Circulating cardiac troponin I in trauma patients without cardiac contusion

Objectives: To describe the evolution and the diagnostic value of cardiac troponin I (cTnI) and to relate its concentrations with the indicators of injury in trauma patients. Design: Prospective, observational study of 17 young, previously healthy, mechanically-ventilated patients during the early post-traumatic period in the Surgical ICU of a University Hospital. Methods: Serial measurements of serum cTnI, total creatine kinase activity (CKtot) and its isoenzyme MB (CK-MB) (on admission, 12 h later, then daily for 7 days), clinical data and repeated electrocardiographic (ECG) and transesophageal echocardiographic (TEE) recordings. Results: Rhabdomyolysis was observed in all the patients with a significant relationship between CK-MB and CKtot. Despite the fact that no patient demonstrated ECG or TEE signs of myocardial contusion, elevated serum levels of cTnI were observed in six patients (35 %) without obvious dilutional interference. As compared with the others, these patients exhibited a more frequent arterial hypotension (83 % vs 18 %, p = 0.035), required greater volume expansion on day 1 (22,000 vs 8,500 ml, p = 0.027) and usually demonstrated early (83 % vs 9 %, p = 0.005) and late (66 % vs 9 %, p = 0.028) multiple organ dysfunction syndrome. Conclusions: Taking into account the high reported sensitivity and specificity of cTnI dosage, the present results suggest cTnI can play a role in the evaluation of indirect myocardial injury following traumatic shock. Received: 20 November 1997 Accepted: 3 March 1998     

非心脏术后应激性高血糖对心脏疾病患者心肌功能的影响

目的：探讨非心脏手术后应激性高血糖对心脏疾病患者心肌功能的影响。方法回顾性分析中山大学肿瘤防治中心重症医学科收治211例接受胸部或腹部手术的非心脏手术患者的临床资料。根据患者术后3 d内平均血糖水平和既往有无心血管疾病分为无高血糖（血糖≤10 mmol/L）无心血管疾病组（HG0CV0组）,无高血糖有心血管疾病组（HG0CV1组）,有高血糖（血糖＞10 mmol/L）无心血管疾病组（HG1CV0组）,有高血糖有心血管疾组（HG1CV1组）。观察各组血糖与超敏心肌肌钙蛋白I（hs-cTnI）水平、B型钠尿肽（BNP）及心肌酶谱天冬氨酸氨基转移酶（AST）、肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）、乳酸脱氢酶（LDH）、乳酸脱氢酶同工酶（LDH-1）、肌红蛋白（MYO）、α-羟丁酸脱氢酶（HBDH）的相关性。结果211例患者术后血糖均明显高于术前（mmol/L：8.7±0.2比5.7±0.2,P＜0.05）,术后血糖＞6.1 mmol/L的患者占84.8%（179例）。HG0CV0组术后血糖与MYO、AST水平呈正相关〔r值分别为0.193、0.307,95%可信区间（95%CI）分别为0.010～0.362、0.096～0.479,P值分别为0.038、0.003〕,与hs-cTnI、BNP、LDH、LDH-1、HBDH、CK、CK-MB均无相关性（均P＞0.05）;HG0CV1组术后血糖与hs-cTnI水平呈负相关（r＝-0.609,95%CI为-0.810～-0.264,P＝0.001）,与BNP、MYO、AST、LDH、LDH-1、HBDH、CK、CK-MB均无相关性（均P＞0.05）;HG1CV0组术后血糖水平与hs-cTnI、BNP、MYO、AST、LDH、LDH-1、HBDH、CK、CK-MB均无相关性（均P＞0.05）;HG1CV1组术后血糖与hs-cTnI水平呈正相关（r＝0.837,95%CI为0.476～0.984,P＝0.001）,与BNP、MYO、AST、LDH、LDH-1、HBDH、CK、CK-MB均无相关性（均P＞0.05）。结论非心脏手术后早期应激性高血糖对心脏疾病患者心肌功能可能有保护作用。     

Role of tissue disorder markers in the evaluation of disease progress and outcome prediction: a prospective cohort study in non-cardiac critically ill patients

