蝮蛇咬伤患者肌酸激酶和肌钙蛋白I的变化与心功能相关性研究

Study on correlation between heart function and the dynamic change of cardiac enzymes and troponin I in patients by the viper bites

目的探讨蝮蛇咬伤患者心肌酶学(CK-MB、CK)和肌钙蛋白I(cTnI)变化与心功能的相关性。方法将106例蝮蛇咬伤患者按病情程度分为轻、重、危重型3组,对3组患者的心肌肌钙蛋白I及心肌酶学、左室Tei指数进行测定并进行比较分析。结果危重型组患者的CK、CK-MB、Tei指数、cTnI阳性率均高于轻、重型组,差异有显著性(P<0.05)。cTnI呈阳性患者的左室Tei指数与CK、CK-MB相关系数为0.311、0.266。结论 cTnI对蝮蛇咬伤患者心肌损伤的敏感性及特异性均高于CK和CK-MB。蝮蛇咬伤中毒患者心肌酶学升高可以判断骨髂肌损伤程度,只有极少数危型蝮蛇咬伤患者合并有心肌损伤,左室Tei指数测定也证实蝮蛇咬伤cTnI呈阳性者均有心功能受损。

Objective To investigate the relationship between the dynamic change of cardiac enzymes,cardiac tro- ponin I（cTnI） ,Tei index and the degree of viper. Methods 106 cases of viper-bitten patient in Emergency De- partment from July, 2010 to July, 2012 are divided into light, heavy, severe type snakebite poisoning group, fasting serum level of cTnI and cardiac enzymes （CK-MB, CK）, myocardial function （Tei index） were detected in three group before treatmen. The three groups myocardial enzyme and the Tel index are recorded respectively and the differences are analyzed by t test. The differences of the cTnI positive rate between the two groups are analyzed by chi-square test. Results There is significant difference in the changes of CK-MB, CK,cTnI and Tei index be- tween patients with light, heavy,severe type snakebite poisoning group （P〈0. 01）. There was an increase of differ- ent levels in cTnI and cardiac enzymes along with the degree of viper. Conclusion cTnl was more sensitive and special marker for myocarditis than CK and CK-MB. The evaluation of myocardial enzyme in patients by the viper bites may be caused by skeletal muscle injury,not by direct myocardium injury. The level of cardiac cTnI,cardiac enzymes and Tei index in patients with viper may be as useful markers of degree of poisoning and prognosis.