急性肺血栓栓塞患者血清肌钙蛋白I阳性的相关影响因素
| 作者: |
1李敏,
1贺洵莹
1 华中科技大学同济医学院附属武汉中心医院心内科，武汉 430014 |
| 通讯: |
李敏
Email: limin703@sina.com |
| DOI: | 10.3978/j.issn.2095-6959.2019.05.018 |
摘要
目的：分析急性肺血栓栓塞(pulmonar y thromboembolism，PTE)发作患者首次入院时血清肌钙蛋白I(serum troponin I，cTnI)升高的相关临床因素，分析其与临床结局的关系。方法：回顾性分析我院2011年3月至2017年3月诊断为急性PTE的患者65例，依据入院时cTnI首次检验的结果，将患者分为阴性组(<0.2 ng/mL)、弱阳性组(0.2~<0.5 ng/mL)及阳性组(≥0.5 ng/mL)，比较三组的临床表现、影像学检查、治疗方式、实验室检查及临床结果，logistic回归分析cTnI阳性和主要心肺不良事件的相关影响因素。结果：阴性组高脂血症发生率较阳性组和弱阳性组高(P=0.024)；与阴性组和弱阳性组比，阳性组更易发生右心室功能不全(P=0.003)，经超声心动图检测血栓发生率较高(P=0.009)，更可能接受纤维蛋白溶解治疗(P=0.017)；阳性组外周血白细胞计数、中性粒细胞/淋巴细胞比值、血尿素氮、血糖、ALT及AST水平高于阴性组和弱阳性组，差异有统计学意义(P<0.05)；阳性组于住院期间总体上更可能出现临床不良结局，阳性组院内死亡及心血管不良事件发生率高于阴性组和弱阳性组(P<0.001)；阳性组休克指数高于阴性组和弱阳性组(P=0.028)；机械通气比例高于阴性组和弱阳性组(P=0.007)；阳性组血肌酐高于阴性组和弱阳性组(P=0.006)；年龄(P=0.029)、高脂血症(P=0.025)、血肌酐浓度(P=0.019)是预测急性PTE入院时血清肌钙蛋白I阳性的独立因素。血清肌钙蛋白I阳性(P=0.007)是住院期间发生不良心肺事件的独立危险因素。 结论：cTnI是诊断急性PTE发作患者短期主要不良心肺事件发生的独立预测因子，可能有助于PTE患者的危险分层和管理。
关键词：
肺血栓栓塞症；肌钙蛋白I；影响因素
Influence factors of serum troponin I of pulmonary thromboembolism patients
CorrespondingAuthor: LI Min Email: limin703@sina.com
DOI: 10.3978/j.issn.2095-6959.2019.05.018
Abstract
Objective: To analyze the influence risk factors of serum troponin I of pulmonary thromboembolism patients during the first hospitalization, and the association between serum troponin I and clinical results. Methods: Sixty-five PTE patients from March, 2011 to March, 2017 was collected in our hospital. According to cTnI expression level, the patients was divided into a negative group (<0.2 ng/mL), a weakly positive group (0.2–<0.5 ng/mL) and a positive group (≥0.5 ng/mL). The clinical features, radiological examination, treatment methods, laboratory examination and clinical results was compared between the 3 groups. The risk factors of serum troponin I positive and adverse cardiac and pulmonary events was analyzed by logistic regression analysis. Results: The hyperlipoidemia rate of the negative group was significantly higher than the weakly positive group and the positive group (P=0.024). Compared with the negative and the weakly positive group, right ventricular insufficiency is more likely to occur in the positive group (P=0.003). Thromboembolism rate was higher in the positive group (P=0.009), which was more likely to receive fibrinolysis treatment (P=0.017). Compared with the negative and the weakly positive group, leucocyte count, neutrophil/lymphocyte ratio, blood urea nitrogen, blood glucose, ALT and AST level of the positive group was significantly higher than those of the negative and the weakly positive group. Clinical adverse outcomes were more likely to occur in the positive group. Mortality rate and adverse cardiac events of the positive group was significantly higher than those of the negative and the weakly positive group (P<0.001). The shock index of the positive group was significantly higher than the negative and the weakly positive group (P=0.028). Mechanical ventilation ratio of the positive group was significantly higher than that of the negative and the weakly positive group (P=0.007). The level of serum creatinine was significantly higher than that of the negative and the weakly negative group (P=0.006). Age (P=0.029), hyperlipoidemia (P=0.025) and serum creatinine (P=0.019) were independence risk factors in predicting positive serum troponin I during first hospitalization. Positive serum troponin I was independence risk factor of adverse cardiac and pulmonary events. Conclusion: cTnI is independence risk factor of adverse cardiac and pulmonary events, which may be help to PTE patients risk stratification and management.
Keywords：
pulmonary thromboembolism; serum troponin I; risk factors