摘要
目的探讨高敏肌钙蛋白(cTnT和cTnI)在诊断脓毒性休克合并心肌梗死中的应用价值。方法将2019年1月—2020年7月北京大学深圳医院重症医学科收治的脓毒性休克患者共189例纳入本次回顾性研究。根据患者是否存在心肌功能障碍和急性心肌梗死,将患者分为对照组(99例)、心肌功能障碍组(75例)、急性心梗组(15例)。收集患者的病例资料,如性别、年龄、原发病、感染程度[白细胞、C反应蛋白(CRP)、降钙素原(PCT)水平]等;统计患者发病后28 d内的死亡率;检测并比较三组患者外周血中cTnT和cTnI水平;采用受试者工作特征(ROC)曲线评估cTnT和cTnI对脓毒性休克合并心肌梗死的诊断价值。结果三组患者基础资料比较,性别、年龄、原发感染部位及合并症等差异无统计学意义(P>0.05)。急性心梗组APACHEⅡ评分显著高于心肌功能障碍组,对照组评分最低,差异有统计学意义(P<0.05)。急性心梗组患者28 d内死亡率高达73.33%,显著高于心肌功能障碍组的41.33%和对照组的12.12%(P<0.05)。三组患者心肌功能指标cTnI和cTnT比较,差异有统计学意义(P<0.05)。急性心梗组cTnI和cTnT水平均显著高于心肌功能障碍组和对照组,差异有统计学意义(P<0.05)。三组患者感染指标(CRP和PCT)差异无统计学意义(P>0.05)。在诊断脓毒性休克合并心肌梗死时,血cTnI的截断值为1.295 ng/mL,曲线下面积为0.972(95%CI:0.949~0.996),特异度为0.937,灵敏度为0.933;血cTnT的截断值为0.494 ng/mL,曲线下面积为0.968(95%CI:0.938~0.999),特异度为0.914,灵敏度为0.933。结论cTnT和cTnI水平在脓毒性休克合并心肌梗死患者中明显升高,外周血检测cTnT和cTnI有助于脓毒性休克合并心肌梗死的诊断,具有较高的灵敏度和特异度。
Objective To investigate the value of hypersensitive troponin(cTnT and cTnI) in the diagnosis of septic shock complicated with myocardial infarction.Methods A total of 189 patients with septic shock admitted to the intensive care department of our hospital from January 2019 to July 2020 were included in this retrospective study.According to the existence of myocardial dysfunction and acute myocardial infarction, the patients were divided into control group(99 cases), myocardial dysfunction group(75 cases), and acute myocardial infarction group(15 cases).Patients′clinical data, such as gender, age, primary disease, infection degree(WBC, C-reactive protein, procalcitonin level) and so on, were collected. The mortality rate within 28 days after the onset of the disease was also counted. The levels of cTnT and cTnI in peripheral blood of the three groups were detected and compared. Receiver operating characteristic(ROC) curve was used to evaluate the diagnostic value of cTnT and cTnI in septic shock complicated with myocardial infarction.Results There was no statistical significance in gender, age, site of primary infection and complications among the three groups(P>0.05). The APACHEⅡ score in the acute myocardial infarction group was significantly higher than that in the myocardial dysfunction group, and the score in the control group was the lowest,with statistical significance(P<0.05). The mortality within 28 days in the acute myocardial infarction group was73.33%, which was significantly higher than that in the myocardial dysfunction group(41.33%) and the control group(12.12%)(P<0.05). There was significant difference of cTnI and cTnT among three groups(P<0.05). The levels of cTnI and cTnT in acute myocardial infarction group were significantly higher than those in myocardial dysfunction group and control group(P<0.05). There was no statistical significance in infection indexes(CRP and PCT) among the three groups(P>0.05). In the diagnosis of septic shock complicated with myocardial infarction, the cutoff value of cTnI in blood was 1.295 ng/mL, the area under the curve was 0.972(95%CI: 0.949~0.996), the specificity was 0.937, the sensitivity was 0.933. The cut-off value of cTnT was 0.494 ng/mL with the area under the curve of 0.968(95%CI0.938~0.999), the specificity of 0.914, and the sensitivity of 0.933.Conclusion The levels of cTnT and cTnI were significantly increased in patients with septic shock complicated with myocardial infarction, and high level of cTnT and cTnI in peripheral blood was helpful for the diagnosis of septic shock complicated with myocardial infarction, with high sensitivity and specificity.
作者
熊焕宏
魏衍召
陈启明
XIONG Huanhong;WEI Yanzhao;CHEN Qiming(Peking University Shenzhen Hospital,Shenzhen Guangdong 518036,China)
出处
《中国急救复苏与灾害医学杂志》
2022年第9期1139-1142,共4页
China Journal of Emergency Resuscitation and Disaster Medicine
基金
深圳市科技计划项目(编号:JCYJ201404151623388)。