Background: Acute Physiology and Chronic Health Evaluation (APACHE) has a remarkable association with clinical syndrome, life expectancy, and length of ward stay. But the defects are obvious. It is crucial to detect an effective and convenient evaluation method to monitor disease progress and predict outcome. Objective: To determine whether myoglobin (Mb) and other five tissue disorder biomarkers, troponin‐I, creatine‐kinase, creatine kinase–muscle brain, aspartate aminotransferase, and lactate dehydrogenase are independent predictors of disease progress and mortality in non‐cardiac critical illness. Methods: A prospective study with 179 patients admitted to the Intensive Care Unit was conducted. All serum tissue disorder markers and APACHE‐II score were measured within 24 hr of admission. Results: All the six biomarkers were significantly correlated with disease severity stratified by APACHE‐II and outcome. Serial blood samples were taken from 17 patients on detection of two new organs failure. The occurrence of organs failure was significantly associated with the elevation of Mb, troponin‐I, and APACHE‐II. Multivariate analysis demonstrated that elevated Mb was the principal risk factor related to mortality either during hospitalization or 180‐day followup. Kaplan–Meier method and log‐rank test also showed that patients with elevated Mb levels had significantly shorter survival. The mortality was higher in patients with both Mb>500 ng/ml and APACHE‐II>20 than in those with only Mb>500 ng/ml or APACHE‐II>20. Conclusion: All the six tissue disorder markers are predictors of disease severity, organ failure, and outcome in non‐cardiac critically illness. Among them, Mb plays a pivotable role. The combined use of Mb and APACHE‐II suggest an effective method to determine the outcome of critical ill syndrome. J. Clin. Lab. Anal. 24:376–384, 2010. © 2010 Wiley‐Liss, Inc.     

肌钙蛋白I和T测定对急性心肌梗塞的诊断意义

目的探讨肌钙蛋白I（cTnI）和肌钙蛋白T（cTnT）测定对急性心肌梗塞（AMI）的诊断价值。方法对52例AMI患者采用免疫层析法进行检测cTnI和cTnT,以对照区和检测区均有显色带者为阳性,并作灵敏度和特异性的比较。结果以胸痛0～3h、4～6h两个时段观察其灵敏度,cTnI为56.7%和96.1%;cT-nT为50.0%和92.3%。特异性cTnI为100%和96.2%;cTnT为100%和91.6%。cTnI灵敏度高于cTnT,特异性cTnI与cTnT之间无显著性差异。结论对AMI急性胸痛患者可同时进行cTnI和cTnT检测,有利于AMI的诊断和治疗。     

心肺复苏患者心肌损伤的临床研究

目的 探讨血清心肌肌钙蛋白T对复苏患者心肌损伤的临床价值。方法 对69例心跳、呼吸骤停的患者进行标准心肺复苏，观察心室颤动前和复苏后患者心肌肌钙蛋白T水平的变化。结果 复苏患者在恢复自主循环1h后，血清心肌肌钙蛋白T就明显升高，且升高水平与患者的病死率相对应。结论 复苏患者存在急性心肌损伤；心肌肌钙蛋白T浓度能客观地反映心肌受损状态。     

