Prognostic value of N-terminal pro B-type natriuretic peptide and troponin Ⅰ in children with dengue shock syndrome

Objective:To investigate the contribution of N-terminal pro B-type natriuretic peptide(NT-pro BNP)and troponin Ⅰ to mortality in children with dengue shock syndrome.Methods:A longitudinal study was conducted on children with dengue shock syndrome in a hospital in southern Vietnam.Detailed clinical histories,physical examinations,and laboratory parameters,including NT-pro BNP and troponin Ⅰ,were recorded.A comparison between survival and non-survival was carried out to identify factors influencing mortality.Results:A total of 107 patients with a median age of 9 years were included in the study.Among them,63.6%(68/107)presented with compensated shock,36.4%(39/107)had hypotensive shock,23.4%(25/107)required mechanical ventilation,and 12.1%(13/107)died.The NT-pro BNP levels were 3.9 pmol/L(IQR:1.9,10.3)and 15.2 pmol/L(5.8,46.3),while the median high sensitivity troponin Ⅰ levels were 20 pg/L(6,95)and 62 pg/L(12,325)at the first and second measurements,respectively.The mortality group exhibited higher rates of hypotensive shock,prolonged shock,lactate levels,liver damage,NT-pro BNP,and troponin Ⅰ levels.Hypotensive shock(OR 12.96,95%CI 2.70-62.30,P=0.004),prolonged shock(OR 39.40,95%CI 6.68-232.70,P<0.001),AST>1000 IU/L(OR 9.50,95%CI 2.63-34.34,P=0.041),and NT-pro BNP>7 pmol/L(OR 44.40,95%CI 5.44-362.20,P=0.001)were identified as predictive factors for mortality in dengue shock syndrome.Conclusions:The NT-pro BNP level could serve as a potential biomarker for predicting mortality in children with dengue shock syndrome.

深静脉血栓形成患者下肢深静脉血栓密度、血清cTnI、Hcy水平与合并肺栓塞风险的关系研究

目的探讨深静脉血栓(DVT)形成患者下肢深静脉血栓密度、血清心肌肌钙蛋白I(cTnI)及同型半胱氨酸(Hcy)水平与合并肺栓塞风险的关系。方法回顾性分析2016年1月至2019年1月在秦皇岛市第一医院进行治疗的108例DVT患者,依据是否合并肺栓塞分为对照组(单纯DVT)68例,观察组(DVT合并肺栓塞)40例。收集两组基线资料[年龄、性别、高血压史、高血脂史、慢性肺部疾病、脑血管意外、下肢骨折、吸烟史、饮酒史、血栓受累肢体、受累静脉、下肢深静脉血栓密度比、wells评分、血小板计数(PLT)、中性粒细胞计数(NEUT)、C反应蛋白(CRP)、D二聚体(D-D)、cTnI及Hcy水平]并进行比较,分析DVT合并肺栓塞的影响因素。根据肺栓塞危险程度将DVT合并肺栓塞患者划分为高危组(n=10)、中危组(n=17)、低危组(n=13);比较不同危险程度肺栓塞间下肢深静脉血栓密度、血清cTnI、Hcy水平及wells评分间差异。分析下肢深静脉血栓密度、血清cTnI及Hcy水平与wells评分的关系。结果两组患者年龄、性别、高血压、高血脂、慢性肺部疾病、脑血管意外、下肢骨折、吸烟史、饮酒史、血栓受累肢体及受累静脉比较,差异均无统计学意义(P>0.05);观察组下肢深静脉血栓密度比、wells评分、PLT、NEUT、CRP、D-D、cTnI及Hcy水平分别为(52.37±12.19)%、(5.16±1.07)分、(284.63±90.72)×10^(9)/L、(71.22±10.16)%、(15.29±2.39)mg/L、(1051.27±271.19)ng/mL、(0.33±0.13)ng/mL、(21.27±2.16)μmol/L,均高于对照组[41.67±10.28)%、(3.28±0.94)分、(206.27±86.15)×10^(9)/L、(64.31±8.75)%、(10.33±1.71)mg/L、(739.52±206.34)ng/mL、(0.21±0.06)ng/mL、(10.19±1.75)μmol/L],差异均有统计学意义(P<0.05)。Logistic回归分析结果显示,下肢深静脉血栓密度比、wells评分、cTnI及Hcy为DVT合并肺栓塞的独立预测因子(P<0.05)。肺栓塞低危组下肢深静脉血栓密度比、cTnI、Hcy水平及wells评分均低于中危组、高危组,差异均有统计学意义(P<0.05)。经Spearman相关性分析,下肢深静脉血栓密度比、cTnI、Hcy水平与wells评分呈正相关(P<0.05)。结论DVT患者下肢深静脉血栓密度、血清cTnI、Hcy可有效预测合并肺栓塞,同时可判断患者肺栓塞严重程度。

