肌钙蛋白Ⅰ对严重脓毒症患者预后临床研究

Clinical study of troponin Ⅰ in prognosis of patients with severe sepsis

目的:研究严重脓毒症患者肌钙蛋白Ⅰ(Troponin I,TnⅠ)水平,分析TnⅠ增高对严重脓毒症患者预后的临床意义。方法:入选138例符合条件的患者为研究对象,分析TnⅠ增高的发生率,比较TnⅠ增高组和TnⅠ正常组的死亡率。根据患者的预后结果划分为存活、死亡两组,多因素Logistic回归分析探讨与疾病死亡相关的不利因素。结果:在138名患者中,有85名(61. 59%)患者TnⅠ增高,53例(38. 40%)患者TnⅠ正常。TnⅠ增高组患者的死亡率高于TnⅠ正常组(41. 8%vs. 18. 87%,P <0. 05)。死亡组TnⅠ水平、急性生理学及慢性健康状况评分II(APACHEII)均显著高于存活组(P <0. 01)。通过校正其他显著变量,TnⅠ增高是严重脓毒症患者死亡的独立预测因子(OR:2. 05,95%CI:1. 14～3. 45)。结论:在严重脓毒症患者中,TnⅠ增高与患者预后不良独立相关。

Objective：To study levels of troponin-I （TnI） in severe sepsis patients. And analysis the clinical significance of troponin I in prognosis of patients with severe sepsis. Methods： 138 patients with severe sepsis were selected as the subjects. The incidence of increased TnI was analyzed and the mortality rates were compared between the increased TnI group and the normal TnI group. The patients were divided into two groups：survival group and death group according to the prognosis. A stepwise logistic regression procedure was used to select significant prognosticator of mortality. Results：Among study patients,85 （61.59%） patients were increased and 53 （38.40%） patients were normal in TnI . The mortality of TnI increased group was higher than that of TnI normal group （41. 8% vs. 18.87% ,P 〈 0.05）. TnI levels and Acute Physiology and Chronic Health Evaluation II scores （ APCHE II） in death group were higher than survival group （ all P 〈 0.01 ）. Elevated TnI was an independent prognosticator of mortality （ OR ：2.05,95 % CI：I. 14 - 3.45） after adjusting for other significant variables. Conclusion： In patients with severe sepsis,increased TnI is independently associated with unfavourable prognosis.