中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2012年
15期
27-30
,共4页
时启标%刘继华%贺春荣%郭庆争%高亚平%高超
時啟標%劉繼華%賀春榮%郭慶爭%高亞平%高超
시계표%류계화%하춘영%곽경쟁%고아평%고초
有机磷化合物%中毒%肌酸激酶%肌酸激酶,MB型%肌钙蛋白I
有機燐化閤物%中毒%肌痠激酶%肌痠激酶,MB型%肌鈣蛋白I
유궤린화합물%중독%기산격매%기산격매,MB형%기개단백I
Organophosphorus compounds%Poisoning%Creatine kinase%Creatine kinase,MB form%Troponin I
目的 探讨同步测定血清肌酸激酶同工酶(CK-MB)与肌酸激酶(CK)比值( CK-MB/CK)及心肌肌钙蛋白I(cTnI)在急性有机磷农药中毒(AOPP)中的变化及其在病情判断、评估中的临床价值和意义.方法 对868例无心、肺、脑、肾、肌肉及其他结缔组织疾病史的AOPP患者于中毒后2、12、24、48、96、120 h抽取空腹静脉血4ml同步测定CK、CK-MB及cTnI,计算出CK-MB/CK.其中轻度中毒279例(轻度组),中度中毒289例(中度组),重度中毒300例(重度组),合并发生中毒中间型综合征(IMS) 208例(IMS组),未发生IMS 660例(非IMS组).并与同期288例健康查体者(对照组)比较.结果 (1)中毒后2～ 12、13～24、25 ～ 120 h轻度组、中度组、重度组CK、CK-MB、cTnI显著高于对照组,CK-MB/CK显著低于对照组,差异均有统计学意义(P＜ 0.01)；轻度组、中度组、重度组CK、CK-MB、cTnI、CK-MB/CK组间两两比较差异均有统计学意义(P＜ 0.01或＜0.05).IMS组中毒后2～120 h CK、CK-MB、cTnI显著高于非IMS组,CK-MB/CK显著低于非IMS组,差异均有统计学意义(P＜ 0.05或＜0.01).IMS组心脏猝死发生率23.08％( 48/208),多器官功能障碍综合征(MODS)发生率37.50％(78/208);非IMS组分别为4.24％(28/660)、9.85％(65/660).两组心脏猝死和MODS发生率比较差异均有统计学意义(P＜0.01).(2)对IMS组及非IMS组建立以cTnI(X1)、CK(X2)及CK-MB/CK(X3)为自变量的判别分析方程式:Y=-0.0014X1+ 0.0225X2+ 65.2376X3,F=21.4911,P＜0.01.判别临界值Y0=2.8124.若Y＜2.8124属IMS组,Y≥2.8124属非IMS组.其中各指标的贡献率X1为34.5％,X2为25.4％,X3为40.1％,回代符合率为91.26％.结论 CK-MB/CK 变化与AOPP程度呈负相关,cTnI与AOPP程度呈正相关.CK-MB/CK变化、cTnI可用于协助AOPP 临床分级、病情判断及指导AOPP的急诊、救治和预后评估；利用cTnI、CK及CK-MB/CK所得的函数方程可早期作为IMS和MODS及心脏猝死的有效预报指标.
目的 探討同步測定血清肌痠激酶同工酶(CK-MB)與肌痠激酶(CK)比值( CK-MB/CK)及心肌肌鈣蛋白I(cTnI)在急性有機燐農藥中毒(AOPP)中的變化及其在病情判斷、評估中的臨床價值和意義.方法 對868例無心、肺、腦、腎、肌肉及其他結締組織疾病史的AOPP患者于中毒後2、12、24、48、96、120 h抽取空腹靜脈血4ml同步測定CK、CK-MB及cTnI,計算齣CK-MB/CK.其中輕度中毒279例(輕度組),中度中毒289例(中度組),重度中毒300例(重度組),閤併髮生中毒中間型綜閤徵(IMS) 208例(IMS組),未髮生IMS 660例(非IMS組).併與同期288例健康查體者(對照組)比較.結果 (1)中毒後2～ 12、13～24、25 ～ 120 h輕度組、中度組、重度組CK、CK-MB、cTnI顯著高于對照組,CK-MB/CK顯著低于對照組,差異均有統計學意義(P＜ 0.01)；輕度組、中度組、重度組CK、CK-MB、cTnI、CK-MB/CK組間兩兩比較差異均有統計學意義(P＜ 0.01或＜0.05).IMS組中毒後2～120 h CK、CK-MB、cTnI顯著高于非IMS組,CK-MB/CK顯著低于非IMS組,差異均有統計學意義(P＜ 0.05或＜0.01).IMS組心髒猝死髮生率23.08％( 48/208),多器官功能障礙綜閤徵(MODS)髮生率37.50％(78/208);非IMS組分彆為4.24％(28/660)、9.85％(65/660).兩組心髒猝死和MODS髮生率比較差異均有統計學意義(P＜0.01).(2)對IMS組及非IMS組建立以cTnI(X1)、CK(X2)及CK-MB/CK(X3)為自變量的判彆分析方程式:Y=-0.0014X1+ 0.0225X2+ 65.2376X3,F=21.4911,P＜0.01.判彆臨界值Y0=2.8124.若Y＜2.8124屬IMS組,Y≥2.8124屬非IMS組.其中各指標的貢獻率X1為34.5％,X2為25.4％,X3為40.1％,迴代符閤率為91.26％.結論 CK-MB/CK 變化與AOPP程度呈負相關,cTnI與AOPP程度呈正相關.CK-MB/CK變化、cTnI可用于協助AOPP 臨床分級、病情判斷及指導AOPP的急診、救治和預後評估；利用cTnI、CK及CK-MB/CK所得的函數方程可早期作為IMS和MODS及心髒猝死的有效預報指標.
