风湿性心脏病患者CK-MB、cTnⅠ水平变化与心脏指数关系及对瓣膜置换术后LCOS风险评估价值  

The relationship between changes of CK-MB and cTnⅠ levels and cardiac index in patients with rheumatic heart disease and risk assessment value of low cardiac output syndrome(LCOS) after valve replacement

作　　者：秦逸辉 颜安明 余研 李毅[1] 蔡累 王军 QIN Yihui;YAN Anming;YU Yan;LI Yi;CAI Lei;WANG Jun(Department of Geriatrics,The 73rd Army Hospital of the PLA,Xiamen Fujian 3610033,China;Department of Outpatient,The 73rd Army Hospital of the PLA,Xiamen Fujian 3610033,China;Department of Cardiovascular,Xiamen Hongai Hospital,Xiamen Fujian 361000,China)

机构地区：[1]中国人民解放军陆军第73集团军医院老年科,福建厦门361003 [2]中国人民解放军陆军第73集团军医院门诊部,福建厦门361003 [3]厦门弘爱医院心血管内科,福建厦门361000

出　　处：《新疆医科大学学报》2022年第7期718-725,共8页Journal of Xinjiang Medical University

基　　金：福建卫健委科技计划项目(20210N01001291)。

摘　　要：目的 探讨风湿性心脏病(RHD)患者肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白Ⅰ(cTnⅠ)水平变化与心脏指数关系及对瓣膜置换术后低心排血量综合征(LCOS)发生风险的评估价值。方法选取2016年4月—2021年3月中国人民解放军陆军第73集团军医院收治的198例RHD患者作为研究组,均采用人工瓣膜置换术,根据术后是否发生LCOS分为LCOS组(n=18)、非LCOS组(n=180),另选取同期健康体检者121例作为对照组。对比研究组、对照组及LCOS组、非LCOS组CK-MB、cTnⅠ水平,Logistic逐步回归模型分析CK-MB、cTnⅠ水平变化与LCOS发生的关系。采用受试者工作特征曲线(ROC)、决策曲线(DCA)、临床影响曲线分析CK-MB、cTnⅠ水平评估LCOS的价值。结果研究组血清CK-MB、cTnⅠ水平高于对照组(P<0.05);198例RHD患者术后18例发生LCOS,180例未发生LCOS,LCOS组、非LCOS组合并房颤比例、心脏指数、平均动脉压(MAP)、乳酸水平、CK-MB、cTnⅠ水平对比,差异有统计学意义(P<0.05);Logistic逐步回归模型校正房颤后,心脏指数、MAP、乳酸、CK-MB、cTnⅠ水平变化仍与LCOS发生相关(P<0.05);CK-MB、cTnⅠ与心脏指数、MAP呈负相关,与乳酸水平呈正相关(P<0.05);CK-MB、cTnⅠ水平联合检测评估发生LCOS的AUC值0.837最大,对应敏感度为72.22%,特异度为90.12%;经DCA比较CK-MB、cTnⅠ单独及联合检测评估LCOS的净受益率,结果显示,在阈值0.19~0.59范围内,CK-MB、cTnⅠ联合检测评估LCOS的净受益率优于单独检测,在各阈值下,被联合检测方案划分为高风险的人数与真阳性例数在阈值概率为0.38时,两者基本达到一致。结论 RHD患者CK-MB、cTnⅠ水平显著升高,且与心脏指数关系密切,CK-MB、cTnⅠ水平联合检测可为临床早期评估LCOS风险提供参考。Objective To investigate the relationship between the changes of creatine kinase isoenzyme(CK-MB), cardiac troponin I(cTnI) and cardiac index in patients with rheumatic heart disease(RHD) and its value in assessing the risk of low cardiac output syndrome(LCOS) after the valve replacement. Methods A total of 198 RHD patients in the hospital from April 2016 to March 2021 were selected as the study group with using artificial valve replacement, according to whether LCOS occurred after the operation, LCOS group(n=18) and non-LCOS group(n=180) were divided,in addition, 121 healthy patients during the same period were selected as the control group. The CK-MB and cTnI levels with general data were compared between the two groups and whether LCOS patients occurred. The Logistic stepwise regression model was used to analyze the relationship between the changes in CK-MB and cTnI levels and the occurrence of LCOS. Receiver operating characteristic curve(ROC), decision curve analysis(DCA) and clinical impact curve analysis of CK-MB and cTnI level were used to evaluate the value of LCOS. Results The levels of serum CKMB and cTnI in the study group were higher than those in the control group(P<0.05). Among 198 patients with RHD,18 patients developed LCOS and 180 patients did not. There were statistically significant differences in the proportion of atrial fibrillation, cardiac index, mean arterial pressure(MAP), lactic acid level, CK-MB and cTnI between LCOS group and non-LCOS group(P<0.05).With using Logistic stepwise regression model to correct atrial fibrillation, changes in cardiac output, MAP, lactate, CK-MB, and cTnI levels were still correlated with LCOS(P<0.05). CK-MB and cTnI were negatively correlated with cardiac output and MAP, and it positively correlated with lactic acid level(P<0.05).The AUC value of 0.837 in the combined assessment of CK-MB and cTnI levels of LCOS were the highest with a corresponding sensitivity of 72.22% and a specificity of 90.12%. DCA was used to compare the net benefit rate of CK-MB and cT

关 键 词：风湿性心脏病 肌酸激酶同工酶 心肌肌钙蛋白Ⅰ 低心排血量综合征 人工瓣膜置换术 

分 类 号：R541.2[医药卫生—心血管疾病]