Liu X T, Wang L, Chen J, Qi H N, Ma G Y
Hengshui People's Hospital EICU, Hengshui 053000, China.
Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2020 Apr 20;38(4):241-245. doi: 10.3760/cma.j.cn121094-20190529-00215.
To investigate the value of high-sensitivity cardiac troponin I (hs-cTnI) and soluble suppression of tumorigenicity 2 (sST2) in predicting cardiac complications of severe acute organophosphorus pesticide poisoning (SAOPP) . All 274 SAOPP patients from September 2014 to February 2019 were selected. According to the results of hs-cTnI detection, the patients were divided into non-elevated troponin group (78 cases) and troponin elevation group (196 cases) at 1 hour after admission. 3 days after admission, there were 109 cases of complication and 165 cases of non-complication according to the presence or absence of cardiac complications. The changes of hs-cTnI, sST2, N-terminal B-type brain natriuretic peptide (NT proBNP) , acute physiology and chronic health (APACHE-Ⅱ) , cholinesterase activity, left ventricular ejection fraction (LVEF) , short axis shortening rate (FS) were observed and analyzed. The predictive value of hs-cTnI and sST2 were evaluated by receiver operating characteristic curve (ROC) analysis. The sST2 level in patients with troponin elevation group was significantly higher than that in non-elevated troponin group (<0.05) . Compared with the non-complication and non-elevated troponin group, the patients with non-complication and troponin elevation group had elevated hs-cTnI, sST2 and decreased cholinesterase (<0.05) . Compared with other groups, the hs-cTnI, sST2, NT-proBNP, and APACHE-Ⅱ scores in the complication and troponin elevation group were significantly increased, and cholinesterase was significantly reduced (<0.05) . In the non-complication group, LVEF and FS were in the normal range, and there was no significant difference between the groups (>0.05) . Compared with other groups, the LVEF and FS of patients with elevated troponin in the complications group were significantly decreased (<0.05) . Correlation analysis showed that hs-cTnI and sST2 were positively correlated in patients with SAOPP complications (=0.725, <0.01) . hs-cTnI, sST2 and APACHE-Ⅱ scores were positively correlated in the complications group (=0.846, 0.885, <0.01) . ROC results showed that the areas under the curve for predicting SAOPP secondary heart damage of hs-cTnI (1 hour after admission) and sST2 (3 days after admission) were 0.945 and 0.833, respectively. hs-cTnI and sST2 may have important clinical value in the early diagnosis and prognosis evaluation of patients with SAOPP secondary cardiac damage.
探讨高敏心肌肌钙蛋白I（hs-cTnI）和可溶性肿瘤抑制因子2（sST2）在预测重度急性有机磷农药中毒（SAOPP）心脏并发症中的价值。选取2014年9月至2019年2月期间的274例SAOPP患者。根据hs-cTnI检测结果，将患者入院1小时后分为肌钙蛋白未升高组（78例）和肌钙蛋白升高组（196例）。入院3天后，根据是否发生心脏并发症分为并发症109例和无并发症165例。观察并分析hs-cTnI、sST2、N末端B型脑钠肽（NT proBNP）、急性生理与慢性健康状况评分系统（APACHE-Ⅱ）、胆碱酯酶活性、左心室射血分数（LVEF）、短轴缩短率（FS）的变化。采用受试者工作特征曲线（ROC）分析评估hs-cTnI和sST2的预测价值。肌钙蛋白升高组患者的sST2水平显著高于肌钙蛋白未升高组（<0.05）。与无并发症且肌钙蛋白未升高组相比，无并发症且肌钙蛋白升高组患者的hs-cTnI、sST2升高，胆碱酯酶降低（<0.05）。与其他组相比，并发症且肌钙蛋白升高组的hs-cTnI、sST2、NT-proBNP和APACHE-Ⅱ评分显著升高，胆碱酯酶显著降低（<0.05）。在无并发症组中，LVEF和FS在正常范围内，组间差异无统计学意义（>0.05）。与其他组相比，并发症组中肌钙蛋白升高患者的LVEF和FS显著降低（<0.05）。相关性分析显示，SAOPP并发症患者中hs-cTnI与sST2呈正相关（=0.725，<0.0）。并发症组中hs-cTnI、sST2与APACHE-Ⅱ评分呈正相关（=0.846、0.885，<0.01）。ROC结果显示，hs-cTnI（入院1小时）和sST（入院3天）预测SAOPP继发性心脏损害的曲线下面积分别为0.945和0.833。hs-cTnI和sST2在SAOPP继发性心脏损害患者的早期诊断和预后评估中可能具有重要临床价值。
