两指标在一氧化碳中毒性心脏病评估中的应用

Application of two indexes in the evaluation of carbon monoxide toxic heart disease

目的探讨心率校正后的QT离散度(QTcd)及可溶性生长刺激表达基因2蛋白(sST2)与急性一氧化碳中毒性心脏病患者病情严重程度与预后的关系。方法回顾性分析2017年1月至2020年3月入住本院急救医学部的急性一氧化碳中毒性心脏病患者135例,记录入院即刻、3 h、12 h、2 d、3 d血sST2、肌酸激酶同工酶(CK-MB)及肌钙蛋白I(cTnI)浓度;由专人测量并计算患者入院当天、2 d、3 d及出院时QTcd;根据一氧化碳中毒性心脏病严重程度分为轻度心脏病组(58例)、中度心脏病组(45例)、重度心脏病组(32例),按照是否发生重度心脏病分为重度组(32例)和非重度组(103例),在重度心脏病患者中根据患者是否死亡分为死亡组和存活组。两组间比较采用t检验,相关性分析采用Spearman相关法分析,并绘制受试者工作特征曲线(ROC),分析sST2、QTcd对重度急性一氧化碳中毒性心脏病早期的预测价值及相关性。结果135例患者中有32例为重度中毒性心脏病,发生率为23.7%。重度组sST2自入院时开始升高,cTnI自24 h开始升高,CK-MB自2 d开始升高,检测值均高于非重度组及健康对照组,差异有统计学意义(P<0.05)。治疗前各中毒组患者sST2、QTcd与非重度组、健康对照组比较,差异有统计学意义(P<0.05)。中毒后2 d、3 d不同程度中毒组之间各指标比较,差异有统计学意义(P<0.05)。ROC曲线分析显示,sST2曲线下面积为0.726,95%CI为0.555~0.898,敏感度56.3%,特异度94.1%,截断值为88.5 ng/mL;QTcd曲线下面积为0.745,95%CI为0.602~0.889,敏感度56.3%,特异度82.4%,截断值为68.5 ms;两者联合检测曲线下面积为0.939,95%CI为0.874~1.000,敏感度81.3%,特异度91.2%。结论急性一氧化碳中毒性心脏病患者sST2水平升高时间早于cTnI、CK-MB,sST2与QTcd两者联合观测可作为早期预测急性一氧化碳中毒性心脏病及其严重程度的指标。

Objectives To investigate the relationship between heart rate adjusted QT dispersion(QTcd)and soluble growth stimulating gene 2 protein(sST2)and the severity and prognosis of patients with acute carbon monoxide toxic heart disease.Methods Retrospective analysis was performed on 135 patients with acute carbon monoxide toxic heart disease admitted to the Emergency Medical Department of our hospital from January 2017 to 2020.Blood sST2,creatine kinase isoenzyme(CK-MB)and troponin I(cTnI)concentrations were recorded at 3 h,12 h,2 d and 3 d immediately after admission.The patient was measured and calculated on the day of admission,2 d,3 d and QTcd at discharge.According to the toxicity of carbon monoxide in heart disease severity was divided into mild heart disease group(58 cases),moderate heart disease group(45 cases),severe heart disease group(32 cases),according to whether severe heart disease were divided into severe group(32 cases)and non severe group(103 cases),according to whether the patients death in patients with severe heart disease.Results Thirty-two of the 135 patients had severe toxic heart disease,with an incidence of 23.7%.In the severe group,sST2,cTnI and CK-MB increased from 24 h and 2 d after admission,and the detected values were all higher than those of the non-severe group and the normal control group,with statistically signifi cant differences(P<0.05).Before treatment,there were statistically signifi cant differences in sST2 and QTcd between the toxic group and the non-severe group and the normal control group(P<0.05).After 2 d and 3 d poisoning,there were statistically significant differences between the two groups(P<0.05).ROC curve analysis showed that the area under the sST2 curve was 0.726,95%CI was 0.555-0.898,sensitivity was 56.3%,specifi city was 94.1%,and truncation was 88.5 ng/mL.The area under the QTcd curve was 0.745,95%CI was 0.602-0.889,sensitivity was 56.3%,specifi city was 82.4%,and truncation value was 68.5 ms.The area under the combined detection curve was 0.939,95%CI was 0.874-1.000,sensitivity was 81.3%,specifi city was 91.2%.Conclusions In patients with acute carbon monoxide toxic heart disease,the level of sST2 increased earlier than THAT of cTnI and CK-MB,and the combined observation of sST2 and QTcd can be used as an indicator for early prediction of acute carbon monoxide toxic heart disease and its severity.