心肌肌钙蛋白Ⅰ在多发伤合并心肌挫伤中的诊断价值

Diagnostic significance of cardiac troponin I in multiple trauma patients combined with myocar-dial contusion

目的探讨心肌肌钙蛋白Ⅰ（cardiac troponinⅠ，cTnⅠ）在多发伤合并心肌挫伤中的诊断价值。方法采用回顾性观察研究，98例并钝性胸部伤的多发伤患者按是否合并心肌损伤分为两组，合并心肌挫伤组48例，未合并心肌挫伤对照组50例，比较cTnI和肌酸激酶心肌同工酶与肌酸激酶比值（CKMB／CK）不同界值及联合指标在两组患者中的检出率及诊断价值。结果cTnⅠ≥0．60ng／ml诊断心肌挫伤的特异度和敏感度分别为90．0％和64．6％，Youden指数为0．54。联合cTnI≥0．60ng／ml和CKMB／CKt〉6％较单独检测cTnⅡ〉0．60ng／m1或CKMB／CK≥6％敏感度显著提高（85．4％：64．6％，P〈0．05）（85．4％：27．1％，P〈0．05），且较二者特异度无显著下降（84．0％：90．0％，P〉0．05）（84．0％：88．0％，P〉0．05）。cTnI水平与多发伤合并心肌挫伤患者ISS评分呈正相关（r=0．534，P〈0．01）；与cTnⅠ轻中度异常组比较，cTnⅠ重度异常组死亡率明显增加（P〈0．01）。结论cTnⅡ〉0．60ng／ml对多发伤合并心肌挫伤诊断有高度的特异度和较好的敏感度，可作为多发伤合并心肌挫伤的生化监测诊断指标，其联合CKMB／CK≥6％可提高诊断的敏感度。cTnⅠ可作为多发伤并心肌挫伤的早期危险分层和预后评价指标。

Objective To investigate the value of cardiac troponin I （cTn I ） in diagnosis of multi-trauma patients combined with myocardiac contusion. Methods A retrospective review was made on 98 cases of multi-trauma patients combined with blunt chest trauma. The groups were identified acording to whether the patients were associated with myocardiac contusion or not, including myocardiac contusion group （n =48） and non-myocardiac contusion group （n =50）. The detection and diagnosis of myocardiac contusion in the use of different cuoff points of cTn I and creatine kinase MB isoenzyme/ creatine kinase （CKMB/CK） or their combination were compared between groups. Results cTn Ⅰ≥ 0. 60 ng/ml had a specificity of 90.0%, a sensitivity of 64.6% and a Youden index of 0.54 in diagnosis of myocardiac contusion, indicating a best diagnostic accuracy as a single parameter. As compared with the single use of cTn Ⅰ ≥ 0.60 ng/ml or CKMB/CK ≥ 6% in diagnosis of myocardiac contusion, the combined use of two parameters presented a significantly higher diagnostic sensitivity （85. 4% vs 64.6% ; 85.4% vs 27.1% respectively, both P 〈0.05 ）, but no markedly lower specificity （84.0% vs 90.0% ; 84.0% vs 88.0% respectively, both P 〉 0.05）. cTn I level was positively correlated with ISS score of the multi-trauma patients combined with myocardiac contusion （ r = 0. 534 ,P 〈 0.01 ）. Mortality rate in patients with severely increased cTn Ⅰ was much higher than that in patients with mild-moderately increased cTn I （P 〈 0.01 ）. Conclusions cTn Ⅰ≥ 0.60 ng/ml presents a high sensitivity and preferable specificity for diagnosis of multiple trauma patients combined with myocardiac contusion. It can be served as a biomarker for diagnosis of MC and its combination with CKMB/CK≥6% improves the diagnostic sensitivity, cTn Ⅰ can be used as an assessment indicator for the early risk stratification and outcome in multi-trauma patients combined with myocardiac contusion.