急性中毒心肌损伤早期检测和肽素与缺血修饰白蛋白的临床价值

摘要

目的：探讨急性中毒心肌损伤早期检测和肽素与缺血修饰白蛋白（ IMA）的临床意义。方法将急性中毒3 h内患者255例，根据是否存在心肌损伤分为心肌损伤组160例（其中轻度30例、中度60例、重度70例）和非心肌损伤组95例，另选健康体检者50例作为对照组。比较3组心肌酶、心肌肌钙蛋白 I（ cTnI）、和肽素、IMA 水平。结果心肌损伤组、非心肌损伤组患者和肽素水平明显高于对照组（P＜0．05），且心肌损伤组明显高于非心肌损伤组（P＜0．05），重度组高于心肌损伤轻、中度组（P＜0．05）；心肌损伤组IMA水平明显低于对照组和非心肌损伤组（P＜0．05），重度组低于心肌损伤轻、中度组（P＜0．05）。心肌损伤组、非心肌损伤组、对照组肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）、cTnI水平比较，差异均无统计学意义（P＞0．05）。心肌损伤重度组患者cTnI水平明显高于轻、中度组（P＜0．05），但轻、中度两组间cTnI水平比较无统计学意义（P＞0．05）。心肌损伤轻、中、重度组患者CK、CK-MB比较，差异均无统计学意义（P＞0．05）。心肌损伤组患者和肽素与IMA水平呈负相关（r＝－0．603，P＜0．01）。结论和肽素、IMA水平可在早期反映急性中毒性心肌损伤程度并评估预后转归情况。%Objective To investigate the clinical significance of copeptin and ischemia-modified albumin( IMA) in early detection of acute poisoning patients with myocardial injury.Methods Two hundred and fifty-five patients with acute poisoning attacked within three hours were divided into myocardial injury group(160 cases,mild 30,moderate 60,severe 70) and non-myocardial injury group (95 cases) according to whether they suffered from myocardial injury.Fifty normal healthy controls were enrolled in the study.The levels of myocardial enzymes,cardiac troponin( cTnI) ,copeptin and IMA were compared among three groups.Results The levels of copeptin in the myocardial injury group and non-myocardial injury group were significantly higher than that in the control group( P<0.05) .The level of copeptin in the myocardial injury group was significantly higher than that in the non-myocardial injury group(P<0.05).The levels of copeptin in the mild and moderate myocardial injury groups were significantly lower than that in the severe myocardial injury group(P<0.05).The level of IMA in the myocardial injury group was significantly lower than that in the control group and in the non-myocardial injury group(P<0.05). The level of IMA in the severe myocardial injury group was lower than those in the mild and moderate myocardial injury groups(P<0.05).There was no significant difference in the levels of creatine kinase (CK),creatine kinase isoenzyme MB(CK-MB),or cTnI among myocardial injury group,non-myocardial injury group,and control gorup(P>0.05).The level of cTnI was significantly higher in the severe myocardial injury group compared with mild and moderate myocardial injury groups(P<0.05),but it showed no significant difference between mild and moderate myocardial injury groups(P>0.05).There was no significant difference in the levels of CK and CK-MB among mild,moderate and severe myocardial injury groups ( P >0.05).The level of copeptin negatively correlated with the level of IMA in the myocardial injury group (r=-0.603,P<0.01).Conclusion The levels of copeptin and IMA can reflect the severity of acute poisoning with myocardial injury and evaluate the prognosis in the early stage.