血清NT-ProBNP和TnI联合心电图检查早期诊断肝硬化性心肌病价值研究  

Elevated serum NT-ProBNP and TnI levels occurs before abnormal electrocardiogram manifestations in patients with cirrhotic cardiomyopathy

作　　者：朱春芬 任春霖 郭霞[2] Zhu Chunfen;Ren Chunlin;Guo Xia(Department of Clinical Function,Hanyang Hospital Affiliated to Wuhan University of Science and Technology,Wuhan 430050,Hubei Province,China;不详)

机构地区：[1]武汉科技大学附属汉阳医院/武汉市汉阳医院功能科,武汉市430050 [2]武汉科技大学附属汉阳医院/武汉市汉阳医院中医科,武汉市430050

出　　处：《实用肝脏病杂志》2024年第2期242-245,共4页Journal of Practical Hepatology

基　　金：湖北省科技厅重点科技计划项目(编号:2021KJ0210)。

摘　　要：目的探讨应用血清氨基末端B型尿钠肽前体(NT-ProBNP)和肌钙蛋白Ⅰ(TnI)联合心电图(EKG)检查诊断肝硬化性心肌病(CCM)的价值。方法2020年1月~2023年3月我院收治的肝硬化患者93例和健康体检者49例,均接受EKG检查,采用化学发光免疫法检测血清TnI水平,采用ELISA法检测血清NT-ProBNP水平。应用受试者工作特征曲线(ROC)并计算曲线下面积(AUC)评估指标的诊断效能。结果本组肝硬化患者存在CCM者51例(NYHAⅠ级18例,Ⅱ级20例和Ⅲ级13例);CCM组血清NT-ProBNP和TnI水平分别为(41.5±7.9)pmol/L和(0.6±0.2)μg/mL,显著高于肝硬化组【分别为(28.9±5.2)pmol/L和(0.3±0.1)μg/mL,P<0.05】或健康人【分别为(8.3±1.6)pmol/L和(0.1±0.1)μg/mL,P<0.05】;CCM组心电图异常率为98.0%,显著高于肝硬化组的71.4%或健康人组的2.0%(P<0.05);CCMⅢ级患者血清NT-ProBNP和TnI水平分别为(48.3±8.5)pmol/L和(0.8±0.2)pmol/L,显著高于Ⅱ级患者【分别为(42.1±7.8)pmol/L和(0.6±0.1)pmol/L,P<0.05】或Ⅰ级患者【分别为(35.9±7.9)pmol/L和(0.5±0.1)pmol/L,P<0.05】;分别以血清NT-ProBNP水平=40.4 pmol/L和TnI水平=0.5μg/mL为截断点,联合心电图检查异常诊断CCM的AUC=0.923,其诊断的灵敏度和特异度分别为94.1%和78.6%,显著优于各指标单独诊断(P<0.05)。结论检测血清NT-ProBNP和TnI水平联合心电图检查可以帮助临床医生早期诊断肝硬化患者并发CCM,值得深入研究。Objective The aim of this study was to explore serum N-terminal pro-brain natriuretic peptide(NT-ProBNP)and troponin I(TnI)level changes in patients with liver cirrhosis for early diagnosis of cirrhotic cardiomyopathy(CCM).Methods 93 patients with liver cirrhosis and 49 healthy persons at physical examination were enrolled in our hospital between January 2020 and March 2023,and all underwent electrocardiography(EKG).Serum TnI level was detected by chemiluminescence immunoassay and serum NT-ProBNP level was measured by ELISA.The diagnostic performance was evaluated by the area under the receiver operating characteristic curve(AUROC)analysis.Results Out of our series,the CCM was found in 51 cases,including NYHA classⅠin 18 cases,classⅡin 20 cases and classⅢin 13 cases based on cardiac Doppler ultrasonography;serum NT-ProBNP and TnI levels in patients with CCM were(41.5±7.9)pmol/L and(0.6±0.2)μg/mL,significantly higher than[(28.9±5.2)pmol/L and(0.3±0.1)μg/mL,respectively,P<0.05]in cirrhotics without CCM or[(8.3±1.6)pmol/L and(0.1±0.1)μg/mL,P<0.05]in healthy individuals;the abnormal EKG manifestation in patients with CCM accounted for 98.0%,much higher than 71.4%in patients with liver cirrhosis or 2.0%(P<0.05)in healthy persons;serum NT-ProBNP and TnI levels in patients with CCM classⅢwere(48.3±8.5)pmol/L and(0.8±0.2)pmol/L,significantly higher than[(42.1±7.8)pmol/L and(0.6±0.1)pmol/L,P<0.05]in patients with CCM classⅡor[(35.9±7.9)pmol/L and(0.5±0.1)pmol/L,P<0.05]in patients with CCM classⅠ;the AUC was 0.923,with the sensitivities of 94.1%and the specificities of 78.6%when serum NT-ProBNP level equal to 40.4 pmol/L and serum TnI level equal to 0.5μg/mL were set as the cut-off-value,and with abnormal EKG combination in predicting CCM,much superior to any of the parameters did alone(P<0.05).Conclusion The elevated serum NT-ProBNP and TnI levels in patients with decompensated liver cirrhosis might hint the existence of CCM,which occurs early before abnormal EKG manifestations loom.

关 键 词：肝硬化性心肌病 氨基末端B型尿钠肽前体 肌钙蛋白Ⅰ 心电图 诊断 

分 类 号：R575.2[医药卫生—消化系统] R542.2[医药卫生—内科学]