枸杞多糖对心肌梗死大鼠心肌肌钙蛋白I表达及心脏微血管的影响

【目的】探讨枸杞多糖对心肌梗死大鼠的治疗作用及机制。【方法】实验将SD大鼠随机分为正常组、模型组、氯沙坦组、枸杞多糖组。除正常组,其他3组大鼠采用左冠状动脉主干结扎法建立心肌梗死模型。给予相应干预后,采用心脏彩超检查大鼠心功能[左室收缩末期内径(LVSD)、左室舒张末期内径(LVDD)、室间隔(IVS)、左心室劳损(LVS)、左室射血分数(LVEF)],苏木素-伊红(HE)染色法观察心肌组织病理形态,酶联免疫吸附法(ELISA)检测血清心肌肌钙蛋白I(cTnI)、一氧化氮(NO)含量,心脏凝胶墨汁染色法测定微血管密度,蛋白免疫印迹(Western Blot)法检测心肌组织cTnI、内皮型一氧化氮合酶(eNOS)、血小板内皮细胞黏附因子1(PECAM-1)蛋白表达。【结果】与正常组比较,模型组LVSD、LVDD、IVS、LVS均显著升高(P<0.05),LVEF显著降低(P<0.05),HE染色可见心肌组织结构破坏,心肌细胞大量坏死,心肌纤维断裂,大量炎症细胞浸润,血清NO含量显著降低(P<0.05),cTnI含量显著升高(P<0.05),心脏微血管密度显著降低(P<0.05),cTnI蛋白表达明显升高(P<0.05),eNOS、PECAM-1蛋白表达显著降低(P<0.05);与模型组比较,氯沙坦组、枸杞多糖组大鼠以上各指标均得到明显改善(P<0.05),且枸杞多糖组的改善效果均优于氯沙坦组(P<0.05)。【结论】枸杞多糖可通过抑制心肌梗死大鼠cTnI表达,改善心脏微血管损伤,发挥对心脏的保护作用。

超声心动图联合血清cTnI、GDF-15检测对老年乳腺癌患者术后化疗心脏损伤的评估价值

目的探究超声心动图联合血清心肌肌钙蛋白I(cTnI)、生长分化因子-15(GDF-15)对老年乳腺癌(BC)患者术后化疗心脏损伤的评估价值。方法选取北京市大兴区人民医院2019年9月至2022年8月收治的112例老年BC术后应用表柔比星为主的化疗患者为研究对象,按照是否发生心脏损伤将其分为:心脏损伤组(40例)和心脏未损伤组(72例)。评估超声心动图对老年BC患者术后化疗心脏损伤的诊断价值;采用酶联免疫吸附法检测两组血清cTnI、GDF-15水平;采用受试者工作特征曲线评估血清cTnI、GDF-15对老年BC患者术后化疗心脏损伤的诊断价值;以心脏损伤判定标准为金标准,评价超声心动图、血清cTnI、GDF-15及三者联合对老年BC患者术后化疗心脏损伤的诊断价值。结果超声心动图诊断老年BC患者术后化疗心脏损伤的灵敏度、特异度、准确度分别为77.50%、88.89%、84.82%;心脏损伤组患者血清cTnI、GDF-15水平均明显高于心脏未损伤组(P<0.05);血清cTnI、GDF-15诊断老年BC患者术后化疗心脏损伤的曲线下面积分别为0.864、0.834,截断值分别为221.88 ng/L、8.06 ng/L,灵敏度分别为75.00%、80.00%,特异度分别为94.44%、87.50%,准确度分别为87.50%、84.82%;超声心动图联合血清cTnI、GDF-15诊断老年BC患者术后化疗心脏损伤的灵敏度、特异度、准确度分别为97.50%、86.11%、90.18%,优于单独诊断。结论超声心动图联合血清cTnI、GDF-15对老年BC患者术后化疗致心脏损伤有较高诊断价值,可有效提高灵敏度、准确度,具有较高特异度。

