／L、11．57（5．13，21．62）mg／L、（12．36±5．22）μg／L]明显高于对照组[0．01（0，0．03）μg／L、3．62（2．31，6．80）mg／L、（7．33±4．31）μg／LJ（P〈0．01）。AOPP患者血清cTnI水平与hs-CRP及TNF-α水平呈显著正相关（r=0．53、0．62，P〈0．01）。高水平cTnI患者（56例）阿托品化时间、胆碱酯酶活性恢复时间及住院时间[（7．31±1．96）、（15．29±3．66）、（17．23±3．62）d]均较低水平cTnI患者（56例）[（5．32±1．03）、（11．32±2．59）、（13．66±3．03）d]延长，差异有统计学意义（P〈0．01）。结论AOPP患者中，炎性反应与心脏损害有关；在无猝死AOPP患者中，心脏损害亦会影响AOPP的疗效。

Objective To explore the relationship between serum cardiac troponin I （cTnI） and high sensitivity C-reactive protein （hs-CRP）, tumor necrosis factor-alpha （TNF-α ） in patients with acute organophosphorus pesticide poisoning （AOPP） and their clinical significance. Methods One hundred andtwelve patients with AOPP （without sudden death） were as AOPP group. One hundred and twelve healthy controls were as control group. Serum cTnI,hs-CRP and TNF-α levels were determined by ELISA and compared between two groups. The relationship between serum cTnI and hs-CRP, TNF-α was analyzed. Time for atropinization and acetylcholinesterase activity recovery and days of hospitalization were observed. The effectiveness of AOPP patients in different serum cTnI levels was compared. Results Serum cTnI, hs-CRP and TNF-α levels in AOPP group [ 0.75 （0.26,0.99） μg/L, 11.57 （5.13,21.62） μg/L, （ 12.36 ± 5.22） μg/L] were higher than those in control group[0.01 （0,0.03） 0, g/L,3.62（2.31,6.80） mg/L, （7.33 ± 4.31 ） μg/L] （P 〈 0.01 ）. Serum cTnI levels were positive correlation with serum hs-CRP and TNF-α levels in AOPP patients （r = 0.53,0.62, P 〈 0.01 ）. Time for atropinization and acetylcholinesterase activity recovery and days of hospitalization in higher serum cTnI levels patients （56 cases） [ （7.31 ± 1.96）,（ 15.29 ± 3.66）, （17.23 ±3.62） d] was longer than that in lower serum cTnI levels patients （56 cases） [（5.32 ± 1.03）, （11.32 ± 2.59）, （13.66 ± 3.03） d ] （P 〈 0.01 ）. Conclusions Cardiac insults in AOPP patients are related to inflammation. Sudden death-free AOPP patients with higher cTnI levels have less response to treatments.