脓毒症患者动态监测肌钙蛋白Ⅰ的意义

目的动态测定脓毒症患者肌钙蛋白Ⅰ的变化，探讨肌钙蛋白Ⅰ用于脓毒症患者病情和疗效评估方面的价值。方法分别测定脓毒症患者入院时、入院后第3天和第7天的肌钙蛋白Ⅰ浓度．分析不同时点与相同时点的APACHE Ⅱ评分、JCU病死率和28d生存率之间的相关性．比较不同时间点肌钙蛋白Ⅰ升高组（cTnI〉0．1ng／m1）和正常组（cTnⅠ〈0．1ng／ml）的ICU病死率和28d生存率。结果66例脓毒症患者中有47例患者肌钙蛋白Ⅰ升高，升高率达到71．21％。患者入院时和入院后第3天的肌钙蛋白Ⅰ的浓度与对应的APACHE Ⅱ评分呈正相关（r分别=0．37、0．34，P均〈0．05），与ICU病死率成正相关（r分别=0.34、0．36，P均〈0．05），与28d生存率呈负相关（r分别=-0．39、-0．42，P均〈0．05）；入院后第7天患者肌钙蛋白Ⅰ的浓度虽与同时点APACHE Ⅱ评分没有相关性（1=-0．21，P〉0．05），但是与ICU病死率和28d生存率具有相关性（r分别=0．37、-0．42，P均〈0．05）。患者入院时、入院后第3天和入院后第7天，肌钙蛋白Ⅰ升高组的ICU病死率明显高于正常纽，差异均有统计学意义（x^2分别=-2．21、-3．06、-3．35，P均〈0．05）；而28d生存率低于正常组，差异均有统计学意义（x^2分别=-2．40、-3．13、-3．78，P均〈0．05）。结论脓毒症患者肌钙蛋白Ⅰ的914定可以有助于临床医生早期进行病情判断，并且对疾病的顸后也有较高的预测价值。

Measurement of cardiac troponin I in sepsis patients

Objective To investigate cardiac troponin Ⅰ changes in sepsis patients, and analyze its value on severity criterion and prognosis. Methods Sepsis patients who had been admitted into the intensive care unit were studied. Cardiac troponin Ⅰ were measured on admission , the 3rd day and the 7th day after admission. The APACHE Ⅱ scores were recorded simultaneously. The correlations of cardiac troponin Ⅰ, APACHE Ⅱ score, ICU mortality, and 28-days survival rate were evaluated. The ICU mortality and 28-days survival rate between the elevated group （cTnI 〉0.1ng/ml）and the normal group（cTnI 〈0.1ng/ml）were compared. Results Cardiac troponin Ⅰ was elevated in 47 of 66 sepsis patients , elevation rate was 71.21%.Cardiac troponin Ⅰ were significantly correlative with the APACHE Ⅱ score on admission and the 3rd day （ r = 0.37, 0.34 , P 〈 0.05） . Cardiac troponin I on admission and the 3rd day were correlative with the ICU mortality （r=0.34,0.36,P〈0.05） and 28-days survival rate （r=-0.39,-0.42,P〈0.05）. Cardiac troponin Ⅰ on the 7th day did not correlate with APACHE Ⅱ score （r=-0.21 ,P〉 0.05）. But it was correlative with the ICU mortality and the 28-days survival rate （r=0.37,-0.42, P〈0.05）. The mortality were higher in elevated group than that in normal group on admission, the 3rd day and the 7th day （X^2=- 2.21,-3.06,-3.35,P〈0.05）. The 28-days survival rate was worse in elevated group than that in normal group on admission , the 3rd day and the 7th day （X^2=-2.40,-3.13,-3.78,P〈0.05）. Conclusion Serial troponin I is a useful marker for severity criterion and prognosis of sepsis patients.