High-sensitivity cardiac troponins in everyday clinical practice

High-sensitivity cardiac troponin(hs-cTn) assays are increasingly being used in many countries worldwide,however,a generally accepted definition of high-sen-sitivity is still pending.These assays enable cTn mea-surement with a high degree of analytical sensitivity with a low analytical imprecision at the low measuring range of cTn assays(coefficient of variation of < 10% at the 99th percentile upper reference limit).One of the most important advantages of these new assays is that they allow novel,more rapid approaches to rule in or rule out acute coronary syndromes(ACSs) than with previous cTn assay generations which are still more commonly used in practice worldwide.hs-cTn is also more sensitive for the detection of myocardial damage unrelated to acute myocardial ischemia.Therefore,the increase in early diagnostic sensitivity of hs-cTn assays for ACS comes at the cost of a reduced ACS specificity,because more patients with other causes of acute or chronic myocardial injury without overt myocardial isch-emia are detected than with previous cTn assays.As hs-cTn assays are increasingly being adopted in clinical practice and more hs-cTn assays are being developed,this review attempts to synthesize the available clinical data to make recommendations for their everyday clini-cal routine use.

Comparison of plasma microRNA-1 and cardiac troponin T in early diagnosis of patients with acute myocardial infarction

BACKGROUND:Early reperfusion can effectively treat acute myocardial infarction(AMI) and reduce the mortality signif icantly. This study aimed to compare the role of plasma microRNA-1(miR-1) and cardiac troponin T(cTnT) in early diagnosis of AMI patients.METHODS:From May 2011 to May 2012,plasma samples were collected from 56 AMI patients and 28 non-AMI controls. The expression of plasma miR-1 was measured by quantitative reverse transcription-polymerase chain reaction(qRT-PCR),and the level of plasma cTnT was measured using electrochemiluminescence-based methods on an Elecsys 2010 Immunoassay Analyzer. SPSS 16.0 was used for the statistical analysis of the results. Data were expressed as mean±standard deviation unless otherwise described. The differences about clinical characteristics between the AMI patients and controls were tested using Student's t test or Fisher's exact test. The Mann-Whitney U test was conducted to compare the expression of microRNAs between the AMI patients and controls. MicroRNAs expression between different intervals of the AMI patients was compared using Wilcoxon's signed-rank test. The receiver operating characteristic(ROC) curve was established to discriminate the AMI patients from the controls.RESULTS:In the present study,the expression of plasma miR-1 was signifi cantly increased in the AMI patients compared with the healthy controls(P<0.01). The plasma miR-1 in the AMI patients decreased to the normal level at 14 days(P>0.05). The expression of plasma miR-1 was not related to the clinical characteristics of the study population(P>0.05). ROC curve analyses demonstrated that miR-1 was specifi c and sensitive for the early diagnosis of AMI,but not superior to cTnT.CONCLUSION:Plasma miR-1 could be used in the early diagnosis of AMI,but it is similar to cTnT.

The combination of creatine kinase-myocardial band isoenzyme and point-of-care cardiac troponin/contemporary cardiac troponin for the early diagnosis of acute myocardial infarction

BACKGROUND:The early diagnosis of acute myocardial infarction(AMI)remains challenging,especially for institutions without the high-sensitive cardiac troponin(hs-c Tn)assay.Herein,we aim to assess the value of creatine kinase-myocardial band isoenzyme(CK-MB)combined with different cardiac troponin(c Tn)assays in AMI diagnosis.METHODS:This multicenter,observational study included 3,706 patients with acute chest pain from September 1,2015,to September 30,2017.We classified the participants into three groups according to the c Tn assays:the point-of-care c Tn(POC-c Tn)group,the contemporary c Tn(c-c Tn)group,and hs-c Tn group.The diagnostic value was quantified using sensitivity and the area under the curve(AUC).RESULTS:Compared to the single POC-c Tn/c-c Tn assays,combining CK-MB and POC-c Tn/c-c Tn increased the diagnostic sensitivity of AMI(56.1%vs.63.9%,P<0.001;82.7%vs.84.3%,P=0.025).In contrast,combining CK-MB and hs-c Tn did not change the sensitivity compared with hs-c Tn alone(95.0%vs.95.0%,P>0.999).In the subgroup analysis,the sensitivity of combining CKMB and c-c Tn increased with time from symptom onset<6 h compared with c-c Tn alone(72.8%vs.75.0%,P=0.046),while the sensitivity did not increase with time from symptom onset>6 h(97.5%vs.98.3%,P=0.317).The AUC of the combination of CK-MB and POC-c Tn significantly increased compared to the single POC-c Tn assay(0.776 vs.0.750,P=0.002).The AUC of the combined CKMB and c-c Tn/hs-c Tn assays did not significantly decrease compared with that of the single c-c Tn/hs-c Tn assays within 6 h.CONCLUSIONS:The combination of CK-MB and POC-c Tn or c-c Tn may be valuable for the early diagnosis of AMI,especially when hs-c Tn is not available.

