道路交通伤后心脏肌钙蛋白I的动态变化及其与损伤严重度和急性生理学与既往健康状况Ⅱ评分的关系

Dynamics of plasma troponin I in acute myocardial injury patients following road traffic trauma and relationship with injury severity score and acute physiology and chronic health evaluation

目的 观察道路交通伤患者心脏肌钙蛋白I的动态变化并阐明其与损伤严重度 (injuryseverityscore ,ISS)评分和急性生理学与既往健康状况 (acutephysiologyandchronichealthevaluation ,APACHE)Ⅱ评分的关系。方法 将 10 8例道路交通伤患者根据有无合并胸部创伤分为 2组 :合并胸部创伤组 76例 ,无合并胸部创伤组 32例 ,均进行ISS和APACHEⅡ评分。定期采集 2组患者血样品 ,并用微粒子荧光免疫法检测样本cTnI浓度。结果 10 8例道路交通伤患者中cTnI升高 31例 ,发生率为 2 8.7% ,其中合并胸部创伤组 2 5例 ,占 80 .6 % ;无合并胸部创伤组 6例 ,占 19.4 %。动态监测 12例道路交通伤患者血清cTnI释放呈单峰陡降曲线 ,13例为单峰缓降型曲线 ,6例为双峰曲线。通过对道路交通伤分组观察提示 ,无论有无合并胸部创伤 ,在一定范围内 ,ISS值与cTnI峰值成一定相关性 (r =0 .6 76 ,P <0 .0 1) ,而在无胸部创伤的严重道路交通伤患者ISS值与cTnI峰值的相关性更高 (r =0 .734,P <0 .0 1)。单峰曲线的APACHEⅡ分值与双峰曲线的APACHEⅡ分值有明显的差异(P <0 .0 1)。结论 道路交通伤患者血清cTnI释放动力学特点 :其浓度—时间曲线大致有 3种特征 ,即单峰陡降型、单峰缓降型、双峰型 ;在一定范围内 ,ISS值与cTnI峰值正相?

ObjectiveTo define dynamics of plasma troponin I in acute myocardial injury patients following road traffic trauma and relationship with injury severity score(ISS) and acute physiology and chronic health evaluation II(APACHEII). Methods108 road traffic trauma patients were divided into two groups:one group with blunt chest trauma(n=76);another group without blunt chest trauma (n=32), assessment was performed by ISS and APACHEⅡ. Serum samples from these patients were analyzed for cTnI by microparticle-enzyme immunoassay (MEIA). ResultsElevated plasma cTnI was found in 31 cases(28.7%), 25 cases (80.6%)belonged to the group with blunt chest trauma;6 cases (19.4%)belonged to the group without blunt chest trauma. It showed a single peak and sharp down curve in 12 road traffic trauma patients, it showed a single peak and slow down curve in 13 patients ,and it showed a double peak curve in 6 patients. In patients with or without blunt chest trauma, ISS was related with cTnI peak concentration in some extent (r=0.676 ,P<0.01)and there was closer relationship between ISS and cTnI peak concentration in patients with blunt chest trauma(r= 0.734,P<0.01). APACHEII was significantly different between patients with single peak cTnI curve and patients with double peak cTnI curve(P<0.01). ConclusionsThe dynamics of plasma cTnI in acute myocardial injury patients following road traffic trauma:there were three types about cTnI curve:single peak and sharp down type, single peak and slow down type, double peak type;In some extent, there was a positive correlation between ISS and cTnI peak concentration. Furthermore, outcome and prognosis in patients with double peak cTnI curve was awful.