血清肌钙蛋白诊断继发性心肌损伤及预后观察

目的：观察血清肌钙蛋白I（cTnI)对危重病患者急性心肌损伤诊断及预后判断的价值。方法：49例入ICU的患者，按APACHEⅡ评分分为危重组（APACHE Ⅱ≥16）和普通组（APACHE Ⅱ＜16），以化学发光法测入ICU24小时内及48小时时的血清肌钙蛋白I（cTnI)和肌酸激酶同功酶（CK－MB），另15例健康献血员为对照组，结果：两个时点的cTnI和CK－MB，危重组和普通组均高于对照组，差异显著（P＜0．05），但危重组与对照组差异更显著（P＜0．01），死亡组与生存组比较，两个时点的cTnI均增显著（P＜0．05），生存率与cTnI呈负相关（γ=－0．33，P＝0．026），而CK－MB在两组间差异无显著性（P＞0．05），部分多发伤患者，有CK－MB增高而无cTnI增高，部分心衰患者，有cTnI增高而无CK－MB增高，结论：cTnI和CK－MB均可用于诊断危重病患者的急性心肌损伤，但cTnI特异性较高，对预后的判断更有价值。

Serum Troponin Diagnosis and Prognosis in Secondary Myocardial Injury

Objective To observe the changes of the Cardial Troponin I (cTnI) in serum in critical ill patients with acute myocardial injury and to assess its significant in the diagnosis and prognosis in the these patients.Methods The forty-nine patients who entered The ICU were divided into critical group (APACHE II >=16) and general group (APACHE II <16). They were measured the concentration of the cTnI and Creatinkinase-MB (CPK-MB) by the chemoluminescence in 24 hour and on the forty-eighth hour. The other fifteen healthy volunteers who devoted their blood are the normal controls.Results The concentrations of cTnI and CPK-MB in the Two Points of critical group and normal group were both higher than the control group. But the more significant difference was found between critical group and control group (P<0.01) .The death group compared with living group, the cTnI were both higher in the two points (P<0.05), but the CPK-MB not (P>0.05). Some patients with multiple injury, Their CPK-MB were increased but cTnI not, and some patients with congestive heart failure were opposite.Conclusion cTnI and CK-MB are both valuable indications to diagnosis acute myocardial injury. But cTnI are more special and more valuable in prognosis.