心肌酶谱变化对热射病患者预后的临床意义  

Clinical significance of the changes in myocardial enzymes in the prognosis of heat stroke

作　　者：刘福菁 顾体军 魏冬月 张合 易春花 李永畅 Liu Fu-jing;Gu Ti-jun;Wei Dong-yue;Zhang He;Yi Chun-hua;Li Yong-chang(Department of Emergency,the Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University,Changzhou 213000,China)

机构地区：[1]南京医科大学附属常州第二人民医院急诊科,江苏常州213000 [2]南京医科大学附属常州第二人民医院儿科,江苏常州213000 [3]南京医科大学附属常州第二人民医院重症医学科,江苏常州213000

出　　处：《中国急救医学》2022年第12期1094-1098,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨心肌酶谱变化在热射病患者预后中的临床意义。方法回顾性分析2010年6月至2021年9月常州市第二人民医院重症监护病房(ICU)住院的热射病患者163例,根据30 d临床结局分为存活组(n=131)和死亡组(n=32)。收集患者入院24 h内的心肌酶谱,多因素Logistic回归分析筛选热射病30 d死亡危险因素。绘制受试者工作特征(ROC)曲线评估心肌酶谱对热射病患者30 d死亡的预测价值。联合预测模型的对比采用净重新分类指数(NRI)和综合判别指数(IDI),临床决策(DCA)曲线和校准曲线评价模型优劣。结果死亡组患者肌钙蛋白Ⅰ(TnI)、肌酸激酶同工酶(CK-MB)、天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)和乳酸脱氢酶(LDH)均明显高于存活组患者(P<0.05)。校正混杂因素后的多因素Logistic回归分析显示,TnI、CK-MB、AST、ALT和LDH均为患者死亡的独立危险因素。ROC曲线和DCA曲线分析显示,TnI、CK-MB和急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)三者的联合预测效能(AUC=0.873)优于TnI和CK-MB两者的联合预测效能(AUC=0.817),NRI和IDI显示,两个模型的预测效能差异有统计学意义(P<0.05)。校准曲线显示,TnI、CK-MB和APACHEⅡ评分三者的联合预测具有良好的准确度。结论心肌酶谱增高是热射病患者死亡的高危因素,对30 d死亡具有预测价值,联合APACHEⅡ评分有更大的预测效能。Objective To explore the clinical significance of the changes in myocardial enzymes in the prognosis of heat stroke.Methods The medical data of 163 patients with severe heat stroke hospitalized in the intensive care unit of Changzhou No.2 People's Hospital between June 2010 and September 2021 were retrospectively analyzed,and were divided into two groups based on their prognosis:the survival group(n=131)and the death group(n=32).Myocardial enzymes were collected within 24 hours of admission.Multivariate Logistic regression analysis was used to screen 30-day mortality risk factors for heat stroke.Receiver operating characteristic(ROC)curves were drawn to assess the predictive value of myocardial enzymes for 30-day mortality in the patients with heat stroke.The two models were compared by using the net reclassification index(NRI)and the integrated discriminant index(IDI).Clinical decision curve(DCA)and calibration curve were used to evaluate the quality of the models.Results Troponin I(TnI),creatine kinase-isoenzyme(CK-MB),aspartate aminotransferase(AST),alanine aminotransferase(ALT)and lactate dehydrogenase(LDH)were significantly higher in the death group than in the survival group(P<0.05).Multivariate Logistic regression analysis showed that TnI,CK-MB,AST,ALT,and LDH were independent risk factors for death after adjusting for confounding factors.ROC curve and DCA curve analysis showed that the combined predictive efficiency of TnI,CK-MB and APACHEⅡ(AUC=0.873)was superior to the combined predictive efficiency of TnI and CK-MB(AUC=0.817),while NRI and IDI demonstrated that the predictive efficiency of the two models was statistically different(P<0.05).The calibration curve showed that the combined prediction of TnI,CK-MB and APACHEⅡhad good accuracy.Conclusions Increased myocardial enzymes were high-risk factors for death in the patients with heat stroke.They had predictive value for 30-day mortality risk,and the combination with APACHEⅡhas greater predictive efficiency.

关 键 词：热射病 心肌酶谱 预后 

分 类 号：R594.1[医药卫生—内科学]