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急性心力衰竭患者肌钙蛋白I水平与基础病因及其预后的相关性(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2011年第4期
页码:
510
栏目:
临床研究
出版日期:
2011-08-25

文章信息/Info

Title:
Correlation of prognosis and changes of cardiac troponin I in patients with acute heart failure
作者:
赵秀芬; 武宗寅
山东省医学科学院济宁市第一人民医院心血管内科，山东 济宁 272000
Author(s):
ZHAO Xiu-fen;  WU Zong-yin
Department of Cardiology, First People’s Hospital, Shandong Academy of Medical Sciences, Jining 272000, Shandong, China
关键词:
肌钙蛋白I; 心力衰竭; 急性; 预后
Keywords:
cardiac troponin I;  acute heart failure;  prognosis
分类号:
R541.61
DOI:
61-1268/R.20110503.1638.023
文献标识码:
A
摘要:
目的:探讨肌钙蛋白I(cTnI)在急性心力衰竭(AHF)患者中水平和变化与基础病因及AHF预后的关系。方法： 84例确诊的AHF患者，按病因分为缺血性心脏病(IHD)组(26例)、心脏瓣膜病(VHD)组(17例)、扩张型心肌病（DCM）组(25例)、高血压性心脏病(HHD)组(16例)。入院即刻与病情缓解时分别测定cTnI浓度。据入院即刻浓度分为cTnI(+)(14例)和cTnI(-)(70例)两组；据cTnI浓度分为入院即刻与病情缓解时均为cTnI(+)(1组)、入院即刻cTnI(+)与病情缓解时cTnI(-)(2组)、入院即刻与病情缓解时均为cTnI(-)(3组)3组。记录住院期间病情缓解时间，出院后1、3、6、12个月再入院及死亡例数，分析cTnI浓度与病因及其预后的相关性。结果： ①入院即刻与病情缓解时IHD组cTnI浓度均较DCM、HHD两组明显升高(分别P<0.01、P<0.05)；IHD、VHD、HHD 3组缓解时cTnI浓度均较入院即刻明显回降(分别P<0.05、P<0.01、P<0.05)。 ②cTnI(+)组缓解时间较cTnI(-)组长(P<0.01)。入院即刻cTnI浓度与缓解时间呈正相关(r=0.286,P<0.01)。③cTnI(+)组住院期间病死率高于cTnI(-)组(P<0.05)；出院后12个月cTnI(+)组病死率明显高于cTnI(-)组(P<0.01)。cTnI(+)组住院期间及出院后12个月累积心源性病死率明显高于cTnI(-)组(P<0.01)。出院后1、3、6、12个月cTnI(+)组再入院率较cTnI(-)组明显升高(分别P<0.05、P<0.01、P<0.01、P<0.01)。治疗前后cTnI均阳性组住院期间及出院后12个月累积病死率较治疗前后阳转阴组和均阴性组明显升高(均P<0.01)。结论： AHF患者cTnI水平及治疗前后的变化与基础病因及其预后相关。
Abstract:
AIM:To study the changes and the prognostic significance of cardiac troponinⅠ(cTnI) in patients with acute heart failure (AHF). METHODS: Serial blood samples were collected from 84 AHF patients, divided etiologically into four groups: ischemic heart disease (IHD, n=26), valvular heart disease (VHD, n=17), dilated cardiomyopathy (DCM, n=25) and hypertensive heart disease (HHD, n=16). Serial venous blood concentrations of cTnI were measured immediately upon admission and at the time of symptom remission. According to the cTnI concentration on admission, patients were divided into two groups: cTnI(+) group (n=14) and cTnI(-) group (n=70). According to cTnI concentration of admission and symptom remission, patients were divided into group of cTnI(+) at admission and at symptom remission, group of cTnI(+) at admission but cTnI(-) at symptom remission, and group of cTnI(-) at admission and at symptom remission. The time of symptom remission, rehospitalization frequency and mortality 1, 3, 6 and 12 months after discharge were recorded. RESULTS: Compared with those in DCM and HHD groups, cTnI concentrations of IHD group on admission and at symptom remission increased significantly (P<0.01, P<0.05, respectively). The cTnI concentrations during symptom remission decreased in IHD, VHD and HHD groups compared with those on admission (P<0.05, P<0.01, P<0.05, respectively). The time of symptom remission in cTnI(+) group was longer than in cTnI(-) group (P<0.01) and the concentration of cTnI on admission was positively related to the time of symptom remission (r=0.286, P<0.01). The in-hospital mortality of cTnI(+) group was higher than in cTnI(-) group (P<0.05). The discharge mortality of cTnI(+) group was significantly higher than in cTnI(-) group in 12 months (P<0.01). Total cardiac deaths in cTnI(+) group including in-hospital and 12 months after discharge were higher than those in cTnI(-) group (P<0.01). Re-hospitalization frequency of 1, 3, 6 and 12 months after discharge in cTnI(+) group was significantly higher than in cTnI(-) group (P<0.05, P<0.01, P<0.01, P<0.01, respectively). Total cardiac deaths including in-hospital and 12 months after discharge in group of cTnI(+) at admission and at symptom remission were significantly higher than those in group of cTnI(+) at admission but cTnI(-) at symptom remission and in group of cTnI(-) at admission and at symptom remission (all P<0.01). CONCLUSION: The changes before and after treatment and level of cardiac troponin I(cTnI) in patients with acute heart tailure (AHF) are related to prognosis and etiology.

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备注/Memo

备注/Memo:
收稿日期: 2010-09-25.作者简介:赵秀芬,硕士生Email:zxf_yy@sina.com
更新日期/Last Update: 2011-06-02