Lodha Rakesh, Arun Sasi, Vivekanandhan Subbiah, Kohli Utkarsh, Kabra Sushil K
Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
Acta Paediatr. 2009 Mar;98(3):478-81. doi: 10.1111/j.1651-2227.2008.01095.x. Epub 2008 Oct 23.
To determine the prevalence of myocardial cell injury in children with septic shock by estimating the levels of biochemical markers of myocardial injury, troponin I (TnI) and creatine kinase MB (CK-MB).
Children aged 3 months to 16 years were admitted to paediatric intensive care unit (PICU) with septic shock. Children with sepsis without shock and children with hypovolaemic shock were enrolled as controls.
Serum TnI and CK-MB levels were measured at admission and serially at 24 h, 48 h and 96 h in children with septic shock, while baseline measurement of the same markers was taken from the controls. In total, 88% (15/18) of children with septic shock had elevated TnI levels compared with 25% (5/20) with sepsis and 6.7% (1/15) with hypovolaemic shock (p < 0.001). Serial TnI levels at admission, 24 h, 48 h and 96 h were higher in the nonsurvivors. There was a positive correlation between the baseline TnI levels and the predicted mortality using the paediatric index of mortality (PIM2) scores at admission (r = 0.51, p = 0.03).
A majority of children with septic shock have evidence of myocardial cell injury. The estimation of serum TnI levels may help in better prognostication of children with septic shock.
通过评估心肌损伤生化标志物肌钙蛋白I（TnI）和肌酸激酶同工酶MB（CK-MB）的水平，确定感染性休克患儿心肌细胞损伤的患病率。
年龄在3个月至16岁的患儿因感染性休克入住儿科重症监护病房（PICU）。将无休克的脓毒症患儿和低血容量性休克患儿作为对照。
对感染性休克患儿在入院时、24小时、48小时和96小时连续测量血清TnI和CK-MB水平，同时从对照组获取相同标志物的基线测量值。与脓毒症患儿中的25%（5/20）和低血容量性休克患儿中的6.7%（1/15）相比，感染性休克患儿中有88%（15/18）的TnI水平升高（p<0.001）。非存活者入院时、24小时、48小时和96小时的连续TnI水平更高。基线TnI水平与入院时使用儿科死亡率指数（PIM2）评分预测的死亡率之间存在正相关（r = 0.51，p = 0.03）。
大多数感染性休克患儿有心肌细胞损伤的证据。血清TnI水平的评估可能有助于更好地预测感染性休克患儿的预后。
