横纹肌溶解症中血清心肌肌钙蛋白I升高。
Elevated serum cardiac troponin I in rhabdomyolysis.
作者信息
Punukollu Gopikrishna, Gowda Ramesh M, Khan Ijaz A, Mehta Nirav J, Navarro Victor, Vasavada Balendu C, Sacchi Terrence J
机构信息
Division of Cardiology, Long Island College Hospital, Brooklyn, NY, USA.
出版信息
Int J Cardiol. 2004 Jul;96(1):35-40. doi: 10.1016/j.ijcard.2003.04.053.
OBJECTIVE
To examine the etiology and clinical significance of elevated serum cardiac troponin I (cTnI) in patients with rhabdomyolysis.
METHODS
Data on 91 (63 men) consecutive patients with rhabdomyolysis were examined.
RESULTS
The mean age was 57.8+/-19.6 years (range 24-97 years). Patients were divided into two groups: cTnI-positive with serum cTnI >0.6 ng/ml (n=19) and cTnI-negative with serum cTnI <0.6 ng/ml (n=72). Prevalence of cardiovascular risk factors was equal in both groups. Illicit substance use was more common in the cTnI-positive group (31% vs. 14%, P=0.04). Peak creatine kinase (CK) was higher in cTnI-positive group (34,811+/-38,309 vs. 15,070+/-21,655 U/l, P=0.04) but there was no difference in the MB isoenzyme (CK-MB) (118+/-132 vs. 89+/-451 ng/ml, P=0.63). In cTnI-positive group, there was a strong correlation between peak CK and CK-MB (r(2)=0.606, P=0.00008) but not between peak cTnI and peak CK (r(2)=0.164 and P=0.08) or CK-MB (r(2)=0.134 and P=0.12) levels. Serum creatinine was higher in cTnI-positive group (3.58+/-2.73 vs. 1.83+/-2.01 mg/dl, P=0.02) but there was no correlation between serum creatinine and cTnI (r(2)=0.121, P=0.158). None of the cTnI-positive patient had segmental wall motion abnormalities. Seventeen (89%) patients in cTnI-positive and 19 (26%) in cTnI-negative group required admission to intensive care unit (P=0.0001). Hypotension (37% vs. 6%, P=0.0002) and sepsis (47% vs. 11%, P=0.0003) were more common in cTnI-positive group. Duration of hospitalization was longer in cTnI-positive group (17.7+/-11.7 vs. 8.9+/-13 days, P=0.007) but there was no significant difference in mortality.
CONCLUSION
In rhabdomyolysis, serum cTnI may be elevated unrelated to the degree of muscle damage, renal failure and cardiovascular risk factors, and is likely related to the etiology of rhabdomyolysis, as is evidenced by significantly higher serum cTnI with illicit substance use, hypotension, and sepsis. Elevated serum cTnI is associated with a higher morbidity.
目的
探讨横纹肌溶解症患者血清心肌肌钙蛋白I（cTnI）升高的病因及临床意义。
方法
对91例（63例男性）连续的横纹肌溶解症患者的数据进行研究。
结果
患者平均年龄为57.8±19.6岁（范围24 - 97岁）。患者分为两组：血清cTnI>0.6 ng/ml的cTnI阳性组（n = 19）和血清cTnI<0.6 ng/ml的cTnI阴性组（n = 72）。两组心血管危险因素的患病率相同。非法药物使用在cTnI阳性组更为常见（31%对14%，P = 0.04）。cTnI阳性组的肌酸激酶（CK）峰值较高（34,811±38,309对15,070±21,655 U/l，P = 0.04），但肌酸激酶MB同工酶（CK-MB）无差异（118±132对89±451 ng/ml，P = 0.63）。在cTnI阳性组中，CK峰值与CK-MB之间存在强相关性（r² = 0.606，P = 0.00008），但cTnI峰值与CK峰值（r² = 0.164，P = 0.08）或CK-MB（r² = 0.134，P = 0.12）水平之间无相关性。cTnI阳性组的血清肌酐较高（3.58±2.73对1.83±2.01 mg/dl，P = 0.02），但血清肌酐与cTnI之间无相关性（r² = 0.121，P = 0.158）。cTnI阳性患者均无节段性室壁运动异常。cTnI阳性组17例（89%）患者和cTnI阴性组19例（26%）患者需要入住重症监护病房（P = 0.0001）。低血压（37%对6%，P = 0.0002）和脓毒症（47%对11%，P = 0.0003）在cTnI阳性组更为常见。cTnI阳性组的住院时间较长（17.7±11.7对8.9±13天，P = 0.007），但死亡率无显著差异。
结论
在横纹肌溶解症中，血清cTnI可能升高，且与肌肉损伤程度、肾衰竭及心血管危险因素无关，可能与横纹肌溶解症的病因有关，非法药物使用、低血压和脓毒症导致血清cTnI显著升高即证明了这一点。血清cTnI升高与较高的发病率相关。
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