肌酸激酶同工酶、肌钙蛋白T和N端B型脑钠肽联合检测对胸部放疗时心脏损伤的评估价值研究

The Estimated Value of Creatine Kinase-MB,Troponin T and Brain Natriuretic Peptide in Heart Injury for Patients Treated with Chest Radiation-therapy

目的探讨肌酸激酶同工酶(creatine kinase isoenzymes,CK-MB)、肌钙蛋白T(cardiac troponin,cTnT)和N端B型脑钠肽(brain natriuretic peptide, BNP)联合检测对胸部放疗时心脏损伤的评估价值。方法选取2015年1月至2017年1月间我院行胸部三维适形放疗的80例患者作为研究对象,所有患者进行三维适形放疗。评价放射性心脏损伤发生情况,比较放疗前后CK-MB、cTnT和BNP水平变化,以及CK-MB、cTnT、BNP各单项检测和联合检测的诊断放射性心脏损伤价值。结果本研究中发生放射性心脏损伤包括T波低平、心动过速或过缓、ST段压低、I度房室传导阻滞等。其中,T波低平发生率最高,发生率为18.75%(15/80)。本研究中II级放射性心脏损伤发生率最高,发生率为15.00%(12/80)。与放疗前相比,放疗后4周、6周时CK-MB、cTnT、BNP水平均降低,且随时间延长呈现下降趋势,差异具有统计学意义(P <0.05)。与CK-MB、cTnT、BNP的各单项检测比较,CK-MB、cTnT、BNP联合检测的灵敏度、特异性、准确性、阳性预测值、阴性预测值均升高,差异均具有统计学意义(P<0.05)。结论胸部放疗后患者CK-MB、cTnT、BNP水平降低,三者联合检测可提高放射性心脏损伤的诊断效果。

Objective To investigate the estimated value of creatine kinase-MB (CK-MB),troponin T(cTnT) and brain natriuretic peptide (BNP) in heart injury in patients treated with chest radiation-therapy.Methods 80 cases of patients underwent chest radiation-therapy in our hospital were analyzed.All patients were treated with the threedimensional conformal radiation therapy.After the treatment,the radioactive heart injury,levels of CK-MB.cTnT,BNP were estimated.Results Radioactive heart injury included tachycardia or bradycardia, T wave flat,ST segment depression,andⅠdegree atrioventricular block.The rate of T wave flat was the highest 18.75%(15/80).The Ⅱ class of radioactive heart injury was the highest 15.00%(12/80)in our study.The levels of CK-MB,cTnT,and BNP 4 and 6 weeks after the radiotherapy were lower than before radiotherapy(P<0.05).Compared with the single detection,the joint detection had higher sensitivity, specificity,accuracy,positive predictive value,and negative predictive value (P<0.05).Conclusion The levels of CK-MB,cTnT,and BNP after the chest radiation-therapy are lower.The joint detection of CK-MB, cTnT and BNP can increase the diagnostic efficiency inpatients with radioactive heart injury.