血清肌钙蛋白诊断继发性心肌损伤及预后观察

Serum Troponin Diagnosis and Prognosis in Secondary Myocardial Injury

目的 观察血清肌钙蛋白I(cTnI)对危重病患者急性心肌损伤诊断及预后判断的价值。方法 49例入住ICU的患者 ,按APACHEII评分分为危重组 (APACHEII≥ 16 )和普通组 (APACHEII <16 ) ,以化学发光法测入ICU 2 4小时内及 48小时时的血清肌钙蛋白I(cTnI)和肌酸激酶同功酶 (CK—MB)。另 15例健康献血员为对照组。结果 两个时点的cTnI和CK—MB ,危重组和普通组均高于对照组 ,差异显著 (P <0 .0 5 ) ,但危重组与对照组差异更显著 (P <0 .0 1) ;死亡组与生存组比较 ,两个时点的cTnI均增高显著 (P <0 .0 5 ) ,生存率与cTnI呈负相关 (γ =- 0 .33,P =0 .0 2 6 ) ;而CK—MB在两组间差异无显著性 (P >0 .0 5 )。部分多发伤患者 ,有CK—MB增高而无cTnI增高。部分心衰患者 ,有cTnI增高而无CK—MB增高。结论 :cTnI和CK—MB均可用于诊断危重病患者的急性心肌损伤 ,但cTnI特异性更高 。

Objective To observe the changes of the Cardial Troponin I (cTnI) in serum in critical ill patients with acute myocardial injury and to assess its significant in the diagnosis and prognosis in the these patients.Methods The forty-nine patients who entered The ICU were divided into critical group (APACHE II >=16) and general group (APACHE II <16). They were measured the concentration of the cTnI and Creatinkinase-MB (CPK-MB) by the chemoluminescence in 24 hour and on the forty-eighth hour. The other fifteen healthy volunteers who devoted their blood are the normal controls.Results The concentrations of cTnI and CPK-MB in the Two Points of critical group and normal group were both higher than the control group. But the more significant difference was found between critical group and control group (P<0.01) .The death group compared with living group, the cTnI were both higher in the two points (P<0.05), but the CPK-MB not (P>0.05). Some patients with multiple injury, Their CPK-MB were increased but cTnI not, and some patients with congestive heart failure were opposite.Conclusion cTnI and CK-MB are both valuable indications to diagnosis acute myocardial injury. But cTnI are more special and more valuable in prognosis.