心肌梗死三合一指标在非冠状动脉心脏手术后的影响因素和预测意义

Risk factors and predictive value of the triple biomarkers for myocardial infarction in non-coronary cardiac surgery

目的研究心肌梗死三合一指标[肌红蛋白、肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnⅠ)]在非冠状动脉心脏病患者围术期的变化及预测术后恢复的意义。方法回顾性分析2016年3~11月上海交通大学医学院附属新华医院心胸外科77例非冠状动脉心脏病手术患者的临床资料,其中男37例、女40例,中位年龄2岁。简单先天性心脏病45例,复杂先天性心脏病10例,心脏瓣膜病22例。所有患者均在体外循环下手术。收集术后第1 d心肌梗死三合一指标浓度、呼吸机辅助时间、住ICU时间,由高年资医师根据临床结果判断患者恢复过程是否顺利。结果术后第1 d心肌梗死三合一指标均上升,其中cTnⅠ上升最显著;多因素线性回归分析提示其升高仅与体外循环时间、主动脉阻断时间显著相关(P<0.001)。cTnⅠ浓度升高显著延长术后呼吸机辅助时间和住ICU时间。14例(18.2%)患者恢复慢于预期,偏离预期恢复患者cTnⅠ浓度显著高于正常恢复患者[(16.8±16.7)ng/ml vs.(5.1±4.4)ng/ml,P<0.001]。cTnⅠ浓度>5.33 ng/ml可预测患者术后是否恢复顺利(受试者工作特征曲线下面积0.862,P<0.001),预测效果优于肌红蛋白和CK-MB。结论心肌梗死三合一指标在非冠状动脉心脏病手术后显著升高,与体外循环时间、主动脉阻断时间延长相关。术后24 h cTnⅠ浓度可预测患者术后恢复是否顺利,可作为有用的临床参考指标。

Objective To investigate the perioperative change and the predictive value of myoglobin, creatine kinase-MB （CK-MB）, and cardiac troponin I （cTnI） in non-coronary cardiac surgery. Methods The clinical data of 77 patients undergoing cardiac surgery for non-coronary lesions in the Shanghai Xinhua Hospital from March 2016 to November 2016 were retrospectively reviewed, including 37 males and 40 females with a median age of 2 years. There were simple congenital heart diseases in 45 patients, complicated congenital heart diseases in 10, and heart valve diseases in 22. The levels of myoglobin, CK-MB and cTnI were collected at the first postoperative day. The ventilation duration and the length of ICU stay were recorded. The recovery condition was accessed by senior surgeons. Results The myoglobin, CK-MB and cTnI concentrations increased at the first postoperative day, and cTnI increased most significantly. The multivariate linear regression analysis indicated that these changes were only related to cardiopulmonary bypass time and aortic cross-clamping time （P〈0.001）. The high cTnI level was associated with prolonged ventilation duration and length of ICU stay. Fourteen patients （18.2%） did not recovered well, and their cTnI level was significantly higher than that of well-recovered patients （16.8±16.7 ng/mlvs. 5.1±4.4 ng/ml,P〈0.001）. The cTnI cutoff value of 5.33 ng/ml could predict whether patients had good postoperative recovery （area under the receiver operating characteristic curve=0.862,P〈0.001）, and the predictive value of cTnI was superior to that of myoglobin and CK-MB. Conclusion The increase levels of myoglobin, CK-MB and cTnI post non-coronary cardiac surgery are associated with prolonged cardiopulmonary bypass time and aortic cross-clamping time. cTnI on postoperative 24 h may predict good recovery, and it is a useful biomarker.