Spies C, Haude V, Fitzner R, Schröder K, Overbeck M, Runkel N, Schaffartzik W
Department of Anesthesiology and Operative Intensive Care Medicine, Universitaetsklinikum Benjamin Franklin, Freie Universitaet Berlin, Germany.
Chest. 1998 Apr;113(4):1055-63. doi: 10.1378/chest.113.4.1055.
Sepsis is the leading cause of death in the noncardiologic ICU. Maldistributed nutritive blood flow and altered convective and diffusive oxygen transport during sepsis can lead to organ dysfunction and multiple organ failure. One of the causes of myocardial dysfunction is thought to be myocardial ischemia in sepsis; however, conventional biochemical parameters to detect myocardial ischemia lack sensitivity and specificity. Serum cardiac troponin T (S-TnT) was reported to have higher sensitivity and specificity in diagnosing minor myocardial injury. The aim of this study was to investigate if and how often S-TnT is pathologically elevated in patients with sepsis and to evaluate whether S-TnT might be a prognostic marker in early sepsis.
Prospective study.
Surgical ICU.
Twenty-six patients with sepsis were included in this study within 24 h of the onset of sepsis. The patients were allocated a priori to a high S-TnT group (S-TnT > or = 0.2 microg/L) and a low S-TnT group (S-TnT<0.2 microg/L).
Blood samples for the determination of S-TnT and conventional myocardial ischemia markers as well as for adhesion molecules were drawn. Hemodynamic measurements were performed every 4 h during the first 24 h and then once per day over 7 days. S-TnT was determined by enzyme-linked immunosorbent sandwich assay.
Eighteen patients had pathologically high S-TnT values. High S-TnT values were associated with an increased mortality rate (15/18 in the high S-TnT group vs 3/8 in the low S-TnT group; p=0.02). Significant differences between the two groups were found in the norepinephrine dosages at maximum values of S-TnT. Soluble intercellular adhesion molecule-1 was significantly elevated in the high S-TnT group.
As high S-TnT values were associated with an increased mortality rate, it seems reasonable to further evaluate S-TnT as a prognostic marker of myocardial ischemia in patients with sepsis under different therapeutic regimens.
脓毒症是非心脏重症监护病房（ICU）死亡的主要原因。脓毒症期间营养血流分布不均以及对流和扩散性氧转运改变可导致器官功能障碍和多器官衰竭。心肌功能障碍的原因之一被认为是脓毒症中的心肌缺血；然而，用于检测心肌缺血的传统生化参数缺乏敏感性和特异性。据报道，血清心肌肌钙蛋白T（S-TnT）在诊断轻度心肌损伤方面具有更高的敏感性和特异性。本研究的目的是调查脓毒症患者中S-TnT病理性升高的情况及频率，并评估S-TnT是否可能是早期脓毒症的预后标志物。
前瞻性研究。
外科ICU。
26例脓毒症患者在脓毒症发作后24小时内纳入本研究。患者被预先分为高S-TnT组（S-TnT≥0.2μg/L）和低S-TnT组（S-TnT<0.2μg/L）。
采集用于测定S-TnT、传统心肌缺血标志物以及黏附分子的血样。在最初24小时内每4小时进行一次血流动力学测量，然后在7天内每天进行一次。S-TnT通过酶联免疫吸附夹心测定法测定。
18例患者的S-TnT值病理性升高。高S-TnT值与死亡率增加相关（高S-TnT组15/18例，低S-TnT组3/8例；p=0.02）。在S-TnT最大值时，两组去甲肾上腺素剂量存在显著差异。高S-TnT组可溶性细胞间黏附分子-1显著升高。
由于高S-TnT值与死亡率增加相关，进一步评估S-TnT作为不同治疗方案下脓毒症患者心肌缺血的预后标志物似乎是合理的。
