肌钙蛋白T对急性肺血栓栓塞症患者预后评估价值

Prognostic value of elevated cardiac troponin T levels in acute pulmonary thromboembolism

关键词:  肺血栓栓塞症  肌钙蛋白T  预后

Key words:  pulmonary thromboembolism  troponinT  prognosis

摘要:

［目的］探讨肌钙蛋白T（cTnT）对急性肺血栓栓塞症（PTE）患者的预后评估价值。［方法］ 确诊为急性肺血栓栓塞症病例35例，比较cTnT（+）组和cTnT（-）组间右室/左室(RV/LV)舒张末直径、肺动脉高压发生率、血氧分压、 临床不良事件发生率、体循环平均压的差异性。［结果］ 56.5%急性大面积和次大面积PTE患者有血浆中cTnT的水平升高，非大面积PTE中cTnT的水平正常。cTnT（+）组肺动脉高压发生率增加显著(39.2%对比16.4%， P<0.05)，体循环平均压下降显著 (110.9±22.3对比129.4±20.1，P<0.05)，临床不良事件发生率显著增加(41.7%对比5.2%,P<0.01)，RV/LV舒张末直径值显著增加(1.21±0.24对比0.87±0.23,P<0.01) ，升高的cTnT是发生临床不良事件的独立危险因素，其相对危险度（OR）和95%可信区间分别为21.2 （2.7～200）。［结论］急性大面积和次大面积PTE患者多有血浆中cTnT的水平升高，cTnT的水平升高，右室功能不全发生率高，强烈提示预后不良。

Abstract:

［Objective］To evaluate cardiac troponinT (cTnT) in the prognosis in acute pulmonary thromboembolism (PTE). ［Methods］ Thirty-five patients with acute pulmonary thromboembolism were included in the study. The end diastolic RV/LV, rate of pulmonary hypertention, mean systemic blood pressure ,oxygen pressure and clinical adverse outcome were compared in patients with elevated levels of serum cTnT versus patients with normal levels of serum cTnT.［Results］ Serum cTnT levels in 56.5%massive and sub- massive PTE were increased, Serum cTnT levels innon- massive PTE were nomal. Rate of pulmonary hypertention was statistically higher in the cTnT(+) group compared to cTnT(-)group (39.2% vs 16.4%, P<0.05),Mean systemic blood pressure decreased significantly in the patients with elevated serum cTnT levels (110.9±22.3 vs 129.4±20.1, P<0.05),The end–diastolic RV/LV was significantly higher in the cTnT-positive group(1.21±0.24 vs 0.87±0.23, P<0.01), and clinical adverse outcome was significantly higher in the cTnT positive group (41.7% vs 5.2%,P<0.01), The elevated cTnT was an independent risk facter for adverse clinical events (OR 21.2, 95% CI 2.7～200).［Conclusion］ Serum cTnT levels in most massive and sub-massive PTE are increased. Patients with elevated serum cTnT levels are at a higher risk for the development of right ventricular dysfunction and clinical adverse outcome.