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心肌酶诊断重症急性胰腺炎并发心功能不全的临床价值

张一杰1,杨亚鹏2   

  1. 1. 首都医科大学附属北京世纪坛医院
    2. 北京中医药大学附属东直门医院外科
  • 收稿日期:2014-01-20 修回日期:2014-03-07 出版日期:2014-06-15 发布日期:2014-06-15
  • 通讯作者: 张一杰

The diagnostic value of myocardial enzyme on cardiac insufficiency in patients with severe acute pancreatitis

  • Received:2014-01-20 Revised:2014-03-07 Published:2014-06-15 Online:2014-06-15

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摘要： [摘要] 目的 探讨心肌肌钙蛋白I（cTn-I）等心肌酶对诊断重症急性胰腺炎(SAP)并发心功能不全的临床价值。方法 入选我院2008年至2013年收治的50例SAP患者，记录血清cTn-I、肌红蛋白（MYO）、肌酸激酶同工酶MB(CK-MB)、乳酸脱氢酶（LDH）、天冬氨酸氨基转移酶（AST）值。根据临床是否并发心功能不全分为心功能不全组14例和无心功能不全组36例，比较两组间心肌酶的差异，用ROC曲线评价心肌酶水平诊断SAP并发心功能不全敏感性和特异性。同时记录患者的APACHEⅡ评分，并评价心肌酶与APACHEⅡ评分之间的相关性。结果 SAP并发心功能不全组的cTn-I、LDH、 AST水平明显高于无心功能不全组，差异有统计学意义（P ＜0.05）。cTn-I的ROC曲线下面积最大为0.94，其cut-off值为0.07ng/ml，诊断SAP患者并发心功能不全的敏感性和特异性分别为0.857和1.000。LDH、AST的ROC曲线下面积仅为0.762和0.770 。cTn-I与APACHEⅡ评分有很好的相关性（P＜0.05）。结论 心肌酶cTn-I水平的测定，能够很好地预测SAP是否并发心功能不全并反映SAP患者病情的严重程度。

关键词: 重症急性胰腺炎, 心功能不全, 心肌酶, 心肌肌钙蛋白I

Abstract: [Abstract] Objective To explore value of myocardial enzyme， such as cardiac troponin I（cTn-I）, on diagnosis of cardiac insufficiency in patients with severe acute pancreatitis(SAP). Methods Fifty patients with severe acute pancreatitis from emergency, gastroenterology and Intensive Care Unit of our hospital were collected from 2008 to 2013. Serum biochemical markers, such as cTnI, myoglobin (MYO), Creatine kinase MB (CK-MB), lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) were examined, APACHE Ⅱ score was also calculated. All patients were divided into two groups: cardiac insufficiency group and non-cardiac insufficiency group. The values of myocardial enzyme were compared using t test for normally distributed variables and rank-sum test for variables not normally distributed. The sensitivity and specificity of myocardial enzyme for cardiac insufficiency diagnosis in patients with SAP were evaluated using ROC cure. The relationship between myocardial enzyme and APACHE Ⅱ score was assessed by Pearson correlation coefficient. Results The level of cTn-I、LDH and AST in case of cardiac insufficiency group was significantly increased than that in case of non-cardiac insufficiency group（P ＜0.05）. The area under ROC curve for cTn-I was most large (0.940) than that for LDH (0.762) and AST (0.770). With a cut-off value of 0.07ng/ml, the sensitivity and specificity of cTn-I for diagnosing cardiac insufficiency in patients with SAP were 0.857 and 1.000, respectively. cTn-I was positively correlated with APACHE Ⅱ（P＜0.05）. Conclusion Serum cTn-I show the better ability in diagnosis of cardiac insufficiency, and can preferably reflect the severity of SAP.

Key words: severe acute pancreatitis, cardiac insufficiency, myocardial enzyme, cardiac troponin I