急性有机磷中毒患者肌钙蛋白I的变化及临床意义

Change of the serum Troponin I and its clinical significance in acute organophosphorous poisoning

目的 :探讨血清肌钙蛋白I(cTnI)测定在诊断急性有机磷中毒 (AOPP)患者心肌损伤时的应用价值及临床意义。方法 :不同程度的AOPP患者 5 2例 ,于中毒的第 1、第 2、第 3、第 5、第 7天 ,测定血清cTnI、肌酸激酶 (CK)、肌酸激酶同工酶 (CK MB)、乳酸脱氢酶 (LDH)的含量 ,按中毒的严重程度分为轻度、中度、重度中毒组 ,根据AOPP后心肌酶谱达峰值的第 3天对上述项目进行比较分析 ,同时以cTnI与心肌酶谱各参数大于正常对照 2SD为阳性 ,进行阳性率的比较。结果 :AOPP患者血清cTnI在中毒后第 2天～第 3天达高峰 ,第 7天还明显高于对照组 (P <0 .0 1) ,但与中毒后第 1天比较无统计学意义。中毒后第 3天 ,不同程度的中毒患者血清cTnI和心肌酶谱值随病情的加重而增加 ,但cTnI的敏感度高于CK、CK MB及LDH ,其阳性率分别为96 .2 %、78.8%、84 .6 %和 76 .9% (P <0 .0 1或P <0 .0 5 )。结论 :AOPP越重 ,血清cTnI值升高越显著 ;血清cT nI对有机磷农药中毒心肌损伤的诊断敏感性高 ,比心肌酶谱更有价值。

Objective:To evaluation the applied value of the serum troponin I (cTnI) and myocardial zymogram for diagnosing myocardial lesion in the acute organophosphorous poisoning (AOPP).Methods:The content of serum cTnI、Creatine kinase (CK)、Creating kinase isoenzyme-MB (CK-MB)、Lactate dehydrogenase (LDH) were detected in 52 cases of AOPP patients of different degree,on the 1st day、2nd day、3rd day、5th day and 7th day after poisoning. There were partition to Light poisoning、Moderate poisoning and Severe poisoning based to the serious degree of the poisoning when the three days after the coming to peak of myocardial zymogram on the AOPP. At the same time,To compare the positive rate with the serum cTnI and the parameters of myocardial zymogram and there were positive that each parameter was exceed 2SD than the control group.Results:The serum cTnI would come to the peak when the 2nd day to 3rd day after poisoning,and the cTnI on the 7th day after poisoning was significantly higher compared with the control group (P<0.01).But there is no difference between the serum cTnI of 1st day and 7th day after poisoning.With state of the illness more badly,the serum cTnI and myocardial zymogram were increased in the patients of different degree poisoning on the 3rd day after poisoning. But the cTnI were more highly sensitive than CK、CK-MB and LDH,and the positive rate respectively were 96.2% and 78.8%、84.6%、76.9%(P<0.01 or P<0.05).Conclusion:The serum cTnI would more significantly increase when the AOPP were more badly;The cTnI would be highly sensitive in diagnosing myocardial lesion with the AOPP,and it would be more clinical valuable compared with the myocardial zymegram.