Characteristics of elevated cardiac troponin I in patients with acute ischemic stroke

Objective To study prognostic characteristics of cardiac troponin I （cTnI） elevation in acute ischemic stroke. Methods We retrospectively studied patients （n = 248） with acute ischemic stroke, acute ST-segment elevation myocardial infarction, and acute non-ST-elevation myocardial infarction who were treated between January 2013 and October 2015. Baseline demographic data and changes in cTnI levels among these three groups were compared. Patients with acute ischemic stroke were assigned to either the cTnI elevation group （cTnI 〉 0.034 ng/mL） or the no cTnI elevation group （cTnI ≤ 0.034 ng/mL）. Logistic regression analysis was used to identify risk factors associated with elevated serum cTnI in patients with acute ischemic stroke. Moreover, the duration of hospital stay and incidence of major cardiovascular outcomes were compared in patients with acute ischemic stroke, with or without elevated cTnI. Results In this study population of patients with acute ischemic stroke （n = 178）, acute ST-segment elevation myocardial infarction （n = 35）, and acute non-ST-elevation myocardial infarction （n = 35）, patients with acute ischemic stroke with elevated cTnI comprised 18.54% of subjects. Patients with elevated cTnI were older and more likely to have a history of hypertension. In addition, these patients had higher levels of inflammatory markers, reduced renal functions, increased D-dimer levels, higher NIH stroke scores, and lower left ventricular ejection fractions. Logistic regression analysis showed that both percentage of neutrophil and NIH stroke scores were elevated; estimated glomerular filtration rate and left ventricular ejection fraction were decreased in patients with acute ischemic stroke who had elevated cTnI, and they had more frequent major cardiovascular events during hospital stay. Conclusion Elevated cTnI detected in patients with acute ischemic stroke, indicated a greater likelihood of poor short-term prognosis during hospital stay.

A MXene-functionalized paper-based electrochemical immunosensor for label-free detection of cardiac troponin I

Convenient,rapid,and accurate detection of cardiac troponin I(cTnI)is crucial in early diagnosis of acute myocardial infarction(AMI).A paper-based electrochemical immunosensor is a promising choice in this field,because of the flexibility,porosity,and cost-efficacy of the paper.However,paper is poor in electronic conductivity and surface functionality.Herein,we report a paper-based electrochemical immunosensor for the label-free detection of cTnI with the working electrode modified by MXene(Ti_(3)C_(2))nanosheets.In order to immobilize the bio-receptor(anti-cTnI)on the MXene-modified working electrode,the MXene nanosheets were functionalized by aminosilane,and the functionalized MXene was immobilized onto the surface of the working electrode through Nafion.The large surface area of the MXene nanosheets facilitates the immobilization of antibodies,and the excellent conductivity facilitates the electron transfer between the electrochemical species and the underlying electrode surface.As a result,the paper-based immunosensor could detect cTnI within a wide range of 5-100 ng/mL with a detection limit of 0.58 ng/mL.The immunosensor also shows outstanding selectivity and good repeatability.Our MXene-modified paper-based electrochemical immunosensor enables fast and sensitive detection of cTnI,which may be used in real-time and cost-efficient monitoring of AMI diseases in clinics.

Prognostic value of high-sensitivity cardiac troponin T in patients with en-domyocardial-biopsy proven cardiac amyloidosis

