血清CTnI、CK-MB和血浆NT-proBNP对急性有机磷中毒心肌损害的诊断价值  

Value of Serum CTnI,CK-MB and Plasma NT-proBNP in Diagnosis of Myocardial Damage in Patients with Acute Organophosphorus Poisoning

作　　者：张琳[1] 

机构地区：[1]延安大学附属医院急诊内科,陕西延安716000

出　　处：《解放军医药杂志》2017年第10期64-67,共4页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：陕西省科技统筹项目(2012KTCL02-07)

摘　　要：目的探讨血清肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)和血浆N端B型脑钠肽前体(NTproBNP)对急性有机磷中毒(AOPP)心肌损害诊断价值。方法选择延安大学附属医院2014年3月—2016年12月收治的90例AOPP,分为轻度中毒(轻度组)30例、中度中毒(中度组)31例、重度中毒(重度组)29例,根据有无发生中间综合征(IMS)分为IMS组30例,非IMS组60例。选择同期健康体检者90例作为对照组。观察各组入院后4 h、3 d、7 d NT-proBNP、肌酸激酶(CK)、CK-MB、cTnI水平变化,比较IMS组和非IMS组各指标检测水平及心电监护情况。结果在入院后4 h、3 d、7 d AOPP 3组中NT-proBNP、CK、CK-MB、cTnI水平均高于对照组,且重度高于轻、中度组,中度组高于轻度组(P<0.05)。IMS组入院4 h NT-proBNP、CK、CK-MB、cTnI水平高于非IMS组(P<0.05)。IMS组窦性心律失常、ST-T改变、房室传导阻滞及室性心动过速比例明显高于非IMS组(P<0.05,P<0.01)。结论 AOPP患者中存在NT-proBNP、CK、CK-MB、cTnI水平的异常增高,随着病情分级的越重其水平越高,联合检测各指标水平可更好地反映心肌损伤程度,对于AOPP心肌损害有一定的诊断价值。Objective To investigate value of serum troponin I （CTnI） and MB isoenzyme of creatine kinase （ CK-MB） and plasma N-terminal pro-brain natriuretic peptide （ NT-proBNP） in diagnosis of myocardial damage in pa-tients with acute organophosphate poisoning （ AOPP） . Methods A total of 90 patients with AOPP admitted during March 2014 and December 2016 were divided into mild AOPP poisoning group （n=30）, moderate AOPP poisoning group （n=31） and severe AOPP poisoning group （n=29）, and the patients were also divided into intermediate syndrome （IMS group, n=30） and non-IMS group （n=60） according to the presence or absence of IMS, and then other 90 healthy peo-ple taking medical examinations were selected as control group. Changes of NT-proBNP, creatine kinase （ CK） , CK-MB and CTnI levels were compared and analyzed at the 4thh, 3rdd and 7thd after admission were observed in each group, and levels of detection indexes and electrocardio-detecting condition were compared between IMS and non-IMS groups. Re-sults At the 4thh, 3rdd and 7thd after admission, NT-proBNP, CK, CK-MB and CTnI levels were significantly higher in the three AOPP poisoning groups than those in control group, and the levels in severe group were significantly significantly higher than those in mild and moderate groups, and the levels in moderate group were significantly higher than those in mild group （P〈0. 05）. At the 4thh after admission, NT-proBNP, CK, CK-MB and CTnI levels in IMS group were sig-nificantly higher than those in non-IMS group （ P 〈0. 05 ） . Incidence rates of patients with sinus arrhythmia, ST-T change, atrioventricular block （ AVC） and ventricular tachycardia （ VT） in IMS group were significantly higher than those in non-IMS group （P〈0. 05, P〈0. 01）. Conclusion Abnormally increased levels of NT-proBNP, CK, CK-MB and CTnI can be detected in AOPP patients, and the higher the classification is, the higher the level of each index will be. Combined detection of indicators can b

关 键 词：有机磷中毒 心肌损害 血清CTNI 肌酸激酶 MB型 血浆N端B型脑钠肽前体 

分 类 号：R595.51[医药卫生—内科学]