急性肺血栓栓塞症患者血清酶及心肌肌钙蛋白I的变化
[The changes of serum enzymes and cardiac troponin I in patients with acute pulmonary thromboembolism].
作者信息
Zhang Yun, Yang Yuan-Hua, Pang Bao-Sen, Wang Chen
机构信息
Beijing Chaoyang Hospital-Beijing Institute of Respiratory Medicine, Capital Medical University, 100020, China.
出版信息
Zhonghua Jie He He Hu Xi Za Zhi. 2007 Sep;30(9):667-72.
OBJECTIVES
To investigate the changes of serum enzymes and cardiac troponin I (TnI) in patients with acute pulmonary thromboembolism (PTE). The relationships between these changes and the pulmonary artery pressure, the right ventricular function and the prognosis were evaluated.
METHODS
This prospective multi-centre trial included 519 patients with confirmed PTE from 24 collaborating hospitals, with 54 cases of massive PTE, 195 sub-massive PTE and 270 non-massive PTE. Thrombolytic treatment with urokinase or recombinant tissue plasminogen activator (rt-PA) was administered for massive and sub-massive PTE patients; anti-coagulative therapy with unfractionated heparin or low molecular weight heparin was used for non-massive PTE.
RESULTS
The values of serum ALT, AST, CPK and LDH before treatment in massive PTE [(74 +/- 33), (88 +/- 40), (157 +/- 75), (419 +/- 264) U/L] were significantly higher than those in sub-massive [(52 +/- 21), (43 +/- 18), (75 +/- 30), (284 +/- 176) U/L] and non-massive cases [(38 +/- 13), (35 +/- 11), (78 +/- 24), (239 +/- 178) U/L] (P < 0.05). The value of serum ALT at day 7 (84 +/- 39 U/L) in the unfractionated heparin sub-group of the non-massive PTE was significantly higher than that (67 +/- 26 U/L) in the low molecular weight heparin sub-group (P = 0.045). Of the 45 cases with high pulmonary pressure > 80 mm Hg (1 mm Hg = 0.133 kPa), 24 (54.4%) cases showed high serum LDH (P = 0.032) and 17 (41.5%) high serum ALT (P = 0.049). Of the 169 cases with right ventricular dysfunction, 68 (40.2%) cases showed high serum LDH (P = 0.049) and 76 (45.5%) high serum ALT (P = 0.037). Of the 48 cases with poor prognosis, 15 (30.8%) cases showed high serum LDH (P = 0.039) and 26 (54.5%) high serum ALT (P = 0.022). Of the 39 cases with TnI > or = 0.07 microg/L, 24 (63.3%) cases were complicated with decreased right ventricular function (P < 0.01) and 8 (24.2%) with poor prognosis (P = 0.034).
CONCLUSIONS
The values of serum ALT, AST, CPK, LDH and TnI are increased in acute PTE. Unfractionated heparin results in higher levels of ALT than lower molecular weight heparin. The increase of serum ALT, LDH and TnI is correlated with pulmonary artery pressure, right ventricular function and the prognosis of the PTE. These changes may be useful in the risk stratification of PTE patients.
目的
探讨急性肺血栓栓塞症（PTE）患者血清酶及心肌肌钙蛋白I（TnI）的变化，并评估这些变化与肺动脉压、右心室功能及预后的关系。
方法
这项前瞻性多中心试验纳入了来自24家合作医院的519例确诊PTE患者，其中大面积PTE 54例，次大面积PTE 195例，非大面积PTE 270例。对大面积和次大面积PTE患者采用尿激酶或重组组织型纤溶酶原激活剂（rt-PA）进行溶栓治疗；非大面积PTE患者采用普通肝素或低分子肝素进行抗凝治疗。
结果
大面积PTE患者治疗前血清ALT、AST、CPK和LDH值[（74±33）、（88±40）、（157±75）、（419±264）U/L]显著高于次大面积[（52±21）、（43±18）、（75±30）、（284±176）U/L]和非大面积患者[（38±13）、（35±11）、（78±24）、（239±178）U/L]（P<0.05）。非大面积PTE普通肝素亚组第7天血清ALT值（84±39 U/L）显著高于低分子肝素亚组（67±26 U/L）（P=0.045）。45例肺动脉高压>80 mmHg（1 mmHg=0.133 kPa）患者中，24例（54.4%）血清LDH升高（P=0.032），17例（41.5%）血清ALT升高（P=0.049）。169例右心室功能不全患者中，68例（40.2%）血清LDH升高（P=0.049），76例（45.5%）血清ALT升高（P=0.037）。48例预后不良患者中，15例（30.8%）血清LDH升高（P=0.039），26例（54.5%）血清ALT升高（P=0.022）。39例TnI≥0.07 μg/L患者中，24例（63.3%）并发右心室功能减退（P<0.01），8例（24.2%）预后不良（P=0.034）。
结论
急性PTE患者血清ALT、AST、CPK、LDH及TnI值升高。普通肝素导致的ALT水平高于低分子肝素。血清ALT、LDH及TnI升高与PTE患者的肺动脉压、右心室功能及预后相关。这些变化可能有助于PTE患者的危险分层。
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