肌钙蛋白T水平在重症急性胰腺炎合并心肌损伤行持续床旁血滤治疗中的意义  

Significance of troponin T level in patients with severe acute pancreatitis complicated with myocardial injury undergoing continuous renal replacement therapy

作　　者：赵庆华[1] 任为正[1] 王雪飞[1] 赵永生[1] 孔令雪 刘志伟[1] 何蕾[1] Zhao Qinghua;Ren Weizheng;Wang Xuefei;Zhao Yongsheng;Kong Lingxue;Liu Zhiwei;He Lei(Faculty of Hepato-Pancreato-Biliary Surgery,Chinese People’s Liberation Army General Hospital,Institute of Hepatobiliary Surgery of Chinese PLA,Key Laboratory of Digital Hepatobiliary Surgery,PLA,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心肝胆胰外科医学部重症医学科,解放军总医院肝胆外科研究所,全军数字肝胆外科重点实验室,北京100853

出　　处：《中国体外循环杂志》2022年第5期299-303,共5页Chinese Journal of Extracorporeal Circulation

摘　　要：目的 总结和探讨肌钙蛋白T在行持续血液净化治疗的重症急性胰腺炎(SAP)患者中的预后判断应用价值。方法 回顾性分析2015年1月1日至2019年12月31日解放军总医院肝胆胰外科医学部重症医学科收治的接受连续性肾替代治疗(CRRT)的SAP患者的临床资料,包括治疗前后C反应蛋白、肌钙蛋白T,脑利钠肽前体、白细胞计数等指标变化及死亡率。结果 接受CRRT的SAP患者共计79例,男性56例,女性23例。其中肌钙蛋白T>0.03μg/L的SAP患者共55例,经过CRRT治疗后52%的患者肌钙蛋白T显著下降。死亡风险分析显示,机械通气(OR=19.91,95%CI:2.18~182.05,P=0.008),肌钙蛋白T显著下降(OR=0.23,95%CI:0.05~0.78,P=0.001)并为接受CRRT的SAP患者生存的独立风险因素。结论 重症急性胰腺炎患者合并心肌损伤预后不良,在进行持续性血液净化治疗的SAP患者中,肌钙蛋白T显著下降与患者预后密切相关,是预后良好的因素,可能可以作为CRRT治疗参考。Objective To summarize and explore the prognostic value of troponin T in patients with severe acute pancreatitis(SAP) complicated with myocardial injury undergoing continuous renal replacement therapy(CRRT).Methods A retrospective analysis of the clinical data of SAP patients undergoing CRRT in the Department of Critical Care Medicine,Department of Hepatobiliary and Pancreatic Surgery,PLA General Hospital from January 1,2015 to December 31,2019 was conducted,including C-reactive protein before and after treatment,changes in indicators such as troponin T,brain natriuretic peptide precursor,white blood cell count,and mortality.Results A total of 79 SAP patients received CRRT,including 56 males and 23 females.Among them,55 cases showed elevated troponin T,and 52% decreased significantly after CRRT treatment.Death risk analysis showed that mechanical ventilation(OR=19.91,95%CI:2.18-182.05,P=0.008) and a significant decrease in troponin T(OR=0.23,95%CI:0.05-0.78,P=0.001) were independent risk factors for the survival of SAP patients with CRRT.Conclusion Severe acute pancreatitis with elevated troponin T is associated with poor prognosis.In SAP patients undergoing CRRT,the significant decrease of troponin T is a beneficial prognostic factor.

关 键 词：持续性血液净化 重症急性胰腺炎 心肌损伤 肌钙蛋白T 

分 类 号：R576[医药卫生—消化系统] R542.2[医药卫生—内科学]