心肌损伤标记物对ARDS预后评估的价值

Effect of myocardial injury markers on the prognosis of ARDS

目的 :探究常见心肌损伤标记物对急性呼吸窘迫综合征(ARDS)的预后评估的价值。方法 :收集60例被诊断为ARDS的患者,比较存活组和死亡组中心肌损伤标记物的水平差异;按照柏林定义将其分为轻度组(30例)和中重度组(30例),比较在发病6h内,第3天,第7天中,心肌损伤标记物随治疗时间变化的差异,以及分组对差异的影响;最后利用受试者工作特征曲线(ROC)评估三种心肌损伤标记物在ARDS患者预后评估中的临床价值。结果 :存活组和死亡组患者在发病6h内测量得到的三个心肌损伤标记物差异均有统计学意义。开始治疗的6h内,第3天和第7天,肌钙蛋白T、肌钙蛋白I和CK-MBmass在中重度组和轻度组之间差异均有统计学意义。中重度组和轻度组内同一个指标在治疗的6h内,第3天和第7天表达水平差异也具有统计学意义;根据ROC曲线分析,肌钙蛋白T(AUC=0.788 95%CI:0.657-0.920 P=0.000敏感度=87.5%特异度=76.6%)肌钙蛋白I(AUC=0.65295%CI:0.503-0.801 P=0.048敏感度=71.2%特异度=72.3%)CK-MBmass(AUC=0.741 95%CI:0.594-0.888 P=0.030敏感度=81.5%特异度=70.6%)。结论 :心肌损伤标记物肌钙蛋白T、肌钙蛋白I和CK-MBmass可以作为评估ARDS预后的指标。

Objective To investigate the value of common myocardial injury markers in the assessment of prognosis of acute respiratory distress syndrome(ARDS). Methods Sixty patients diagnosed with ARDS were enrolled. The differences in the levels of myocardial injury markers between the surviving group and the death group were compared. According to the definition of Berlin, they were divided into low-risk group and middle-high risk group, compared with the disease within 6 hours and the third day. On day 7, the difference of myocardial injury markers with treatment time, and the difference caused by grouping;Finally, using the receiver operating characteristic curve(ROC) to evaluate the clinical use value of three myocardial injury markers. Results There were significant differences between the three groups of myocardial injury markers measured in the survival group and the death group within 6 hours. In the middle-high-risk group and the low-risk group, there were significant differences between the middle-high-risk group and the low-risk group in the middle and high-risk groups on the 3rd and 7th day after the start of treatment. The expression of the same indicator in the group within 6h of treatment, on the 3rd day and the 7th day was statistically significant;according to the ROC curve analysis, Troponin T(AUC=0.788 95% CI: 0.657-0.920 P=0.000Sensitivity=87.5% Specificity=76.6%) Troponin I(AUC=0.652 95% CI: 0.503-0.801 P=0.048 Sensitivity=71.2% Specificity=72.3%) CK-MBmass(AUC =0.741 95% CI: 0.594-0.888 P=0.030 Sensitivity=81.5% Specificity=70.6%). Conclusion Myocardial injury markers can be used as indicators to evaluate the prognosis of ARDS.