Lim Wendy, Cook Deborah J, Griffith Lauren E, Crowther Mark A, Devereaux P J
The Department of Medicine, McMaster University, Hamilton, Ontario, CA.
Am J Crit Care. 2006 May;15(3):280-8; quiz 289.
Levels of cardiac troponin, a sensitive and specific marker of myocardial injury, are often elevated in critically ill patients.
To document elevated levels of cardiac troponin I in patients in a medical-surgical intensive care unit and the relationship between elevated levels and electrocardiographic findings and mortality.
A total of 198 patients expected to remain in the intensive care unit for at least 72 hours were classified as having myocardial infarction (cardiac troponin I level >or=1.2 microg/L and ischemic electrocardiographic changes), elevated troponin level only (>or=1.2 microg/L and no ischemic electrocardiographic changes), or normal troponin levels. Events were classified as prevalent if they occurred within 48 hours after admission and as incident if they occurred 48 hours or later after admission. Factors associated with mortality were examined by using regression analysis.
A total of 171 patients had at least one troponin level measured in the first 48 hours. The prevalence of elevated troponin level was 42.1% (72 patients); 38 patients (22.2%) had myocardial infarction, and 34 (19.9%) had elevated troponin level only. After the first 48 hours, 136 patients had at least 1 troponin measurement. The incidence of elevated troponin level was 11.8% (16 patients); 7 patients (5.1%) met criteria for myocardial infarction, and 2 (1.5%) had elevated troponin level only. Elevated levels of troponin I at any time during admission were associated with mortality in the univariate but not the multivariate analysis.
Elevated levels of cardiac troponin I in critically ill patients do not always indicate myocardial infarction or an adverse prognosis.
心肌肌钙蛋白是心肌损伤的敏感且特异的标志物，其水平在危重症患者中常升高。
记录内科-外科重症监护病房患者中心肌肌钙蛋白I水平升高情况，以及升高水平与心电图表现和死亡率之间的关系。
总共198例预计在重症监护病房至少停留72小时的患者被分类为患有心肌梗死（心肌肌钙蛋白I水平≥1.2微克/升且有缺血性心电图改变）、仅肌钙蛋白水平升高（≥1.2微克/升且无缺血性心电图改变）或肌钙蛋白水平正常。如果事件在入院后48小时内发生则分类为现患事件，如果在入院后48小时或更晚发生则分类为新发病例事件。使用回归分析检查与死亡率相关的因素。
总共171例患者在最初48小时内至少测量了一次肌钙蛋白水平。肌钙蛋白水平升高的现患率为42.1%（72例患者）；38例（22.2%）患有心肌梗死，34例（19.9%）仅肌钙蛋白水平升高。在最初48小时后，136例患者至少进行了1次肌钙蛋白测量。肌钙蛋白水平升高的发病率为11.8%（16例患者）；7例（5.1%）符合心肌梗死标准，2例（1.5%）仅肌钙蛋白水平升高。入院期间任何时候肌钙蛋白I水平升高在单变量分析中与死亡率相关，但在多变量分析中不相关。
危重症患者中心肌肌钙蛋白I水平升高并不总是表明心肌梗死或不良预后。