Objective To investigate prognostic predictors of long-term survival of patients with cardiac amyloidosis （CA）, and to determine predictive value of high-sensitivity cardiac troponin T （hs-cTnT） in CA patients. Methods We recruited 102 consecutive CA cases and followed these patients for 5 years. We described their clinical characteristics at presentation and used a new, high-sensitivity assay to determine the concentration of cTnT in plasma samples from these patients. Results The patients with poor prognosis showed older age （56 ±12 years vs. 50 ±15 years, P=0.022）, higher incidences of heart failure （36.92%vs. 16.22%, P=0.041）, pericardial effusion （60.00%vs. 35.14%, P=0.023）, greater thickness of interventricular septum （IVS） （15 ±4 mm vs. 13 ±4 mm, P=0.034）, higher level of hs-cTnT （0.186 ±0.249 ng/mL vs. 0.044 ±0.055 ng/mL, P=0.001） and higher NT-proBNP （N-terminal pro-B-type natriuretic pep-tide） levels （11,742 ± 10,464 pg/mL vs. 6,031 ± 7,458 pg/mL, P=0.006）. At multivariate Cox regression analysis, heart failure （HR：1.78, 95%CI：1.09-2.92, P=0.021）, greater wall thickness of IVS （HR：1.44, 95%CI：1.04-3.01, P=0.0375） and higher hs-cTnT level （HR：6.16, 95%CI：2.20-17.24, P=0.001） at enrollment emerged as independent predictors of all-cause mortality. Conclusions We showed that hs-cTnT is associated with a very ominous prognosis, and it is also the strongest predictor of all-cause mortality in multivariate analysis. Examination of hs-cTnT concentrations provides valuable prognostic information concerning long-term outcomes.

SYNTAX积分联合血清NT-pro BNP、CK-MB、cTnI水平对急性心肌梗死患者PCI术预后的评估价值

目的探讨SYNTAX积分联合血清N末端钠尿肽前体(NT-pro BNP)、肌酸激酶同工酶(CK-MB)、心肌钙蛋白(cTnI)水平评估急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)术预后的价值。方法选取2020年1月—2022年11月我院85例行PCI术的AMI患者为研究对象,根据患者术后是否存在主要不良心脑血管事件(MACCE)分为预后良好组(n=63)和预后不良组(n=22),术前均行冠脉造影,采用SYNTAX积分评估患者冠脉变程度,住院期间常规测定患者血清NT-pro BNP、CK-MB、cTnI水平,术后随访半年。比较两组一般临床资料、SYNTAX积分及血清NT-pro BNP、CK-MB、cTnI水平,采用多因素Logistic回归分析法分析影响AMI患者PCI术预后的危险因素,采用受试者工作曲线分析SYNTAX积分联合血清NT-pro BNP、CK-MB、cTnI水平对AMI患者PCI术预后的评估价值。结果两组性别、年龄、BMI、合并高血压、糖尿病、血清TC、TG、HDL-C、LDL-C、Scr、LVEF、LVEDD比较,差异无统计学意义(P>0.05),Killip分级、病变支数分布、支架置入数、介入治疗时间、住院时间比较,差异均有统计学意义(P<0.05);预后不良组SYNTAX积分、血清NT-pro BNP、CK-MB、cTnI水平均显著高于预后良好组(P<0.05);多因素Logistic回归分析显示,病变支数、支架置入数、SYNTAX积分、血清NT-pro BNP、CK-MB、cTnI水平是影响AMI患者PCI术预后的危险因素(P<0.05);ROC曲线显示,SYNTAX积分、NT-pro BNP、CK-MB、cTnI单独及联合预测AMI患者PCI术预后的AUC分别为0.747、0.754、0.752、0.881、0.952。结论SYNTAX积分、血清NT-pro BNP、CK-MB、cTnI水平单独或联合检测均可有效预测AMI患者PCI术后MACCE的发生,联合检测预测效能显著提升。

血清氨基末端脑肽钠前体、心肌肌钙蛋白I联合检测对川崎病合并冠状动脉损害的早期诊断价值

目的探讨血清氨基末端脑肽钠前体(NT-proBNP)、心肌肌钙蛋白I(CTnI)联合检测对川崎病合并冠状动脉损害(CAL)的早期诊断价值。方法选择2019年9月至2022年5月唐山市妇幼保健院收治的182例急性期川崎病病儿(川崎病组)和182例健康儿童(对照组)为研究对象,川崎病病儿根据入院时心脏超声检查结果分为CAL组(n=38)和无CAL(N-CAL)组(n=144)。比较各组血清NT-proBNP、CTnI水平;多因素logistic回归分析川崎病合并CAL的影响因素;血清NT-proBNP、CTnI对川崎病合并CAL的诊断效能采用受试者操作特征曲线(ROC曲线)。结果川崎病组血清NT-proBNP(204.96±41.37)ng/L、CTnI(5.78±0.82)μg/L水平均明显高于对照组[(48.52±7.18)ng/L、(1.94±0.16)μg/L](P<0.05)。CAL组病儿血清NT-proBNP(263.91±52.68)ng/L、CTnI(6.63±0.97)μg/L水平均明显高于N-CAL组[(189.40±38.39)ng/L、(5.56±0.78)μg/L](P<0.05)。logistic回归分析显示,发热时间、C反应蛋白、NT-proBNP、CTnI是影响川崎病病儿发生CAL的危险因素(P<0.05)。ROC曲线显示,血清NT-proBNP、CTnI及联合诊断川崎病病儿合并CAL的曲线下面积(AUC)及其95%CI分别为0.84(0.77,0.91)、0.81(0.74,0.89)、0.92(0.87,0.96)。结论川崎病合并CAL病儿血清NT-proBNP、CTnI水平升高,且二者与CAL密切相关,联合检测可以用于早期诊断CAL。

