肌酸激酶同工酶和肌钙蛋白在尿毒症合并急性左心衰竭中的诊断价值  

Detection of Creatine Kinase Isoenzyme and Cardiac Troponin for the Diagnosis of Uremia Complicated with Acute Left Heart Failure

作　　者：胡媛琴[1] 赵宸龙 任杨杨 Hu Yuanqin;Zhao Chenlong;Ren Yangyang(Department of Emergency,Navy General Hospital,Beijing 100048,China)

机构地区：[1]海军总医院急诊科

出　　处：《国际老年医学杂志》2018年第6期290-292,320,共4页International Journal of Geriatrics

摘　　要：目的回顾性分析肌酸激酶同工酶(CK-MB)和肌钙蛋白(cTnI)在尿毒症合并急性左心衰竭患者中的诊断价值。方法收集我院2015年1月~2016年1月期间行维持性血液透析(MHD)治疗的尿毒症患者共110例资料进行分析,其中合并急性左心衰竭患者30例为心衰组,未合并急性左心衰竭患者80例为对照组。对两组不同发病时间点的CK-MB、cTnI、血清肌酐(Scr)、尿素氮(BUN)、N末端脑钠肽前体(NT-proBNP)和左室射血分数(LVEF)水平进行检测,比较1年内总死亡率和心源性死亡率。将患者的年龄、性别、透析时间、不同时间点的CK-MB、cTnI、Scr、BUN、NT-proBNP和LVEF作为自变量,分别将总死亡率和心源性死亡率作为因变量,纳入logistic回归分析。结果不同时间点心衰组的CK-MB和cTnI水平均明显高于对照组,差异有统计学意义(P<0.05);心衰组的CK-MB和cTnI无明显峰值和下降趋势;CK-MB、cTnI、Scr、BUN、NT-proBNP和LVEF是总死亡率的独立危险因素,CK-MB、cTnI和NT-proBNP是心源性死亡率的独立危险因素。结论CK-MB和cTnI在尿毒症合并急性左心衰竭患者中具有较敏感的变化趋势,对预测死亡率有较好的应用价值。Objective To retrospectively analyze the diagnostic value of creatine kinase isoenzymes (CK -MB)and cardiac troponin I (cTnI)in uremic patients with acute left heart failure.Methods A total of 110cases of uremic patients undergoing maintenance hemodialysis (MHD)between January 2015and January 2016were enrolled.Among them,30patients with acute left heart failure were assigned to the heart failure group,and 80patients without heart failure were assigned to the control group.The levels of CK-MB,cTnI,serum creatinine (Scr),blood urea nitrogen (BUN),N -terminal pro -brain natriuretic peptide (NT- proBNP)and left ventricular ejection fraction (LVEF)at different time points were compared in two groups.Total mortality and car- diogenic mortality within 1year were recorded.Logistic regression analysis was conducted by using the age,sex,dialysis time,the levels of CK -MB,cTnI,Scr,BUN,NT -proBNP,and LVEF at different time points as independent variables,and the total mortality and cardiogenic mortality as dependent variables,respectively.Results The levels of CK -MB and cTnI in the heart failure group were significantly higher than those in the control group at different time points (P <0.05).No peak level and declining trend of CK -MB and cTnI in the heart failure group were observed.CK -MB,cTnI,Scr,BUN,NT -proBNP,and LVEF were independent risk factors for total mortality.CK -MB,cTnI,and NT -proBNP were independent risk factors for cardiac mortality.Conclusion The changes of CK -MB and cTnI levels are sensitive in patients with uremia complicated by acute left heart failure and are helpful to predict mortality.

关 键 词：肌酸激酶同工酶 肌钙蛋白 尿毒症 急性左心衰竭 

分 类 号：R692.5[医药卫生—泌尿科学] R541.6[医药卫生—外科学]