Ⅲ级胆管炎合并心肌损伤患者的预后影响因素分析

Analysis of prognostic factors in patients with Grade in cholangitis-related myocardial injury

目的探讨Ⅲ级胆管炎合并心肌损伤患者预后的相关影响因素。方法回顾性收集2015年6月至2020年12月首都医科大学附属北京友谊医院急诊科收治的Ⅲ级胆管炎合并心肌损伤患者91例。根据是否给予内镜逆行胰胆管造影(ERCP)治疗分为ERCP组(n=75)与非ERCP组(n=16);根据28d存活情况分为死亡组(n=35)与存活组(n=56)。记录患者入院后第1、3、7天血清心肌肌钙蛋白T(cTnT)、心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、B型氨基端利钠肽原(NT-proBNP)、白细胞计数(WBC)、血小板计数(PLT)、血肌酐(Scr)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)、国际标准化比值(INR)、格拉斯哥昏迷评分(GCS)等指标,观察并分析影响患者预后的危险因素。结果ERCP组入院后第3天的cTnT、NT-proBNP、PLT、GCS评分,入院后第7天的cTnI、cTnT、CK-MB、NT-proBNP、PLT及GCS评分与非ERCP组比较差异有统计学意义(P<0.05)。ERCP组患者28 d内的存活率与非ERCP组相比差异有统计学意义(P<0.001)。存活组第1天的cTnT,第3天的cTnT、NT-proBNP、WBC、GCS评分,第7天的cTnI、cTnT、CK-MB、PLT、NT-proBNP、GCS与死亡组比较差异有统计学意义(P<0.05)。ERCP治疗及心肌损伤标志物水平对Ⅲ级胆管炎合并心肌损伤患者的死亡有显著影响(P<0.05)。结论在Ⅲ级胆管炎合并心肌损伤的患者中,心肌损伤标志物、NT-proBNP及GCS评分与死亡相关。ERCP可显著提高28 d内的生存率,改善预后。

Objective To explore the related factors influencing prognosis of patients with grade M cholangitis with myocardial injury.Methods 91 patients with grade III cholangitis complicated with myocardial injury treated in the emergency department of Beijing Friendship Hospital Affiliated to Capital Medical University from June 2015 to December 2020 were collected retrospectively.They were divided into endoscopic retrograde cholangiopancreatography(ERCP)group(re=75)and non-ERCP group(re=16)according to whether ERCP was performed.According to 28-day survival patients were divided into survival group(re=56)and death group(re=35).The level of serum cardiac troponin T(cTnT),cardiac troponin I(cTnl),creatine kinase isoenzyme(CK-MB),N terminal pro-brain natriuretic peptide(NT-proBNP),white blood cell(WBC),platelet(PLT),serum creatinine(Scr),alanine transaminase(ALT),aspartate transaminase(AST),total bilirubin(TBIL),International Standardized Ratio(INR),Glasgow Coma Score(GCS)at different time points were detected and the risk factors influencing the prognosis of patients were analyzed.Results The cTnT(P=0.018),NT-proBNP(P<0.001),PLT(P=0.016),GCS score(P=0.07)on day 3 and cTnl(P=0.027),cTnT(P=0.002),CK-MB(P=0.046),NT-proBNP(P<0.001),PLT(P=0.041),GCS score(P<0.001)on day 7 in the ERCP group were significantly different with the non-ERCP group respectively.The survival rate within 28 days of the ERCP group was significantly different from that in the non-ERCP group(P<0.001).The cTnT(P=0.006)on day 1,the cTnT(P=0.021),NT-proBNP(P=0.02),WBC(P=0.037),GCS score(P<0.001)on day 3,and the cTnl(P=0.029),cTnT(P=0.008),CK-MB(P<0.001),PLT(P=0.008),NT-proBNP(P=0.004),GCS(P<0.001)on day 7 in survival group were significantly different from the death group.Logistic regression showed that the mean value of myocardial injury markers and ERCP process were significantly correlated with the 28 days survival rate.Conclusions In patients with Grade HI cholangitis-related myocardial injury,the levels of myocardial injury markers,NT-proBNP,platelet(PLT)and Glasgow Coma Score(GCS)are related to mortality.ERCP for patients can significantly improve 28 days survival and prognosis.