脑外伤合并肌钙蛋白升高与心肌梗死关系的研究

Relationship between brain injury with elevated cardiac troponin and myocardial infarction

目的研究脑外伤合并肌钙蛋白升高的患者与心肌梗死的相关性。方法选取2012年1月~2015年12月因脑外伤收住哈尔滨医科大学附属第一医院的患者135例,动态监测患者血清肌钙蛋白I(c Tn I)和肌酸激酶同工酶(CK-MB)水平,心电图(ECG)和经胸超声心动图观察心脏电活动及结构功能是否发生改变,分析GCS评分同心肌梗死的关系。结果脑外伤患者血清c Tn I和CK-MB均有不同程度的升高,其升高水平与GCS评分均呈负相关;脑外伤患者ECG出现异常者107例(79.3%),余为大致正常ECG,且随着时间的增加,部分患者可逆转;经胸超声心动图只在极重度患者中有2例出现异常,随着时间变化,心功能逐渐恶化。结论脑外伤可引起不同程度的心肌损伤,GCS评分越低,发生急性心肌梗死的风险越高,血清c Tn I可反映脑外伤患者的心脏损害。

Objective To evaluate the relationship between brain injury with elevated cardiac troponin and myocardial infarction. Methods Total of 135 patients with brain injury coming to the First Affiliated Hospital of Harbin Medical University from January 2012 to December 2015 were selected and serum cardiac troponin I （cTnI） and creatine kinase （CK-MB） levels were monitored dynamically. The electrical activity of the heart was evaluated by ECG and the functional changes were observed by transthoracic echocardiography. The relationship between GCS score and myocardial infarction was analyzed. Results The serum levels of cTnI and CK-MB were elevated in different degrees in patients with brain injury, and the higher levels were negatively correlated with GCS score. The ECG of 107 （79. 3% ） patients were abnormal and the rest was roughly normal. With the increase of time, partial abnormal ECG were reversed. The transthoracic echocardiography of 2 cases were abnormal in the very severe patients, and with the change of time, heart function deteriorated gradually. Conclusion Brain injury can lead to myocardial injury in different degrees, and the lower the GCS score, the higher the risk of acute myocardial infarction, and serum cTnI can reflect the heart damage in patients with brain injury.