Department of Pediatrics, SATH, Govt. Medical College, Thiruvananthapuram, Kerala, 695011, India.
Department of Pediatric Cardiology, SATH, Govt. Medical College, Thiruvananthapuram, Kerala, India.
Indian J Pediatr. 2018 Oct;85(10):877-884. doi: 10.1007/s12098-018-2667-3. Epub 2018 Apr 14.
To describe the diagnostic test properties of Cardiac Troponin-T (cTnT) in predicting myocardial dysfunction in asphyxiated term neonates by taking echocardiography as the gold standard and to establish the optimum cut-off values of cTnT for myocardial dysfunction, shock, severe hypoxic ischemic encephalopathy (HIE) and mortality by receiver operator characteristic (ROC) curve analysis.
This was a prospective study based on diagnostic test evaluation. The study included 120 term asphyxiated neonates in a tertiary care neonatal intensive care unit (NICU) in Southern India from June 2011 through June 2015. All the neonates were clinically evaluated. Venous blood was taken at 4 h of life for cTnT estimation. Echocardiography was done within 24 h of birth.
The mean cTnT level of asphyxiated term neonates was 0.207±0.289 ng/ml (mean ± SD). Asphyxiated neonates with myocardial dysfunction had higher cTnT levels (0.277±0.231) as compared to those without myocardial dysfunction (0.061±0.036, p = 0.0001). Using ROC curve, the cut-off cTnT values for myocardial dysfunction was 0.1145 ng/ml with sensitivity 92.4% and specificity 94.1%. Cardiac Troponin-T levels were significantly higher among asphyxiated neonates with shock (0.378±0.348, p = 0.0001) and the levels also correlated positively with increasing grades of HIE. The cut-off cTnT value for mortality was 0.2505 ng/ml with sensitivity 83.9% and specificity 96.6%.
In asphyxiated term neonates, early cTnT elevation is a marker for predicting myocardial dysfunction and elevated cTnT levels had high sensitivity and specificity. There was significant relation with increasing cTnT values and increasing grades of HIE.
通过以超声心动图为金标准，描述心脏肌钙蛋白 T（cTnT）在预测窒息足月新生儿心功能障碍方面的诊断试验特性，并通过接受者操作特征（ROC）曲线分析建立 cTnT 用于预测心功能障碍、休克、严重缺氧缺血性脑病（HIE）和死亡率的最佳截断值。
这是一项基于诊断试验评估的前瞻性研究。该研究纳入了 2011 年 6 月至 2015 年 6 月在印度南部一家三级新生儿重症监护病房（NICU）的 120 例窒息足月新生儿。所有新生儿均进行临床评估。在出生后 4 小时内采集静脉血以检测 cTnT 水平。在出生后 24 小时内进行超声心动图检查。
窒息足月新生儿的平均 cTnT 水平为 0.207±0.289ng/ml（均值±标准差）。与无心功能障碍的窒息新生儿相比，有心功能障碍的窒息新生儿的 cTnT 水平更高（0.277±0.231，p=0.0001）。使用 ROC 曲线，cTnT 用于诊断心功能障碍的截断值为 0.1145ng/ml，敏感性为 92.4%，特异性为 94.1%。在伴有休克的窒息新生儿中，cTnT 水平明显更高（0.378±0.348，p=0.0001），且水平与 HIE 分级的增加呈正相关。用于预测死亡率的 cTnT 截断值为 0.2505ng/ml，敏感性为 83.9%，特异性为 96.6%。
在窒息足月新生儿中，早期 cTnT 升高是预测心功能障碍的标志物，且 cTnT 水平升高具有较高的敏感性和特异性。cTnT 值与 HIE 分级的增加呈显著正相关。