三七对下腔静脉结扎DVT大鼠模型D-二聚体、cTn-I、BNP的影响

目的观察三七对下腔静脉结扎深静脉血栓(DVT)大鼠D-二聚体、心肌肌钙蛋白I(cTn-I)、血B型钠尿肽(BNP)的影响。方法将20只大鼠随机分为三七组、DVT组、依诺肝素组和假手术组,每组各5只。除假手术组外均行开腹结扎下腔静脉造模。下腔静脉结扎造模成功后48 h处死大鼠,取游离左肾静脉和下腔静脉汇合处及向下1 cm血管进行苏木素-伊红染色,于显微镜下观察,并检测血管D-二聚体、cTn-I、BNP含量。结果四组大鼠血浆cTn-I、D-二聚体、BNP含量比较,差异均有统计学意义(F分别=26.56、9.86、7.34,P均<0.05)。DVT组大鼠血浆中cTn-I、D-二聚体、BNP含量高于假手术组,差异有统计学意义(t分别=11.40、6.67、8.92,P均<0.05)。三七组、依诺肝素组cTn-I含量明显低于DVT组,差异均有统计学意义(t分别=2.62、3.50,P均<0.05)。依诺肝素组D-二聚体含量明显低于DVT组,差异有统计学意义(t=3.66,P<0.05)。结论三七和依诺肝素对于DVT大鼠模型均有一定治疗作用。

基于CDs@SiNWs的光电化学免疫传感器构建及性能研究

采用金属辅助化学蚀刻法制备高定向硅纳米线阵列(silicon nanowire arrays, SiNWs),结合碳点(carbon dots,CDs)改性制备了一种新型无标记光电免疫传感器,用于心肌肌钙蛋白I(cardiac troponin I, cTnI)的检测。N型SiNWs作为光阳极,可获得强的光电信号基底响应。采用旋涂法将CDs负载于SiNWs表面,可以提高SiNWs对可见光的吸收能力,促进光生载流子分离,从而提高SiNWs的光电性能;同时,CDs为抗体连接提供了羧基活性位点。基于CDs@SiNWs的光电免疫传感器对cTnI的检测具有良好的线性范围(0.005~5.000 ng/mL)和较低的检出限(3.79 pg/mL)。所设计的光电化学(photoelectrochemical, PEC)免疫传感器具有良好的灵敏度、稳定性和重复性。该电极可实现无标签检测,为实现c TnI的即时检测提供了新的途径。

脓毒症心功能障碍患者Scr、cTnI与超声心动图指标及预后的关系

目的探讨脓毒症心功能障碍患者血肌酐(Scr)、心肌肌钙蛋白I(cTnI)与超声心动图指标及其预后的关系。方法回顾性选择2019年8月至2022年1月绍兴第二医院收治的脓毒症患者164例,均于入院24 h内行Scr、cTnI水平检测和超声心动图检查。超声心动图指标包括左心室舒张末期内径(LVEDd)、左心室收缩末期内径(LVESd)、左心房内径(LAD)、左心室射血分数(LVEF)、每搏输出量(SV)、二尖瓣舒张早期充盈峰E峰流速与舒张晚期充盈峰A峰流速比值(E/A)、舒张早期二尖瓣峰流速与二尖瓣环运动速度比值(E/e')。采用Pearson相关分析Scr、cTnI水平与超声心动图各指标间的相关性。采用多因素logistic回归分析脓毒症心功能障碍患者28 d死亡的影响因素。采用ROC曲线分析Scr、cTnI水平单独及联合检测对预后预测的价值。结果收缩功能障碍者46例,舒张功能障碍者38例,心功能正常者80例。Pearson相关性分析显示,Scr、cTnI水平与脓毒症心功能障碍患者的LVEDd、LVESd、LAD、E/e'呈正相关(均P<0.05),与LVEF、SV、E/A呈负相关(均P<0.05)。随访28 d,84例心功能障碍患者中死亡49例(58.33%)。死亡组的Scr、cTnI水平及LVEDd、LVESd、LAD、E/e'高于存活组,LVEF、SV、E/A低于存活组,差异均有统计学意义(均P<0.05)。多因素logistic回归分析结果显示,年龄、LVEDd、LVESd、LAD、LVEF、SV、E/A、E/e'及Scr、cTnI水平均是心功能障碍患者28d死亡的影响因素(均P<0.05)。ROC曲线结果显示,Scr、cTnI联合评估心功能障碍患者28 d死亡的AUC高于各单独检测(均P<0.05)。结论脓毒症心功能障碍患者Scr、cTnI水平与超声心动图参数及近期预后相关。

