肌钙蛋白对髋部骨折患者短期和长期病死率的预测作用

Perioperative troponin I to predict short-term and long-term mortality in patients after hip fracture

目的：探讨骨折患者围术期肌钙蛋白升高对短期（30 d）和长期（3年）病死率的预测意义。方法2005年1月－2010年1月，65岁或以上因髋部骨折的患者在入院时均进行登记，在入院时、术前和术后第1、3天完成心电图、肌钙蛋白检测并随访3年。结果285例患者完成研究，其中101例（35．4％）出现肌钙蛋白升高：入院时肌钙蛋白已经升高者31例（30.7％）、术前升高者17例（16．8％）、术后肌钙蛋白升高者53例（52．5％）；153例（53．7％）出现心电图改变，包括65例（22．8％） ST段压低、11例（3．9％） ST段抬高及77例（27．0％） T波倒置。肌钙蛋白升高者其短期和长期病死率均高于正常者（18．8％比3．3％，P＜0.01，61．4％比40.8％，P＜0.01），肌钙蛋白明显升高（肌钙蛋白＞0.15μg／L）者30 d的病死率较轻度升高（肌钙蛋白在0.03～0.15μg／L）者病死率高（21．9％比13．5％，P＜0.01）。肌钙蛋白升高是短期和长期病死率的独立预测因子。除ST段抬高外，缺血性心电图改变对病死率无影响。结论围术期肌钙蛋白升高是短期和长期病死率的强烈预测因子，常规肌钙蛋白检测和及时诊断，有效治疗对这类易损患者有重要临床意义。

Objective To investigate the short-term and long-term prognostic value of perioperative troponin I （ TnI） monito-ring in hip fracture patients.Methods All patients with hip fracture were enrolled on admission from January 2005 to January 2010. Of 285 patients, older than 65 years, serum Troponin I and electrocardiogram （ ECG） was evaluated on admission, before operation, and on first and second postoperative days.Median follow-up time was 3 years （1000 days）.Results TnI elevation was detected in 101 patients （35.4%）：already elevated on admission in 31 patients （30.7%）, before operation in 17 patients （16.8%） and only operated in 53 patients （52.5%）.Ischemic ECG changes were detected in 153 patients （53.7%）, consisting of ST depression （n=65, 22.8%）, ST elevation （n=11, 3.9%）, or T-wave inversion （n=77, 27.0%）.Patients with TnI elevation had higher short-term and long-term mortality （18.8%vs 3.3%, P〈0.01, 61.4%vs 40.8%, P〈0.01）, mortality of 30 days being higher in pa-tients with major （TnI≥0.15 μg/L） compare with mild （TnI=0.03-0.15 μg/L） TnI elevation （21.9% vs 13.5%, P〈0.01）. TnI elevation was the independent predictor of short-term mortality.ECG changes other than ST elevation did not affect mortality.Con-clusion Perioperative TnI elevation is a strong predictor of short-term and long-term mortality.Routine TnI detection and earlier diag-nosis together with effective treatment may improve survival of this fragile patient group.