乌司他丁对脓毒症大鼠血清肌钙蛋白Ⅰ及心肌肿瘤坏死因子-α、内皮素-1的影响

目的 探讨不同剂量乌司他丁(UTI)对脓毒症大鼠心肌损伤的保护作用及其可能机制.方法 40只雄性SD大鼠按随机数字表法均分为正常对照组、假手术组、模型组及UTI小剂量组、大剂量组5组.采用盲肠结扎穿孔术(CLP)建立脓毒症模型,24 h后取动脉血及左室心肌,检测血清心肌肌钙蛋白Ⅰ(cTnI)及心肌组织匀浆上清液中肿瘤坏死因子-α(TNF-α)、内皮素-1(ET-1)水平,观察心肌组织病理改变.结果 模型组血清cTnI及心肌TNF-α、ET-1水平较正常对照组明显升高[cTnI(μg/L):7.58±0.53比1.05±0.21,TNF-α(pg/g):945.6±72.0比238.2±35.2,ET-1(pg/g):776.8±123.9比170.1±28.3,均P＜0.01].UTI小剂量组血清cTnI及心肌TNF-α、ET-1水平与模型组比较差异无统计学意义[cTnI(μg/L):7.21±0.51比7.58±0.53,TNF-α(pg/g):910.5±96.6比945.6±72.0,ET-1(pg/g):714.0±66.7比776.8±123.9,均P＞0.05].UTI大剂量组血清cTnI及心肌TNF-α、ET-1较模型组明显减低[cTnI(μg/L):4.30±0.84比7.58±0.53,TNF-α(pg/g):430.5±75.6比945.6±72.0,ET-l(pg/g):377.1±39.0比776.8±123.9,均P＜0.01].结论 大剂量UTI对脓毒症心肌损伤具有保护作用,其机制可能通过抑制心肌TNF-α、ET-1的表达而实现;小剂量UTI可能对脓毒症心肌损伤无保护作用.     

Minor troponin T elevation in patients 6 months after acute myocardial infarction: an observational study

Background  Troponin elevation in patients with stable coronary heart disease is associated with adverse outcome and prognosis. However, the mechanism is not yet clearly understood. Our objectives were to examine the prevalence and range of cardiac troponin T (cTnT) in stable patients, 6 months after acute myocardial infarction (AMI) using a new high sensitive cTnT assay and to investigate the association of minor cTnT elevation in these patients to clinical variables, NT-proBNP and cardiac MRI-findings. Study design and methods  cTnT was measured in 98 patients 6 months after AMI with a precommercial assay by electrochemiluminescence methods (Roche Diagnostics, Mannheim, Germany). cTnT values were correlated with clinical and angiographic variables, NT-proBNP concentrations and with cardiac MRI-findings. Results  Minor cTnT concentrations were detectable in 90% of the entire cohort, of whom 16% had cTnT values above the 99th percentile (>12 ng/L). These patients were also significantly older, suffered more frequently from hypertension, had a higher New York Heart Association class and received more often diuretics at follow up. Patients with cTnT elevation had a more impaired left ventricular ejection fraction (P = 0.02) but did not have an increased infarct size (P = 0.73). Conclusions  Elevated minor cTnT levels are frequently detectable in patients 6 months after AMI. Increased cTnT level were associated with clinical parameter for heart failure, impaired ejection fraction and higher NT-proBNP levels suggesting that myocardial dysfunction is a main cause for cTnT elevation in these patient group.     

心肌肌钙蛋白Ⅰ和肌钙蛋白T对急性缺血性心脏病预后相关性分析

目的探讨心肌肌钙蛋白I(cTnI)和肌钙蛋白T(cTnT)对急性缺血性心脏病转归的影响。方法对就诊的急性缺血性心脏病患者定性测定入院时及距胸痛发作间隔10h的cTnI和定量测定相同时点的cTnT。同时随访患者发病后1、3、6、12个月的疾病转归,以心绞痛、心肌梗死、心力衰竭、心源性猝死为终点评价指标。结果cTnI或cTnT异常患者与正常者相比较,不稳定型心绞痛、心肌梗死、心力衰竭、心源性猝死的发生率具有显著性差异(P<0.01)。cTnI或cTnT异常与终点事件(不稳定型心绞痛、心肌梗死、心力衰竭、心源性心源性猝死)发生率呈正相关。结论cTnI或cTnT对急性心肌梗死,尤其是微小心肌坏死诊断具有高度的敏感性和特异性,并与急性缺血性心脏病的预后密切相关。     

川崎病患儿血清肌钙蛋白Ⅰ的变化及其意义

目的探讨静脉注射免疫球蛋白（IVIG）治疗川崎病（KD）前后血清心肌肌钙蛋白Ⅰ（cTnⅠ）浓度变化的临床意义.方法检测KD（n=42）组治疗前后及对照组（n=28）患儿血清cTnⅠ、肌酸激酶（CK）、乳酸脱氢酶（LDH）与谷草转氨酶（GOT）的浓度.结果KD组血清cTnⅠ浓度明显高于对照组.CK、LDH、GOT浓度与对照组比较差异无显著性意义.IVIG治疗后cTnⅠ浓度明显低于治疗前.结论cTnⅠ对KD患儿急性期心肌损伤有早期诊断价值;可以指导早期IVIG治疗,并可作为IVIG疗效观察指标,从而减少KD患儿心肌病变的发生.     

