肌钙蛋白Ⅰ对急性肺栓塞危险程度及预后的评判价值  

The assessment of risk stratification and prognostic value of cardiac troponin Ⅰ in patients with acute pulmonary embolism

作　　者：王晓波[1] 刘飒[1] 郑维国[2] 樊蕴辉[3] 王红阳[1] 孙丽霞[2] 贺房勇[2] 程晓明[2] 

机构地区：[1]河北联合大学附属医院呼吸内科,唐山063000 [2]河北联合大学附属医院急诊科,唐山063000 [3]河北联合大学附属医院康复科,唐山063000

出　　处：《中国医师杂志》2015年第6期850-853,共4页Journal of Chinese Physician

基　　金：唐山市科技计划资助项目（12140209A-1）

摘　　要：目的 探讨肌钙蛋白（cTn）Ⅰ对急性肺栓塞（APE）危险程度及预后的评判价值.方法 收集本院2007年1月至2013年12月178例APE患者并按照入院时cTn Ⅰ水平分为cTn Ⅰ＋组（≥0.012 ng/ml）及cTn Ⅰ-组（＜0.012 ng/ml）,两组分别采用肺栓塞严重指数（PESI）进行危险分层,并记录两组心电图、超声心动图、影像学结果及发生良性及不良事件情况.结果 178例APE患者中cTn Ⅰ＋96例（53.9％）,cTn Ⅰ-82例（46.1％）,“不良事件”发生情况,cTn Ⅰ＋与cTn Ⅰ-分别为71例（74.0％）、0例（P =0.000）,“良性事件”发生情况,cTn Ⅰ＋与cTn Ⅰ-分别为80例（83.3％）及18例（22.0％）（P=0.000）,Kaplan-Meier曲线表明,cTn Ⅰ-组较cTn Ⅰ＋组具有更低的良性及不良事件发生率.结论 cTn Ⅰ是评价APE危险程度及预后的一项重要指标。Objective To investigate the assessment of risk stratification and prognostic value of cardiac troponin Ⅰ （cTn Ⅰ） in patients with acute pulmonary embolism （APE）.Methods A total of 178 patients with APE in our hospital from January 2007 to December 2007 were collected and divided into cTn Ⅰ ＋ group （0.012 ng/ml） or higher and cTn Ⅰ-group （〈0.012 ng/ml） according to the initial inspection cTn Ⅰ level.The pulmonary embolism severity index （PESI） was used for clinical risk determination and electrocardiography （ECG）,echocardiography,imaging results,and positive and adverse events were recorded.Results Among 178 consecutive patients with confirmed acute PE;96 （53.9%） were cTnⅠ ＋ and 82 （46.1%） were cTnⅠ-.＂hard events＂ cTn Ⅰ ＋ and cTn Ⅰ-71 cases （74.0%） and 0,respectively （P =0.000）.＂soft events＂ cTn Ⅰ ＋ and cTn Ⅰ-were 80 cases （83.3%） and 18 cases （22.0%）,respectively （P =0.000）.Kaplan Meier curve showed that patients in cTn Ⅰ-groups had higher survival free of hard （P =0.000） or soft （P =0.000） events,irrespective of clinical risk.Conclusions Highly sensitive cTn Ⅰ assay provides an excellent prognostic negative predictive value,thus it has a role in identification of candidates for out-of-hospital treatment of acute PE.

关 键 词：肌钙蛋白Ⅰ/代谢 肺栓塞/代谢 危险 预后 

分 类 号：R563.5[医药卫生—呼吸系统]