危重病患者心肌损伤与前炎细胞因子释放的关系

Relationship between acute myocardial injury and release of pro-inflammatory cytokines in critically ill patients

目的 :探讨前炎细胞因子释放在危重病患者继发性心肌损伤中的作用。方法 :98例入住综合 ICU(GICU)的患者均进行急性生理学和慢性健康状况 (APACHE )评分 ;抽取入院 <2 4、4 8和 12 0小时的静脉血 ,检测肌钙蛋白 I(CTn I)、肌酸激酶同工酶 (CK MB)、白介素 1β(IL 1β )和肿瘤坏死因子α(TNFα)含量。结果 :本组患者继发性心肌损伤发生率为 2 1.4 %。APACHE 评分心肌损伤组为 (18.9± 6 .8)分 ,高于非心肌损伤组 (12 .7± 8.9)分 ,P<0 .0 1。心肌损伤组血清 CTn I呈持续增高 ,无明显高峰 ;血清 CTn I与前炎细胞因子的曲线走势非常相似 ,显示有一定的相关性。生存组与死亡组间 CTn I与前炎细胞因子在各时间点上均存在显著差异。与 CK MB相比 ,CTn I对心肌损伤判断的特异性和灵敏性更高。结论 :急性心肌损伤的发生与前炎细胞因子的过度释放有一定关系。

Objective:To define the relation between acute myocardial injury and release of proinflammatory cytokines in critically ill patients.Methods:Nintyeight cases admitted to the intensive care unit were evaluated with acute physiology and chronic health evaluationⅡ(APACHEⅡ).The serum was obtained within 24 hours,48 hours and 120 hours after admission,and troponin I (CTnI),MB isoenzyme of creatine kinase (CKMB), interleukin1β (IL1β) and tumor necrosis factorα(TNFα) were determined.Results: Morbidity of acute myocardial injury among 98 cases was 21 4%.APACHEⅡ scores were different in myocardial injury group and nonmyocardial injury group (18 9±6 8 or 12 3±8 9,respectively, P <0 01). CTnI in the cases of myocardiial injury showed a steady rise without any obvious peak.The curve of serum CTnI was similar to that of proinflammatory cytokine,showing a correlation.Between the survivors and nonsurvivors,serum CTnI and proinflammatory cytokines showed distinct differences at all time points.For the diagnosis of the acute myocardial injury and patient's prognosis,CTnI was more sensitive and specific than CKMB.Conclusions:Acute myocardial injury is a common complication among critically ill patients.The morbidity shows a relationship with excessive release of proinflammatory cytokines.