心肌肌钙蛋白I、肌钙蛋白T、肌酸激酶同工酶MB早期诊断 急性心肌梗死敏感性及特异性比较分析

目的 探讨心肌肌钙蛋白Ⅰ（cTnI)、 肌钙蛋白T（cTnT)、 肌酸激酶同工酶MB（CK－MB）早期诊断急性心肌梗死的临床应用价值。方法 对60例急性心肌梗死（AMI）和40例不稳定型心绞痛（UA）患者的同一血样标本检测cTnI、cTnT、CK－MB3项指标,分别进行两组间比较,并对 AMI组和UA组各指标作对比分析。结果 cTnI、cTnT早期诊断急性心肌梗死灵敏度高于CK－MB,阳性率分别为63.3%、46.7%、18.3％,P＜0.01;cTnI和cTnT无显著差别,P＞0.05;cTnI、cTnT、CK－MB特异性相当。结论 心肌肌钙蛋白I和肌钙蛋白T对于AMI的早期诊断具有较高灵敏度和较强特异性,是心肌损伤特异笥标志物,cTnI检测方便、快捷、准确,具有较好的临床价值。     

脓毒症小鼠心肌P-选择素基因的表达及意义

目的:探讨脓毒症时小鼠心肌P-选择素表达的改变及其意义.方法:雌性昆明小鼠72只,随机分为对照组(12只)、假手术组(12只)、盲肠结扎穿孔(CLP)组(48只),CLP法制备脓毒症模型,CLP后2、4、8和12 h处死动物分别留取血和心脏组织,采用双抗夹心酶联免疫法(ELISA)检测血清肌钙蛋白Ⅰ(cTnI),测心肌组织髓过氧化物酶(MPO)活性,采用实时荧光定量逆转录多聚酶链反应(RT-PCR)法检测心肌组织P-选择素mRNA表达.结果:CLP组2、4、8和12 h心肌组织P-选择素mRNA表达进行性升高,与对照组和假手术组相比,差异有统计学意义(P＜0.05).而且CLP后心肌组织p-选择素mRNA表达水平与心肌组织MPO活性及血清肌钙蛋白Ⅰ浓度均呈显著正相关.结论:脓毒症时小鼠心肌损伤时,心肌组织P-选择素表达显著升高,可能与心肌组织中性粒细胞浸润及心肌损伤密切相关.     

肌钙蛋白Ⅰ在急性心肌梗死早期诊断和心肌再梗死中的价值

目的探讨心肌肌钙蛋白I(cTnI)在急性心肌梗死(AMI)早期诊断和心肌再梗死中的价值。方法测定131例AMI发作2～10 h患者的血清cTnI和肌酸激酶同工酶(CK-MB)的浓度,并以122名健康体检者作对照,绘制并分析受试者工作特征(ROC)曲线。结果AMI组发病早期血清cTnI和CK-MB水平与对照组相比差异有统计学意义(P<0.01);AMI后2～10 h cTnI和CK-MB的ROC曲线下面积(AUC)分别为:0.925、0.991、0.998和0.648、0.719、0.831;在AMI后2～10 h cTnI和CK-MB各指标临界值对应的敏感度分别为90.6%、97.6%、97.7%和54.1%、56.9%、76.9%;特异度分别为87.3%、95.4%、98.5%和87.3%、93.5%、88.1%;AMI发作10 h的患者若cTnI>20.1μg/L时,心肌再梗死与cTnI相关性良好(r=0.74)。结论cTnI在AMI早期诊断和预测再梗死中有一定的应用价值。     

超声评估急重症患者容量状态研究进展

循环不稳定是急重症患者常见急症之一,快速评估其容量状态是指导治疗的关键。检测中心静脉压（CVP）是目前临床评估容量负荷的较常用方法,但为有创操作,且存在较多近远期并发症。超声作为无创检查已广泛应用于监测血流动力学,近年来,采用急诊超声评估患者容量状态并指导液体治疗日益普及。本文对超声评估急重症患者容量状态的应用进展进行综述。     

