急性一氧化碳中毒患者心肌损伤程度与和肽素及缺血修饰白蛋白水平的相关性分析

目的 研究和肽素、缺血修饰白蛋白（IMA）与急性一氧化碳中毒（ACOP）心肌损伤的关系.方法 选择不同中毒程度ACOP患者110例作为中毒组,其中轻度中毒22例（轻度中毒组）,中度中毒50例（中度中毒组）,重度中毒38例（重度中毒组）,同期健康体检者30例作为对照组,中毒组在入院后2h、7d抽取静脉血3ml,对照组在体检时抽取静脉血3ml,检测心肌肌钙蛋白Ⅰ（cTnⅠ）、IMA、和肽素水平.中毒组依据有无出现并发症,分为并发症组26例,非并发症组84例.比较各组cTnⅠ、IMA、和肽素水平的差异.结果 入院后2h,轻度、中度、重度中毒组IMA降低（62.50 ±2.17）、（59.04±3.10）、（56.01±8.85） kU/L]、和肽素升高（2.82±0.73）、（7.31±0.95）、（13.08±1.96） μg/L],与对照组（67.23±1.40） kU/L和（0.87±0.19）μg/L]比较差异有统计学意义（P＜0.05）,而且中度中毒组与轻度中毒组、重度中毒组与轻度中毒组和中度中毒组比较差异均有统计学意义（P＜0.05）;各组cTnⅠ比较差异无统计学意义（P＞0.05）.入院后7d,各组IMA、和肽素比较差异无统计学意义（P＞0.05）;轻度、中度、重度中毒组cTnⅠ升高（1.80±0.17）、（2.34±0.46）、（2.60±0.54） μg/L],与对照组（1.27±0.28）μg/L]比较差异有统计学意义（P＜0.05）,而且中度中毒组与轻度中毒组、重度中毒组与轻度中毒组和中度中毒组比较差异均有统计学意义（P＜0.05）.并发症组入院后2h和入院后7dIMA、和肽素水平均高于非并发症组（54.62±1.53） kU/L比（57.89±4.02） kU/L、（60.65±3.61） kU/L比（66.84±1.78） kU/L和（13.88±1.45） μg/L比（6.99±3.39）μg/L、（6.65±1.82） μg/L比（2.47±0.61）μg/L],差异有统计学意义（P＜0.05）.并发症组入院后7 dcTnⅠ水平明显高于非并发症组（3.10±0.22） μg/L比（1.87±0.27）μg/L],差异有统计学意义（P＜0.05）.相关分析提示不同程度的ACOP患者早期和肽素水平与IMA水平呈负相关（r=-0.560,P＜0.01）.结论 检测IMA和和肽素对ACOP心肌损伤早期诊断、判断预后转归及指导临床合理用药具有重要意义.

Relationship beween copeptin,ischemia modified albumin and the degree of myocardial injury in patients with acute carbon monoxide poisoning

Objective To study the relationship between copeptin,ischemia modified albumin （IMA） and the degree of myocardial injury in patients with acute carbon monoxide poisoning （ACOP）.Methods A total of 110 ACOP patients with different degree of poisoning were selected as poisoning group and included mild poisoning 22 cases （mild group）,moderate poisoning 50 cases （moderate group）,severe poisoning 38 cases （severe group）,and 30 healthy subjects were selected as control group.The cardiac troponin Ⅰ （cTnⅠ）,IMA,copeptin level was detected at 2 h,7 d after admission in poisoning group and at admission in control group.According to with or without complications,poisoning group was divided into complications group （26 cases） and non-complications group （84 cases）.cTnⅠ,IMA,copeptin level was compared among groups.Results At 2 h after admission,IMA was decreased and copeptin was increased in mild,moderate,severe group（62.50 ± 2.17）,（59.04 ± 3.10）,（56.01 ± 8.85） kU/L and （2.82 ± 0.73）,（7.31 ±0.95）,（13.08 ± 1.96） μg/L],there was statistical difference compared with control group （67.23 ± 1.40） kU/L and （0.87 ±0.19） μg/L]（P＜0.05）,and there was significant difference between moderate group and mild group,severe group and mild group,moderate group （P ＜ 0.05）;there was no statistical difference in cTnⅠ among groups.At 7 d after admission,there was no significant difference in IMA,copeptin among groups （P ＞ 0.05） ; cTnⅠ was increased in mild,moderate,severe group （1.80 ± 0.17）,（2.34 ±0.46）,（2.60 ±0.54） μg/L],and there was statistical difference compared with control group （1.27 ±0.28） μg/L] （P ＜0.05）,and there was significant difference between moderate group and mild group,severe group and mild group,moderate group （P＜ 0.05）.IMA,copeptin at 2 h,7 d after admission in complications group was higher than that in non-complications group （54.62 ± 1.53） kU/L vs.（57.89 ± 4.02） kU/L,（60.65 ± 3.61） kU/L vs.（66.84 ± 1.78） kU/L and （13.88 ± 1.45） μ g/L vs.（6.99 ± 3.39） μ g/L,（6.65 ± 1.82） μ g/L vs.（2.47 ± 0.61） μ g/L]（P＜ 0.05）.cTnⅠ at 7 d after admission in complications group was higher than that in non-complications group （3.10 ± 0.22） μ g/L vs.（1.87 ± 0.27） μ g/L] （P ＜ 0.05）.Correlation analysis showed that copeptin was negatively correlated with IMA in patients with different degree of poisoning （r =-0.560,P ＜ 0.01）.Conclusions The combined detection of IMA and copeptin has important clinical value to the early diagnosis and prognosis in evaluating the prognosis of ACOP myocardial injury.There is important guidance for early clinical drug application.