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目的探讨血清肌钙蛋白I(cTnI)水平与肺栓塞危险性和近期预后的关系。方法选择根据临床表现及螺旋CT诊断的急性肺栓塞病人30例,按照外周血cTnI水平,分为cTnI阳性组与阴性组。比较两组患者临床特征、右室受累程度及近期预后的不同。同时,分析阳性组中5例具有较完整的动态观察cTnI的患者资料,观察cTnI在急性肺栓塞病程中表达水平的动态变化。结果30例急性肺栓塞中,12例cTnI增高(1.53±0.46ng/ml),18例cTnI正常(<0.1ng/ml)。cTnI阳性组中9例(75%)右室增大,而阴性组仅4例(22%),P<0.05;阳性组肺动脉压力(60±12mmHg)显著高于阴性组(44±7mmHg,P<0.05);危重并发症(严重低氧血症、心源性休克)在cTnI阳性组明显增加(33%:6%,P<0.05)。动态观察cTnI,发现高峰出现在发病后第4h,持续时间超过5d。结论急性肺栓塞血清cTnI增高患者合并右室功能衰竭及心源性休克的危险性增加,血清cTnI对评价急性肺栓塞的早期危险性及近期预后有重要意义。
Objective To investigate the relationship between serum troponin I (cTnI) level and the risk of pulmonary embolism and its prognosis. Methods Thirty patients with acute pulmonary embolism diagnosed according to clinical manifestations and spiral CT were divided into cTnI positive group and negative group according to the level of cTnI in peripheral blood. The clinical characteristics, the degree of right ventricular involvement, and the recent prognosis were compared between the two groups. At the same time, we analyzed the data of 5 patients with positive cTnI in the positive group and observed the dynamic changes of cTnI in the course of acute pulmonary embolism. Results Among 30 acute pulmonary embolism cases, cTnI was increased in 12 cases (1.53 ± 0.46ng / ml) and normal cTnI in 18 cases (<0.1ng / ml). In the cTnI positive group, 9 patients (75%) had right ventricular enlargement, while only 4 patients (22%) in the negative group, P <0.05; pulmonary arterial pressure (60 ± 12mmHg) in the positive group was significantly higher than that in the negative group (44 ± 7mmHg, P <0.05). Serious complications (severe hypoxemia and cardiogenic shock) were significantly increased in cTnI positive patients (33% vs 6%, P <0.05). Dynamic observation of cTnI found peak at 4h after onset, lasting more than 5d. Conclusions The risk of right ventricular failure and cardiogenic shock is increased in patients with elevated serum cTnI of acute pulmonary embolism. Serum cTnI is of great importance in evaluating the early risk and prognosis of acute pulmonary embolism.