心脏肌钙蛋白I测定在心血管疾病诊断中的初步应用

目的探讨心脏肌钙蛋白Ｉ（ｃＴｎＩ）测定对心血管疾病心肌损伤的诊断价值。方法用固相层析免疫法测定急性心肌梗死（ＡＭＩ），心绞痛（ＡＰ）、病毒性心肌炎（ＶＭ）、原发性高血压（ＥＨ）和射频消融（ＲＦＣＡ）术后患者血清ｃＴｎＩ。结果 ＡＭＩ、 ＶＭ和 ＲＦＣＡ术后患者血清 ｃＴｎＩ阳性率显著高于正常人（Ｐ＜０．００５）。 ＡＭＩ组ｃＴｎＩ强阳性者较其他组显著增多（Ｐ均＜０． ００１）， Ｉ多数２周内转阴；而 ＶＭ组和 ＲＦＣＡ组弱阳居多（ Ｐ＝０． ２）， ＶＭ患者多于１个月左右转阴； ＲＦＣＡ术后 ７２ｈ内即可转阴。 ｃＴｎＩ测定敏感性高于心肌酶学（Ｐ＜０．００５）。结论 ｃＴｎＩ是一特异性和敏感性具佳的心肌损伤血清标志物，对不同病理改变及不同病理进程的心肌损伤之诊断具有重要应用价值。     

心肌损伤标志物与脓毒症合并心肌病患者预后质量的相关性研究

【】 目的：探讨心肌损伤标志物与脓毒症合并心肌病患者预后质量的相关性。方法：选取2015年2月至2017年11月期间于佛山市顺德区乐从医院就诊的50例脓毒症心肌病患者作为研究对象,依据30天内是否生存为分组依据,分为存活组和死亡组各50例。分别在确诊当天、第3天、第6天、第12天利用酶联免疫吸附实验(ELISA)检测两组患者的肌钙蛋白(cTnI)和肌酸激酶同工酶(CK-MB)的水平,并使用APACHE-Ⅱ评分对患者进行病情评估,分析心肌损伤标志物与脓毒症合并心肌病患者预后质量的相关性。结果：根据两组患者各个时间段的cT-nI、CK-MB含量及APACHE-Ⅱ评分结果显示,死亡组患者各项目的评分均高于存活组,差异有统计学意义(P＜0.05);而两组患者各个时间段cT-nI与APACHE-Ⅱ评分的相关性分析,在确诊当天、第3天、第6天均呈显著正相关(r=0.35,r = 0.31,r = 0.41,P＜0.05);但第12天则不呈现相关性(r = 0.25,P＞0.05)。结论：cTnI和CK-MB可作为心肌损伤标志物,能反映脓毒症患者伴有心肌损伤,且cTnI水平越高提示心肌损害程度越高,预测病情危险更高, 脓毒症患者早期cTnI水平变化与脓毒症心肌病患者的预后质量密切相关。     

急性高容量血液稀释对老年病人循环功能及心肌钙蛋白的影响

目的观察急性高容量血液稀释(AHH)对硬膜外麻醉下老年病人循环功能及心肌钙蛋白I(CTnⅠ)的影响,探讨AHH在老年患者术中应用的安全性。方法选择ASAⅠ～Ⅱ级,无心肺疾患的硬膜外麻醉老年患者30例,随机分血液稀释组(H组)和对照组(C组),每组各15例。硬膜外麻醉成功后,H组按50ml/min的速率输注6%羟乙基淀粉(6%HES,200/0.5)15ml/kg,C组输乳酸林格氏液15ml.kg-1.h-1。麻醉前、切皮前、术毕、术后4h监测并记录SBp、dBp、HR、CVP、HCT、血气及心肌钙蛋白(CTnⅠ)。结果硬膜外麻醉后两组血压均下降,C组下降较H组明显,H组实施AHH后CVP明显升高,但基本在正常范围之内。两组术中各时点血气分析变化差异无显著性。CTnⅠ在组内各时点及组间相应时点差异无显著性(P>0.05),且CTnⅠ始终处在低值(≤0.1ng/ml)。结论一般情况良好,无心肺疾患的老年患者硬膜外麻醉下实施AHH,循环功能影响较小,心肌损伤不明显。     

