急性有机磷农药中毒心肌酶及肌钙蛋白变化对心肌损害诊断的价值  

Comprehensive analysis on variation of cardiac enzyme and troponin induced by acute organophosphorous poisoning

作　　者：万伟国[1] 姜莉[2] 郑舒聪[1] 裘昊昊[1] 宣丹旦[1] 邹和建[1] 

机构地区：[1]复旦大学附属华山医院职业病科,上海200040 [2]山东省临沂市人民医院风湿科

出　　处：《中华劳动卫生职业病杂志》2012年第6期452-455,共4页Chinese Journal of Industrial Hygiene and Occupational Diseases

基　　金：国家“十一五”科技支撑项目“急性职业中毒救治关键技术研究”（2006BA106B01）

摘　　要：目的探讨心肌酶及肌钙蛋白在急性有机磷农药中毒心肌损害诊断中的价值。方法检索国内1979至2010年学术期刊及PubMed上发表的急性有机磷农药中毒并且有心肌酶及肌钙蛋白研究的文献，进行统计和分析。纳入有机磷农药中毒患者病例数2129例。结果与对照组比较，轻、中、重度中毒组血清肌酸激酶（CK）和肌酸激酶同工酶（CK—MB）活力和肌钙蛋白（cTnI）水平均明显增高，差异有统计学意义（P〈0．05）；各中毒组血清CK和CK-MB活力和cTnI水平的差异有统计学意义（P〈0．05）；中、重度中毒组CK—MB／CK明显低于对照组，差异有统计学意义（P〈0．05）。中间期肌无力综合征（IMS）组血清CK、CK—MB活力和cTnI水平均明显高于非IMS组，差异有统计学意义（P〈0．05）。与非呼吸肌麻痹重度中毒组比较，呼吸肌麻痹组血清CK、CK—MB活力均明显增高，CK-MB／CK的比值明显降低，差异有统计学意义（P〈0．05）。结论单纯血清CK、CK—MB活力升高作为有机磷农药中毒患者心肌损害的诊断依据不足，CK—MB／CK的比值的诊断价值更高；cTnI水平作为诊断有机磷农药中毒患者心肌损害的依据值得怀疑。CK、CK—MB活力及cTnI水平可作为有机磷农药中毒病情轻重的辅助判断依据。Objective To discuss the diagnostic value of cardiac enzyme and troponin in acute organophosphorus pesticide poisoning（AOPP）. Methods A retrospective study was performed in the document published in domestic journals and PubMed from 1979 to 2010. The data of the cardiac enzyme and troponin were collected. Statistical analysis was conducted with one-way ANOVA and rank sum test. 2129 cases with AOPP were enrolled. Results The levels of creatine kinase （CK）, creatine kinase-MB （CK-MB） and cardiac troponin 1 （cTnI） in milder, moderate and severe poisoning groups were significantly elevated compared by the healthy control group （P〈0.05）. The differences were also dramatic among three patients groups （P〈0.05）. The ratios of CK-MB to CK in both moderate and severe groups were significantly lower than in healthy controls （P〈 0.05）. The levels of CK, CK-MB and cTnI were higher especially in patients with intermediate myasthenics syndrome （IMS） than patients without IMS. Meanwhile, the levels of CK and CK-MB were elevated in patients with respiratory failure compared by non-failure ones, but decreased in the ratios of CK-MB to CK （P〈0.05）. Conclusions The elevation of CK and CK-MB in serum could not be judged as the criteria of myocardial dam- age in AOPP, the ratio of CK-MB to CK were more valuable; the value of cTnI in myocardial damage was still in suspect. CK, CK-MB and cTnI could be used as auxiliary criteria of AOPP classification.

关 键 词：有机磷 中毒 心肌酶 肌钙蛋白 

分 类 号：R595.4[医药卫生—内科学]