CK-MB和cTnⅠ在尿毒症合并急性左心衰竭患者中的变化趋势

Variation trend of creatine kinase MB and cardiac troponin Ⅰ in patients with uremia complicated by acute left ventricular failure

目的分析肌酸激酶同工酶(CK-MB)和心肌肌钙蛋白Ⅰ(cTnⅠ)在尿毒症合并急性左心衰竭患者中的变化趋势和与预后的关系。方法连续选择2014年1月~2015年1月间于海军总医院接受维持性血液透析(MHD)治疗的尿毒症患者共130例,其中男性76例,女性54例。根据是否出现透析相关的急性左心衰竭分为心衰组(30例)和对照组(100例)。检测发生左心衰竭后不同时间点的CK-MB、cTnⅠ、血清肌酐(Scr)、尿素氮(BUN)水平。出院后随访1年,比较总死亡率和心源性死亡率。检测院内和随访期间(出院后1个月、6个月、12个月)的N末端脑钠肽前体(NT-proBNP)和左室射血分数(LVEF)水平。结果不同时间点心衰组的CK-MB和cTnⅠ水平均明显高于对照组,差异有统计学意义(P均<0.05),心衰组的CK-MB和cTnⅠ缓慢上升达平台期,无明显峰值和下降趋势。不同时间点,心衰组和对照组的Scr和BUN水平比较,差异均无统计学意义(P均>0.05)。心衰组院内、出院后1个月、出院后6个月、出院后12个月的NT-proBNP水平均明显高于对照组,差异有统计学意义(P均<0.05)。心衰组院内LVEF明显低于对照组,差异有统计学意义(P<0.05);而随访期间的LVEF值与对照组比较,差异均无统计学意义(P均>0.05)。心衰组的总死亡率和心源性死亡率均明显高于对照组,60.0%vs.30%,77.8%vs.46.7%,差异有统计学意义(P均<0.05)。结论 CK-MB和cTnⅠ在尿毒症合并急性左心衰竭患者中变化明显,与患者预后有关。

Objective To analyze the change trend of creatine kinase MB （CK-MB） and cardiac troponin I （cTnI） and relationship between them and prognosis in patients with uremia complicated by acute left ventricular failure （ALVF）. Methods The patients with uremia （n=130, male 76 and female 54） received maintenance hemodialysis （MHD） were chosen from Chinese PLA Navy General Hospital from Jan. 2014 to Jan. 2015. All patients were divided, according to whether or not having ALVF related to MHD, into ALVF group （n=30） and control group （n=100）. The levels of CK-MB, cTnI, serum creatinine （SCr） and blood urea nitrogen （BUN） were detected at different time points after ALVF. The groups were followed up for 1 y for comparing the total mortality and cardiac mortality. The levels of N-terminal pro-brain natriuretic peptide （NT-proBNP） and left ventricular ejection fraction （LVEF） were detected during hospitalization and follow-up period （1 m, 6 m and 12 m after discharged from hospital）. Results The levels of CK-MB and cTnI were significantly higher in ALVF group than those in control group at different time points （all P〈0.05）. CK-MB and cTnI increased slowly to platform phase without significant peak value and descending trend in ALVF group. The difference in levels of SCr and BUN had no statistical significance between 2 groups at different time points （all P〉0.05）. The level of NT-proBNP was significantly higher in ALVF group than that in control group during hospitalization and after discharge for 1 m, 6 m and 12 m （all P〈0.05）. The level of LVEF was significantly lower in ALVF group than that in control group during hospitalization （P〈0.05）, and different in level of LVEF had no statistical significance between 2 group during follow-up period （all P〉0.05）. The total mortality （60.0% vs. 30%） and cardiac mortality （77.8% vs. 46.7%） were all higher in ALVF group than those in control group （all P〈0.05）. Conclusion The changes of CK-MB and cTnI are significant and related to prognosis in patients with uremia complicated by ALVF.