心肌酶诊断重症急性胰腺炎并发心功能不全的临床价值  

The Diagnostic Value of Myocardial Enzyme in Cardiac Insufficiency in Patients with Severe Acute Pancreatitis

作　　者：张一杰[1] 杨亚鹏[2] 

机构地区：[1]首都医科大学附属北京世纪坛医院急诊科,100038 [2]北京中医药大学附属东直门医院普外科

出　　处：《天津医药》2014年第6期616-618,共3页Tianjin Medical Journal

摘　　要：目的探讨心肌酶对重症急性胰腺炎(SAP)并发心功能不全的诊断价值。方法将50例SAP患者按是否并发心功能不全分为心功能不全组14例和无心功能不全组36例,测量血清心肌肌钙蛋白I(cTnI)、肌红蛋白(MYO)、肌酸激酶MB型(CK-MB)、乳酸脱氢酶(LDH)、天冬氨酸转氨酶(AST),用ROC曲线评价心肌酶诊断SAP并发心功能不全的敏感性和特异性。记录患者的急性病生理学和长期健康评价(APACHE)Ⅱ分值,并评价心肌酶与APACHEⅡ评分之间的相关性。结果心功能不全组cTnI、LDH、AST水平均明显高于无心功能不全组(P<0.05),MYO、CK-MB与无心功能不全组差异无统计学意义。cTnI的ROC曲线下面积最大为0.940,cut-off值为0.07μg/L,敏感性和特异性分别为0.857和1.000。LDH、AST的ROC曲线下面积大于0.7,但LDH诊断敏感性仅为0.571,AST的特异性仅为0.778。MYO、CK-MB的ROC曲线下面积小于0.7。APACHEⅡ评分与心肌酶中cTnI、CK-MB、LDH呈正相关(r分别为0.639、0.451、0.552,均P<0.05)。结论心肌酶cTnI可作为诊断SAP患者是否并发心功能不全的评价指标,并可反映SAP病情的严重程度。Objective To explore the clinical value of myocardial enzyme on diagnosis of cardiac insufficiency in patients with severe acute pancreatitis （SAP）. Methods Fifty patients with SAP were classified as cardiac insufficiency group （n=14） and non-cardiac insufficiency group （n=36）. The serum biochemical markers, such as cardiac troponin I （cTnI）, myoglobin （MYO）, creatine kinase, MB form （CK-MB）, lactate dehydrogenase （LDH） and aspartate aminotransferase （AST） were examined in two groups. ROC curve was used to evaluate the diagnostic sensitivity and specificity for cardiac insuffi-ciency using myocardial enzyme. The APACHEⅡscore was also calculated. The relationship between myocardial enzyme and APACHEⅡscore was analyzed in two groups. Results The levels of cTnI, LDH and AST were significantly increased in cardiac insufficiency group than those in non-cardiac insufficiency group （P〈0.05）. There were no significant differences in MYO and CK-MB between two groups of patients. The area under ROC curve for cTnI was 0.940, with a cut-off value of 0.07μg/L. The sensitivity and specificity of cTnI for diagnosing cardiac insufficiency in patients with SAP were 0.857 and 1.000, respectively. The area under ROC curve for LDH and AST was more than 0.7, with the low sensitivity for LDH （0.571） and the specificity for AST （0.778）. The area under ROC curve for MYO and CK-MB was less than 0.7. APACHEⅡscore was positively correlated with cTnI, CK-MB and LDH （r= 0.639, 0.451 and 0.552,respectively, P〈0.05）. Conclusion The serum cTnI level can be used as the index for the diagnosis of cardiac insufficiency in patients with SAP, and can prefer-ably reflect the severity of SAP.

关 键 词：重症急性胰腺炎 心功能不全 心肌酶 乳酸脱氢酶 天冬氨酸转氨酶 肌红蛋白 肌酸激酶MB型 急性病生理学和长期健康评价 

分 类 号：R576[医药卫生—消化系统]