Cardiac Troponin I association with critical illness and death risk in 726 seriously ill COVID-19 patients: A retrospective cohort study

Background: For coronavirus disease 2019 (COVID-19), early identification of patients with serious symptoms at risk of critical illness and death is important for personalized treatment and balancing medical resources.Methods: Demographics, clinical characteristics, and laboratory tests data from 726 patients with serious COVID-19 at Tongji Hospital (Wuhan, China) were analyzed. Patients were classified into critical group (n = 174) and severe group (n= 552), the critical group was sub-divided into survivors (n = 47) and non-survivors (n = 127).Results: Multivariable analyses revealed the risk factors associated with critical illness in serious patients were: Advanced age, high respiratory rate (RR), high lactate dehydrogenase (LDH) level, high hypersensitive cardiac troponin I (hs-cTnI) level, and thrombocytopenia on admission. High hs-cTnI level was the independent risk factor of mortality among critically ill patients in the unadjusted and adjusted models. ROC curves demonstrated that hs-cTnI and LDH were predictive factors for critical illness in patients with serious COVID-19 whereas procalcitonin and D-Dimer with hs-cTnI and LDH were predictive parameters in mortality risk.Conclusions: Advanced age, high RR, LDH, hs-cTnI, and thrombocytopenia, constitute risk factors for critical illness among patients with serious COVID-19, and the hs-cTnI level helps predict fatal outcomes in critically ill patients.     

老年慢性心力衰竭病人血清hs-cTnI、MMP-9、sST2水平检测及临床意义

目的 探究老年慢性心力衰竭病人血清高敏肌钙蛋白T(hs-cTnI)、基质金属蛋白酶-9(MMP-9)、可溶性基质溶素-2(sST2)水平检测及临床意义。方法 选取解放军联勤保障部队第九二〇医院2017年5月至2021年6月收治的100例老年慢性心力衰竭病人作为观察组,心功能分级为Ⅱ～Ⅳ级,其中Ⅱ级32例,Ⅲ级34例,Ⅳ级34例;另选取该院同期体检的心功能正常且无心脏病的老年人60例作为对照组。比较两组临床资料、血清hs-cTnI、MMP-9、sST2水平,分析老年慢性心力衰竭影响因素,评价血清hs-cTnI、MMP-9、sST2水平对老年慢性心力衰竭的诊断价值,并比较不同心功能分级病人血清hs-cTnI、MMP-9、sST2水平。结果 两组性别、年龄、体质量指数（BMI）、血胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、吸烟史、高血压及糖尿病比例比较,差异无统计学意义（P>0.05）;观察组血清脑钠肽（BNP）(535.63±60.87)ng/L水平高于对照组（78.62±25.41）ng/L,左室射血分数（LVEF）(49.83±5.47)...     

益心酮滴丸联合辛伐他汀治疗冠心病的临床研究

目的探讨益心酮滴丸联合辛伐他汀片治疗冠心病的临床疗效。方法选取2015年6月—2016年6月四川省医学科学院收治的冠心病患者138例作为研究对象,依据随机化原则将患者分成对照组和治疗组,每组各69例。对照组患者于睡前口服辛伐他汀片,1片/次,1次/d。治疗组患者在对照组治疗的基础上口服益心酮滴丸,10丸/次,3次/d。两组患者均连续治疗28 d。观察两组患者临床疗效,比较治疗前后两组患者血脂水平和血清学指标。结果治疗后,对照组和治疗组总有效率分别为84.06%、95.65%,两组总有效率比较差异有统计学意义(P0.05)。治疗后,两组患者血浆总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)水平均显著降低,高密度脂蛋白胆固醇(HDL-C)水平显著升高,同组治疗前后比较差异具有统计学意义(P0.05);且治疗组血脂水平优于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者超敏肌钙蛋白I(hs-cTnⅠ)、氨基末端脑钠肽前体(NT-proBNP)水平均显著降低,血清脂联素(ADPN)水平显著升高,同组治疗前后比较差异具有统计学意义(P0.05);且治疗组血清学指标明显优于对照组,两组比较差异具有统计学意义(P0.05)。结论益心酮滴丸联合辛伐他汀片治疗冠心病疗效显著,可有效改善患者血脂水平和血清学指标,安全性好,具有一定的临床推广应用价值。     

Association Between High-Sensitivity Cardiac Troponin Levels and Myocardial Ischemia During Mental Stress and Conventional Stress

Objectives

This study sought to investigate whether patients with mental stress–induced myocardial ischemia will have high resting and post–mental stress high-sensitivity cardiac troponin I (hs-cTnI).

超声联合血清学指标建立列线图早期预测乳腺癌术后化疗的心脏毒性

目的：利用列线图探究超声联合血清学指标早期预测乳腺癌术后化疗的心脏毒性。方法：选取于我院乳腺外科术后确诊为乳腺癌的女性患者,所有患者均在术后2周接受化疗,根据化疗1年后是否发生左心室射血分数（Left ventricular ejection fraction, LVEF）下降超过10%,将患者分为毒性组与无毒性组。比较第3化疗周期患者常规超声心动图指标、血清学指标以及二维超声斑点追踪显像（Two-dimensional speckle tracking imaging, 2D-STI）指标的差异。采用多因素COX回归筛选预测心脏毒性的指标并建立列线图探索患者出现心脏毒性的概率。结果：共随访148例患者,失访2例,剩余146例患者中心脏毒性的发生率为12.3%。多因素COX回归显示高敏感性心肌肌钙蛋白I变化量（delta-high sensitive cardiac troponin I,Δhs-cTnI）（P<0.05）、N-端脑钠肽前体变化量（delta-N-terminal pro -B-type natriuretic peptide, NT- pro BNP）（P<0.05）和整体纵向峰值应变变化量（delta-Global longitudinal strain, ΔGLS）（P<0.05）是预测乳腺癌术后化疗患者心脏毒性的独立风险指标。基于Δhs-cTnI、ΔNT- proBNP和ΔGLS建立的用于提示患者发生心脏毒性风险的列线图具有良好的辨别力（C-index 0.904）和校准度（χ2= 8.170,P = 0.417,Hosmer–Lemeshow检验）。结论：ΔGLS联合Δhs-cTnI、ΔNT- proBNP绘制的列线图有助于早期评估乳腺癌术后化疗患者发生心脏毒性的风险。