急性脑出血患者肌钙蛋白T水平、心率变异性与预后不良的相关性分析  

Analysis of cardiac troponin T and heart rate variability in patients with acute cerebral hemorrhage in relation to poor prognosis

作　　者：赵洪 张勋 祝秀蓉 梁世福 赖婷婷 李元斌[3] 何斌 张亚西[4] 吴有林[1] ZHAO Hong;ZHANG Xun;ZHU Xiurong(Department of Neurology,Chongzhou People's Hospital,Chongzhou(611230),Sichuan,China)

机构地区：[1]崇州市人民医院神经内科,四川崇州611230 [2]崇州市人民医院心电诊断科,四川崇州611230 [3]崇州市人民医院神经外科,四川崇州611230 [4]崇州市人民医院心内科,四川崇州611230

出　　处：《癫痫与神经电生理学杂志》2025年第1期16-20,共5页Journal of Epileptology and Electroneurophysiology

基　　金：2021年成都市卫生健康委员会医学科研课题(2021308)。

摘　　要：目的分析急性脑出血患者肌钙蛋白T(cTnT)水平与心率变异性(HRV)的变化,探究其与预后的相关性。方法选取2022年1月至2023年12月于崇州市人民医院就诊的85例急性脑出血患者为研究对象;收集患者入院时的cTnT水平及24 h心电信号,在动态心电图分析基础上进行HRV分析,取24 h HRV时域参数即全程全部窦性R-R间期的标准差(SDNN)、相邻R-R间期差值>50 ms的心搏数占比(PNN50)、24 h相邻R-R间期差值的均方根(r-MSSD)进行记录;根据出院3个月的预后情况分为预后良好组和预后不良组,分析两组患者的cTnT、SDNN、PNN50和r-MSSD的水平变化与预后不良的相关性。结果急性脑出血患者预后不良组的cTnT水平显著高于预后良好组,SDNN、PNN50及r-MSSD水平显著低于预后良好组(P<0.05);多因素分析显示高cTnT水平,低SDNN、PNN50及r-MSSD水平是急性脑出血患者预后不良的影响因素(P<0.05);绘制cTnT联合SDNN、PNN50及r-MSSD水平预测急性脑出血患者预后的ROC曲线显示,曲线下面积(AUC)为0.870。结论急性脑出血患者入院时的cTnT水平更高,SDNN、PNN50及r-MSSD水平更低,即高cTnT水平,低SDNN、PNN50及r-MSSD水平与急性脑出血的预后不良相关,cTnT和HRV联合应用对急性脑出血患者预后的预测更有价值。Objective To explore the changes in cardiac troponin T(cTnT)level and heart rate variability(HRV)in patients with acute cerebral hemorrhage,and investigate their correlations with prognosis.Methods A total of 85 patients with acute cerebral hemorrhage were selected as research subjects from Chongzhou People's Hospital from January 2022 to December 2023.cTnT levels and 24-h ECG signals were collected at admission.On the basis of dynamic ECG analysis,HRV was analyzed.24-h HRV time-domain parameters were recorded,including standard deviation of R-R intervals(SDNN),percentage of R-R intervals with>50 ms(PNN50)and root mean square successive difference(r-MSSD)of 24-h adjacent R-R intervals.According to the prognosis at 3 months after discharge,the patients were divided into good prognosis and poor prognosis groups.The changes in cTnT,SDNN,PNN50 and r-MSSD levels in two groups and the correlation between the changes and the prognosis were analyzed.Results cTnT level in poor prognosis group of patients with acute cerebral hemorrhage was significantly higher than that in good prognosis group,and the levels of SDNN,PNN50 and r-MSSD were significantly lower than those in good prognosis group(P<0.05).Multivariate analysis showed that high cTnT level,low levels of SDNN,PNN50 and r-MSSD were influencing factors for poor prognosis of the patients with acute cerebral hemorrhage(P<0.05).ROC curve of cTnT combined with SDNN,PNN50 and r-MSSD levels in predicting the prognosis of patients with acute cerebral hemorrhage showed that the area of the curve(AUC)was 0.870.Conclusion Patients with acute cerebral hemorrhage have higher cTnT level and lower levels of SDNN,PNN50 and r-MSSD at admission,i.e.,high cTnT level and low levels of SDNN,PNN50 and r-MSSD are associated with poor prognosis for acute cerebral hemorrhage.The combined application of cTnT and HRV is more valuable in predicting the prognosis of patients with acute cerebral hemorrhage.

关 键 词：急性脑出血 肌钙蛋白T 心率变异性 预后 

分 类 号：R743.34[医药卫生—神经病学与精神病学]