早期肌钙蛋白I水平对重症中暑患者预后的临床意义  

Clinical significance of early troponin I levels on the prognosis of patients with severe heat stroke

作　　者：唐云 袁冬 顾体军 张合 沈婉林 刘福菁 Tang Yun;Yuan Dong;Gu Tijun;Zhang He;Shen Wanlin;Liu Fujing(Department of Critical Care Medicine,Jintan First People's Hospital of Changzhou,Jintan 213200,Jiangsu,China;Department of Emergency,the Affiliated Changzhou NO.2 People's Hospital of Nanjing Medical University,Changzhou 213000,Jiangsu,China)

机构地区：[1]常州市金坛第一人民医院重症医学科,江苏金坛213200 [2]南京医科大学附属常州第二人民医院急诊科,江苏常州213000

出　　处：《中华危重病急救医学》2023年第7期730-735,共6页Chinese Critical Care Medicine

基　　金：江苏省常州市科技计划项目(CJ20210002)。

摘　　要：目的探讨早期肌钙蛋白I(TnI)在重症中暑患者预后中的临床意义。方法回顾性分析2013年6月至2022年9月南京医科大学附属常州第二人民医院重症监护病房(ICU)131例重症中暑患者(研究数据集)和常州市金坛第一人民医院ICU 67例重症中暑患者(验证数据集)的临床资料,根据30 d结局分别将患者分为生存组和死亡组。收集患者进入急诊室后24 h内TnI。Cox回归分析重症中暑患者死亡的风险因素。Spearman相关性检验分析TnI与心率和外周收缩压的相关性。绘制受试者工作特征曲线(ROC曲线)评估TnI对重症中暑患者死亡的预测价值。决策曲线分析(DCA)评估TnI预测时的临床净获益率。以TnI临界值分组,Kaplan-Meier生存曲线分析患者30 d累积生存率。敏感性分析包括采用修正Possion回归、E值以及绘制亚组森林图评估TnI在不同人群的死亡风险。外部数据集验证TnI对重症中暑患者死亡的预测价值。结果死亡组患者TnI明显高于生存组〔μg/L:0.623(0.196,1.510)比0.084(0.019,0.285),P<0.01〕。校正混杂因素后的多因素Cox回归分析显示,TnI为患者死亡的独立危险因素〔风险比(HR)=1.885,95%可信区间(95%CI)为1.528~2.325,P<0.001〕。Spearman分析显示TnI与心率存在正相关性(r=0.537,P<0.001),与外周收缩压存在负相关性(r=-0.611,P<0.001)。ROC曲线分析显示,TnI预测预后的曲线下面积(0.817)优于急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ,0.756)。DCA曲线分析显示,TnI临床净获益率范围(6.21%~20.00%)高于APACHEⅡ评分(5.14%~20.00%)。Kaplan-Meier生存曲线分析显示,低风险组(TnI≤0.106)患者30 d累积生存率明显优于高风险组患者(TnI>0.106;Log-Rank检验:χ2=17.350,P<0.001)。校正混杂因素的修正Possion回归显示,TnI仍然为重症中暑患者死亡的独立危险因素〔相对危险度(RR)=1.425,95%CI为1.284~1.583,P<0.001〕。E值为2.215。亚组森林图显示,TnI在男性及≤60岁的患者中为明Objective To investigate the clinical significance of early troponin I(TnI)level in the prognosis of severe heat stroke.Methods Clinical data of 131 patients with severe heat stroke in the intensive care unit(ICU)of the Affiliated Changzhou NO.2 People's Hospital of Nanjing Medical University(study dataset)and ICU 67 patients with severe heat stroke in Jintan First People's Hospital of Changzhou(validation dataset)were retrospectively analyzed from June 2013 to September 2022.The patients were divided into survival group and death group according to 30-day outcomes.TnI was collected within 24 hours after admission to the emergency department.Cox regression analysis was performed to analyze the risk factors of severe heat stroke death.Spearman correlation test was used to analyze the correlation between TnI and heart rate,and peripheral systolic blood pressure.The receiver operator characteristic curve(ROC curve)was drawn to evaluate the predictive value of TnI for death in patients with severe heat stroke.Decision curve analysis(DCA)was conducted to assess the clinical net benefit rate of TnI prediction.Grouping by TnI cut-off value,Kaplan-Meier survival curve was used to analyze 30-day cumulative survival.Sensitivity analysis included modified Possion regression,E-value,and subgroup forest map was used to evaluate the mortality risk of TnI in different populations.External dataset was used to verify the predictive value of TnI.Results The death group had significantly higher TnI compared to the survival group[μg/L:0.623(0.196,1.510)vs.0.084(0.019,0.285),P<0.01].Multivariate Cox regression analysis after adjusting for confounding factors showed that TnI was an independent risk factor for death[hazard ratio(HR)=1.885,95%confidence interval(95%CI)was 1.528-2.325,P<0.001].Spearman correlation test showed that TnI was positively correlated with heart rate(r=0.537,P<0.001)and negatively correlated with peripheral systolic blood pressure(r=-0.611,P<0.001).ROC curve showed that the area under the curve(AUC)of the TnI(0

关 键 词：重症中暑 肌钙蛋白I 预后 

分 类 号：R594.12[医药卫生—内科学]