早期检测hs-cTnI和sST2对急性重度有机磷农药中毒继发心脏损害的预测价值

Predictive value of early detection of hs-cTnI and sST2 for secondary cardiac damage in severe acute organophosphorus pesticide poisoning

目的:探讨超敏肌钙蛋白I(hs-cTnI)和可溶性生长刺激基因表达蛋白2(sST2)对急性重度有机磷农药中毒(SAOPP)继发心脏损害的早期预测价值。方法:收集2014年9月至2019年2月衡水市人民医院SAOPP患者274例。根据入院后1 h hs-cTnI检测结果分为非肌钙蛋白升高组(78例)和肌钙蛋白升高组(196例)。依据入院后3 d有无出现心脏损害分为并发症组(109例)和非并发症组(165例)。观察hs-cTnI、sST2、N末端B型脑钠尿肽(NT-proBNP)、急性生理与慢性健康(APACHE-Ⅱ)评分、胆碱酯酶活力、左心室射血分数(LVEF)和短轴缩短率(FS)的变化情况,并进行相关性分析;采用受试者工作特征曲线(ROC)分析评估hs-cTnI、sST2对SAOPP患者继发心脏损害的预测价值。结果:肌钙蛋白升高组患者sST2水平明显高于非肌钙蛋白升高组(P<0.05)。与非并发症非肌钙蛋白升高组比较,非并发症肌钙蛋白升高组患者hs-cTnI、sST2升高,胆碱酯酶活力降低(P<0.05)。与其他各组比较,并发症肌钙蛋白升高组hs-cTnI、sST2、NT-proBNP、APACHE-Ⅱ评分均明显升高,胆碱酯酶活力明显降低(P<0.05)。非并发症组患者LVEF、FS均在正常范围,组间差异无统计学意义(P>0.05)。与其他各组比较,并发症肌钙蛋白升高组患者LVEF、FS明显下降(P<0.05)。相关性分析显示,SAOPP并发症组患者hs-cTnI与sST2呈正相关(r=0.725,P<0.01);并发症组患者hs-cTnI、sST2与APACHE-Ⅱ评分均呈正相关(r=0.846、0.885,P<0.01)。ROC分析显示,入院后1 h hs-cTnI和入院后3 d sST2预测SAOPP继发心脏损害的曲线下面积分别为0.945、0.833。结论:hs-cTnI和sST2可能对SAOPP继发心脏损害患者的早期诊断及预后评估有重要临床价值。

Objective To investigate the value of high-sensitivity cardiac troponin I(hs-cTnI)and soluble suppression of tumorigenicity 2(sST2)in predicting cardiac complications of severe acute organophosphorus pesticide poisoning(SAOPP).Methods All 274 SAOPP patients from September 2014 to February 2019 were selected.According to the results of hs-cTnI detection,the patients were divided into non-elevated troponin group(78 cases)and troponin elevation group(196 cases)at 1 hour after admission.3 days after admission,there were 109 cases of complication and 165 cases of non-complication according to the presence or absence of cardiac complications.The changes of hs-cTnI,sST2,N-terminal B-type brain natriuretic peptide(NT proBNP),acute physiology and chronic health(APACHE-Ⅱ),cholinesterase activity,left ventricular ejection fraction(LVEF),short axis shortening rate(FS)were observed and analyzed.The predictive value of hs-cTnI and sST2 were evaluated by receiver operating characteristic curve(ROC)analysis.Results The sST2 level in patients with troponin elevation group was significantly higher than that in non-elevated troponin group(P<0.05).Compared with the non-complication and non-elevated troponin group,the patients with non-complication and troponin elevation group had elevated hs-cTnI,sST2 and decreased cholinesterase(P<0.05).Compared with other groups,the hs-cTnI,sST2,NT-proBNP,and APACHE-Ⅱscores in the complication and troponin elevation group were significantly increased,and cholinesterase was significantly reduced(P<0.05).In the non-complication group,LVEF and FS were in the normal range,and there was no significant difference between the groups(P>0.05).Compared with other groups,the LVEF and FS of patients with elevated troponin in the complications group were significantly decreased(P<0.05).Correlation analysis showed that hs-cTnI and sST2 were positively correlated in patients with SAOPP complications(r=0.725,P<0.01).hs-cTnI,sST2 and APACHE-Ⅱscores were positively correlated in the complications group(r=0.846,0.885,P<0.01).ROC results showed that the areas under the curve for predicting SAOPP secondary heart damage of hs-cTnI(1 hour after admission)and sST2(3 days after admission)were 0.945 and 0.833,respectively.Conclusion hs-cTnI and sST2 may have important clinical value in the early diagnosis and prognosis evaluation of patients with SAOPP secondary cardiac damage.