艾司洛尔对脓毒性休克患者心脏保护的临床研究

目的探讨艾司洛尔对脓毒性休克患者的心脏保护作用。 方法选取浙江省立同德医院收治的44例脓毒性休克患者,采用随机数字表法分为对照组（22例）和治疗组（22例）。治疗组在常规治疗基础上静脉泵入艾司洛尔,对照组持续静脉泵入等渗NaCl溶液。记录两组患者入组后0、24、48、72、96 h时的心率、中心静脉压（CVP）、平均动脉压（MAP）、每搏量指数（SVI）、心脏指数、全心舒张末期血容积指数（GEDVI）、左室射血分数（LVEF）、二尖瓣口舒张早晚期血流峰值流速比值（E/A）、心肌肌钙蛋白I（cTnI）、脑钠尿肽、血乳酸和ScvO₂表达水平,比较两组患者的28 d病死率。 结果两组患者各时间点心率、心脏指数、GEDVI、E/A、cTnI及脑钠尿肽表达水平比较,差异均有统计学意义（F = 58.045、11.102、7.132、7.136、2.970、3.006,P均< 0.05）。进一步两两比较发现,治疗组患者24、48、72及96 h心率和心脏指数较对照组同时间点及治疗组0 h均显著降低（P均< 0.05）;治疗组患者48、72及96 h GEDVI及E/A水平较对照组同时间点及治疗组0 h均显著升高（P均< 0.05）;治疗组患者48、72及96 h cTnI和脑钠尿肽表达水平均较对照组同时间点显著降低（P均< 0.05）;治疗组患者72及96 h cTnI和脑钠尿肽表达水平均较同组0 h显著降低（P均< 0.05）。且对照组及治疗组患者28 d病死情况比较,差异无统计学意义（7/22 vs. 5/22,χ²= 0.458,P= 0.498）。 结论艾司洛尔可减轻脓毒性休克患者心肌损伤,改善心肌舒张功能,对循环、组织灌注及氧代谢无影响,对预后无显著改变。     

Initial fractal exponent of heart rate variability is associated with success of early resuscitation in patients with severe sepsis or septic shock: a prospective cohort study

Introduction

Heart rate variability (HRV) reflects autonomic nervous system tone as well as the overall health of the baroreflex system. We hypothesized that loss of complexity in HRV upon intensive care unit (ICU) admission would be associated with unsuccessful early resuscitation of sepsis.

Methods

We prospectively enrolled patients admitted to ICUs with severe sepsis or septic shock from 2009 to 2011. We studied 30 minutes of electrocardiogram, sampled at 500 Hz, at ICU admission and calculated heart rate complexity via detrended fluctuation analysis. Primary outcome was vasopressor independence at 24 hours after ICU admission. Secondary outcome was 28-day mortality.

Results

We studied 48 patients, of whom 60% were vasopressor independent at 24 hours. Five (10%) died within 28 days. The ratio of fractal alpha parameters was associated with both vasopressor independence and 28-day mortality (P = .04) after controlling for mean heart rate. In the optimal model, Sequential Organ Failure Assessment score and the long-term fractal α parameter were associated with vasopressor independence.

Conclusions

Loss of complexity in HRV is associated with worse outcome early in severe sepsis and septic shock. Further work should evaluate whether complexity of HRV could guide treatment in sepsis.     

心肌肌钙蛋白Ⅰ在心肌梗死中的检测意义

目的:探讨心肌肌钙蛋白I(cTnI)在急性心肌梗死(AMI)时的检测意义。方法:比较102例冠心病患者的cTnI和心肌酶谱的测定结果。结果:AMI患者的阳性率分别为:cTnI 87.5％、CK-MB62.5％、CK56.3％、AST46.9％、LDH40.6％。结论:AMI患者胸痛后10h血清cTnI的敏感性最高,血清cTnI对AMI诊断的特异性明显高于心肌谱(CK、Cl-MB、AST和LDH),对诊断AMI有重大临床价值。