高敏肌钙蛋白T对急性心肌炎需ECMO支持的预测价值

High-sensitivity troponin T predicts patients with acute myocarditis requiring ECMO

目的:研究急性心肌炎患者首次高敏肌钙蛋白T(high-sensitivity troponin T,hs-TnT)对其是否需要体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)支持的预测价值。方法:回顾性分析2017年1月─2020年7月在南京医科大学第一附属医院急诊就诊的98例急性心肌炎患者的临床资料,根据患者入院后是否需要ECMO支持分为ECMO支持组(ECMO组,32例)和非ECMO支持组(非ECMO组,66例),比较两组患者急诊首次hs-TnT、氨基末端脑利钠肽前体(N-terminal pro-B type natriuretic peptide,NT-proBNP)等指标的差异,以判断患者是否需要ECMO支持。结果:ECMO组hs-TnT值[3 580(1 656,8 935)ng/L]高于非ECMO组[630(180,1 496)ng/L,P <0.001],ECMO组NT-proBNP[10 577(3 701,24 164)pg/mL]高于非ECMO组[565(240,3 736)pg/mL,P <0.001]。多因素Logistic回归分析显示:首次hs-TnT(OR=1.290,95%CI:1.024~1.626,P=0.031)、首次NT-proBNP(OR=1.081,95%CI:1.019~1.146,P=0.009)为急性心肌炎患者可能需行ECMO支持的相关危险因素。结论:急性心肌炎患者急诊首次hs-TnT值及NT-proBNP值可作为相关指标,用来预测患者是否需要ECMO支持。

Objective:This study aims to investigate the predictive value of first-time high-sensitivity troponin T(hs-TnT)in patients with acute myocarditis to receive extracorporeal membrane oxygenation(ECMO)support. Methods:A retrospective study was conducted for 98 patients with acute myocarditis. They were divided into ECMO group(n=32)and non-ECMO group(n=66). Baseline data,level of serum hs-TnT and N-terminal pro-B type natriuretic peptide(NT-proBNP)were collected and compared. Results:Total98 patients were finally enrolled. The levels of serum hs-TnT-and NT-proBNP-in ECMO group[3 580(1 656,8 935)ng/L,10 577(3 701,24 164)pg/mL]were significantly higher than those in non-ECMO group[630(180,1 496)ng/L,565(240,3 736)pg/mL],respectively(P < 0.001). Logistic regression analysis showed first-time hs-TnT(OR=1.290,95%CI:1.024~1.626,P=0.031)and NTproBNP level(OR=1.081,95%CI:1.019~1.146,P=0.009)were independently risk factors of ECMO therapy. Conclusion:The firsttime hs-TnT and NT-proBNP level in patients with acute myocarditis could be used to predict whether the patient needs ECMO support.