An electrochemiluminescent magneto-immunosensor for ultrasensitive detection of hs-cTnI on a microfluidic chip

Sensitive detection and precise quantitation of trace-level crucial biomarkers in a complex sample matrix has become an important area of research.For example,the detection of high-sensitivity cardiac troponin I (hs-cTnI) is strongly recommended in clinical guidelines for early diagnosis of acute myocardial infarction.Based on the use of an electrode modified by single-walled carbon nanotubes (SWCNTs) and a Ru(bpy)32+-doped silica nanoparticle (Ru@SiO2)/tripropylamine (TPA) system,a novel type of electrochemiluminescent (ECL) magnetoimmunosensor is developed for ultrasensitive detection of hs-cTnI.In this approach,a large amount of[Ru(bpy)3]2+is loaded in SiO2(silica nanoparticles) as luminophores with high luminescent efficiency and SWCNTs as electrode surface modification material with excellent electrooxidation ability for TPA.Subsequently,a hierarchical micropillar array of microstructures is fabricated with a magnet placed at each end to efficiently confine a single layer of immunomagnetic microbeads on the surface of the electrode and enable 7.5-fold signal enhancement In particular,the use of transparent SWCNTs to modify a transparent ITO electrode provides a two-order-of-magnitude ECL signal amplification.A good linear calibration curve is developed for hs-cTnI concentrations over a wide range from 10 fg/ml to 10 ng/ml,with the limit of detection calculated as 8.720 fg/ml (S/N=3).This ultrasensitive immunosensor exhibits superior detection performance with remarkable stability,reproducibility,and selectivity.Satisfactory recoveries are obtained in the detection of hs-cTnI in human serum,providing a potentia analysis protocol for clinical applications.

cTnI、NT-proBNP 检测在急性心源性胸痛筛查及预后中的应用

目的:分析cTnI、NT-proBNP在急性心源性胸痛(CCP)筛查及预后评估中的应用价值。方法:187例急性胸痛患者,依据病因分为急性CCP组及急性NCCP组,分析CCP发生的危险因素以及血清cTnI、NT-proBNP对CCP预后的评估价值。结果:cTnI、NT-proBNP为急性CCP发生的独立危险因素(P<0.05);死亡组血清cTnI、NT-proBNP水平较存活组高(P<0.05);两者联合检测预测急性CCP预后的效能高于单一指标(P<0.05)。结论:血清cTnI、NT-proBNP是急性CCP发生的危险因素,两者联合检测预测预后的效能更高。

老年慢性心衰患者血清cTnI、CK-MB水平与心电图QRS波的相关性研究

目的:分析老年慢性心力衰竭(CHF)患者血清心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶MB(CK-MB)与心电图QRS波的相关性。方法:选取2020年9月至2023年10月六安市中医院接收的100例老年CHF患者,将其纳入观察组,另选同期于本院进行体检的100名老年健康者纳入健康对照组。所有受检者均接受血清cTnI、CK-MB检查及心电图检查,比较两组受检者的QRS波时限、血清cTnI、CK-MB水平。100例观察组患者再根据心电图QRS波时限是否异常分为两个亚组,即QRS异常组(52例,QRS波时限≥120 ms)和QRS正常组(48例,QRS波时限<120 ms);比较两个亚组患者一般资料,血清cTnI、CK-MB水平;分析老年CHF患者血清c Tn I、CK-MB水平与心电图QRS波的相关性。结果:与健康对照组比较,观察组血清c Tn I(1.912±0.401 vs. 0.861±0.173)μg/L、CK-MB(23.272±4.801 vs. 10.573±2.332)U/L水平更高,QRS波时限更长(126.761±17.452 vs. 104.475±13.351)μg/L,两组比较差异有统计学意义(t=24.159、23.802、10.145,P<0.05)。观察组患者经心电图检查发现,有52例患者出现心电图QRS波时限异常,QRS波时限平均为(141.641±12.581)ms;48例患者心电图QRS波时限正常,QRS波时限平均为(110.652±10.751)ms。QRS波时限异常组患者的血清c Tn I、CK-MB水平均高于QRS正常组患者,差异有统计学意义(t=7.534、10.362,P<0.05);经一般线性双变量Pearson检验结果显示,c Tn I、CK-MB两项血清指标与QRS波时限均呈正相关(r=0.395、0.453,P<0.05)。经logistic回归分析结果显示,血清c Tn I、CK-MB水平与心电图QRS波时限有关,过表达可能是心电图QRS波时限异常的风险因子(OR=4.444、1.445,P<0.05)。结论:老年CHF患者血清c Tn I、CK-MB水平异常升高,二者过表达与心电图QRS波时限异常有关,可能是QRS波时限异常的风险因子。

