Objective To investigate the inc:idence of myocardial injury in the critically ill septic childern, and the relationship between elevations of serum troponin Ⅰ ( cTn Ⅰ ), creatine kinase ( CK-MB ) and the prognosis outcomes, including the incidence of myocardial injury ,mortality, acute physiology and chronic health Ⅱ( APACHE Ⅱ ) score.To evaluate the significance of elevations of cTn Ⅰ , CK-MB and APACHE Ⅱ in critically ill children with sepsis.Methods Children with severe sepsis hospitalized in ICU of Hunan Provincial Children's Hospital from August 2009 to May 2010 were retrospectively collected as sepsis group and chidren without sepsis were chosen as control group.The levels of troponin Ⅰ , creatine kinase and APACHE Ⅱ score , myocardial injury , mortality and quality of life were measured.The levels of troponin Ⅰ , creatine kinase concentration and the duration were compared.Results Totally 656 children were enrolled into the study, including 459 in sepsis group( 352 boys and 107 girls ) and 197 in non-sepsis group( 151 boys and 46 girls ).Two hundred and five ( 44.7％ ) of the 459 critically ill children with sepsis showed elevated levels of cTn Ⅰ or/and CK-MB.The levels of cTn Ⅰ.CK-MB and APACHE Ⅱ score were positively correllated.Serum CK-MB , c:Tn Ⅰ and APACHE Ⅱ scores were independent risk factors for predicting mortality of septic patients.The levels of CK-MB and cTn Ⅰ in death group were significantly higher than in survival group.The levels of CK-MB and cTn Ⅰ in high APACHE Ⅱ scores( ≥25 ) group were significantly higher than in low APACHE Ⅱ scores( ＜ 25 )group.The patients with high APACHE n scores and high serum CK-MB,cTn Ⅰ levels had shorter survival time.Conclusions The incdence of myocardial injury defined by elevated levels of cTn Ⅰ and CK-MB is unexpectedly high and is associated with mortality.Continuous monitoring of serum cTn Ⅰ , CK-MB concentration and APACHE Ⅱ score of children with sepsis, not only help to assess the condition of children, but also predict the prognosis of them.%目的 在脓毒症患儿急性生理和慢性健康状况Ⅱ(APACHEⅡ)评分的基础上,探讨心肌酶与预后的关系.方法 回顾性收集2009年8月至2010年5月在湖南省儿童医院ICU的重症脓毒症患儿为研究对象,以非脓毒症患儿为对照.选取入住PICU后第1次和24～72 h的CK-MB和cTnⅠ数据作为心肌酶学观察指标.同时复习相关文献获得与脓毒症病死相关的指标,选取病史资料中第1次检查的数据进行分析.以儿科脓毒症诊断标准分为脓毒症组和非脓毒症组.综合出院生存结局和出院后30 d生存结局分为死亡亚组和生存亚组;依据APACHEⅡ评分结果分为APACHEⅡ评分≥25分亚组和＜25分亚组.以COX比例风险回归法分析CK-MB、cTnⅠ和APACHEⅡ评分与预后关系.结果 656例患儿进入分析,其中脓毒症组459例(男352例,女107例),非脓毒症组197例(男151例,女46例),两组性别、年龄和原发病构成比差异无统计学意义.①复习参考文献提取15项与重症脓毒症患儿死亡相关的单因素变量,单因素分析结果显示,脓毒症组患儿的预后与CK-MB、cTnⅠ水平增高、APACHEⅡ评分≥25分、氧合指数<200、平均动脉压<60 mmHg(1 mmHg=0.133 kPa)和Glasgow昏迷评分<9分有关;②进一步行COX回归分析,结果显示与重症脓毒症死亡有统计学意义的变量为CK-MB、cTnⅠ水平升高和APACHEⅡ评分≥25分;③脓毒症组205/459例(44.7%)CK-MB和(或)cTnⅠ水平升高,非脓毒症组37/197例(18.8%)CK-MB和(或)cTnⅠ水平升高,两组差异有统计学意义;④APACHEⅡ评分≥25分亚组CK-MB和(或)cTnⅠ水平显著高于＜25分亚组,存活亚组CK-MB和(或)cTnⅠ水平显著高于死亡亚组;各亚组24～72 h的CK-MB及cTnⅠ水平均较入ICU时显著升高;⑤生存分析结果显示,APACHEⅡ评分≥25分,且CK-MB和(或)cTnⅠ水平升高患儿的生存时间最短;APACHEⅡ评分<25分,且CK-MB和(或)cTnⅠ正常患儿的生存时间最长.结论 血清cTnⅠ、CK-MB水平升高与重症脓毒症患儿的预后相关,与APACHEⅡ评分结合有助于判断脓毒症的预后.
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