Zochios Vasileios, Valchanov Kamen
Cardiothoracic Intensive Care Unit, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK.
J Intensive Care Soc. 2015 Feb;16(1):52-57. doi: 10.1177/1751143714555303. Epub 2014 Dec 9.
Elevated cardiac troponin in the critically ill has been associated with increased hospital mortality. However, in critically ill patients with sepsis the results are heterogeneous and less easy to interpret. The objectives of this systematic review were to describe the pathophysiology, clinical relevance and prognostic significance of raised troponin in intensive care patients with sepsis. Articles were identified through a detailed MEDLINE search and additional references were retrieved from the selected studies. A growing body of clinical evidence suggests that although troponins are sensitive biomarkers with prognostic value, they are not independent predictors of mortality. However, vigilance for objective evidence of coronary artery disease is required and patients with atherosclerotic risk factors and elevated troponins may benefit from cardiac imaging. In patients with low pre-test probability for coronary artery disease and elevated troponins, therapy should target management of sepsis and optimisation of myocardial oxygen demand/supply balance.
危重症患者心脏肌钙蛋白升高与医院死亡率增加相关。然而，在患有脓毒症的危重症患者中，结果存在异质性且较难解读。本系统评价的目的是描述脓毒症重症监护患者肌钙蛋白升高的病理生理学、临床相关性及预后意义。通过详细的MEDLINE检索确定文章，并从所选研究中获取其他参考文献。越来越多的临床证据表明，尽管肌钙蛋白是具有预后价值的敏感生物标志物，但它们并非死亡率的独立预测指标。然而，需要警惕冠状动脉疾病的客观证据，有动脉粥样硬化风险因素且肌钙蛋白升高的患者可能从心脏成像中获益。对于冠状动脉疾病预测试验概率低且肌钙蛋白升高的患者，治疗应针对脓毒症的管理以及心肌氧供需平衡的优化。