Impact of training specificity on exercise-induced cardiac troponin elevation in professional athletes: A pilot study

BACKGROUND Release of cardiac biomarkers is common after strenuous endurance exercise,but data on intermittent exercise are scarce.It has not been investigated whether cardiac troponin elevation is influenced depending on the type of exercise that an athlete is adapted to perform.We hypothesized that intermittent but not continuous exercise induces cardiac troponin elevation in professional athletes adapted to high-intensity intermittent exercise.AIM To examine how training specificity impacts high-sensitivity cardiac troponin T(hs-cTnT)release.METHODS Nine professional floorball players participated in the study,which comprised two different exercise tests:a continuous incremental cycle ergometer test and a Yo-Yo Intermittent Recovery 2(Yo-Yo IR2)test.Serial assessment of hs-cTnT was performed after the cycle ergometer test and the Yo-Yo IR2 test(baseline,0,2,6,and 24 h).RESULTS No hs-cTnT elevation above the myocardial damage cutoff(≥14 ng/L)was shown after the cycle ergometer test,whereas hs-cTnT levels rose over the cutoff in three of nine participants after the Yo-Yo IR2 test.The hs-cTnT levels peaked at 6 h after both tests,but were significantly higher after the Yo-Yo IR2 test compared to the cycle ergometer test(median hs-cTnT concentration 10.6 ng/L vs 7.8 ng/L,P=0.038).All levels returned to baseline within 24 h.CONCLUSION In professional athletes adapted to high-intensity intermittent exercise,hs-cTnT was significantly elevated after intermittent but not continuous exercise.This principle of specificity training should be considered when designing future studies to avoid misinterpretation of hs-cTnT elevation.

Troponin based studies in search of a biomarker for cardiac arrest

Cardiac arrest is shown to be a cause of a large number of deaths not only in Pakistan but around the globe. The prevalence of this dis-ease demands identification of its etiology. The science of proteomics can be used to identify cardiac specific proteins. The subsequent over expression or under expression of these pro-teins can be utilized as targets not only for therapeutical interventions but also for identi-fying molecular signatures for Cardiac diseases. In context of a number of studies which have shown that the specificity of serum biomarkers like troponin (cTnI and cTnT) are questionable as they may also appear in serum in pathologi-cal conditions other than cardiac dysfunction, the search of a specific marker for cardiac arrest becomes imperative. In this study protein pro-filing of cardiac arrest patients was performed after its quantification through Bradford assay. SDS-PAGE and 2 DE techniques were used as to characterize proteins. The samples of the pa-tients prior to characterizing of proteins were subjected to lipid and cardiac enzymes profiling. The results of these investigations have shown an increase in almost all of these parameters by many folds from that of normal values. In addi-tion to this the samples were found out to be positive for troponin T which strongly confirms the incidence of the cardiac arrest. The results of SDS-PAGE exhibited the induction of three proteins of 100 kDa, 97 kDa and of 66 kDa with 100 kDa as the most highly expressed protein. In addition to that SDS-PAGE gels have shown the down regulation of 45 kDa protein, again indi-cating the changes as a result of cardiac arrest. 2DE gel patterns of cardiac arrest samples demonstrated higher number of protein spots as compare to control in the alkaline range, which might suggest their role in cardiac dysfunction. Therefore it can be concluded that this study may pave the grounds for identification of such proteins which can serve not only as potential therapeutical targets but also as candidate markers for accurate diagnosis of the disease.