목적 탐토동보측정혈청기산격매동공매(CK-MB)여기산격매(CK)비치( CK-MB/CK)급심기기개단백I(cTnI)재급성유궤린농약중독(AOPP)중적변화급기재병정판단、평고중적림상개치화의의.방법 대868례무심、폐、뇌、신、기육급기타결체조직질병사적AOPP환자우중독후2、12、24、48、96、120 h추취공복정맥혈4ml동보측정CK、CK-MB급cTnI,계산출CK-MB/CK.기중경도중독279례(경도조),중도중독289례(중도조),중도중독300례(중도조),합병발생중독중간형종합정(IMS) 208례(IMS조),미발생IMS 660례(비IMS조).병여동기288례건강사체자(대조조)비교.결과 (1)중독후2～ 12、13～24、25 ～ 120 h경도조、중도조、중도조CK、CK-MB、cTnI현저고우대조조,CK-MB/CK현저저우대조조,차이균유통계학의의(P＜ 0.01)；경도조、중도조、중도조CK、CK-MB、cTnI、CK-MB/CK조간량량비교차이균유통계학의의(P＜ 0.01혹＜0.05).IMS조중독후2～120 h CK、CK-MB、cTnI현저고우비IMS조,CK-MB/CK현저저우비IMS조,차이균유통계학의의(P＜ 0.05혹＜0.01).IMS조심장졸사발생솔23.08％( 48/208),다기관공능장애종합정(MODS)발생솔37.50％(78/208);비IMS조분별위4.24％(28/660)、9.85％(65/660).량조심장졸사화MODS발생솔비교차이균유통계학의의(P＜0.01).(2)대IMS조급비IMS조건립이cTnI(X1)、CK(X2)급CK-MB/CK(X3)위자변량적판별분석방정식:Y=-0.0014X1+ 0.0225X2+ 65.2376X3,F=21.4911,P＜0.01.판별림계치Y0=2.8124.약Y＜2.8124속IMS조,Y≥2.8124속비IMS조.기중각지표적공헌솔X1위34.5％,X2위25.4％,X3위40.1％,회대부합솔위91.26％.결론 CK-MB/CK 변화여AOPP정도정부상관,cTnI여AOPP정도정정상관.CK-MB/CK변화、cTnI가용우협조AOPP 림상분급、병정판단급지도AOPP적급진、구치화예후평고；이용cTnI、CK급CK-MB/CK소득적함수방정가조기작위IMS화MODS급심장졸사적유효예보지표.
Objective To investigate the changes of serum creatine kinase isoenzyme (CK-MB) and creatine kinase (CK) ratio(CK-MB/CK) and cardiac troponin I(cTnI) simultaneously in patients with acute organophosphorus pesticide poisoning (AOPP) and the clinical value in disease condition judgment.Methods Eight hundred and sixty-eight AOPP patients without disease history of heart,lung,brain,kidney,muscle and other connective tissue were extracted 4 ml of fasting venous blood to determine CK,CK-MB and cTnI simultaneously at 2,12,24,48,96 and 120 hours after poisoning,and the CK-MB/CK was calculated.There were 279 mild poisoning cases (mild poisoning group),289 moderate poisoning cases (moderate poisoning group) and 300 severe poisoning group (severe poisoning group) ; and 208 cases with intermediate myasthenia syndrome (IMS)(IMS group) and 660 cases without IMS (non-IMS group).The result was compared with 288 healthy people (control group) in the same period.Results ( 1 ) The CK,CK-MB and cTnI of mild,moderate and severe poisoning groups between 2 to 12 h,13 to 24 h,25 to 120 h after poisoning were significandy higher than those in control group,CK-MB/CK was obviously lower (P ＜ 0.01 ).The CK,CK-MB,cTnI and CK-MB/CK had significant differences between each two of mild,moderate and severe poisoning groups (P＜ 0.01 or ＜ 0.05).The CK,CK-MB and cTnI of IMS group in 2 to120 h after poisoning were significantly higher than those in non-IMS group,and CK-MB/CK was lower (P ＜ 0.05 or ＜ 0.01 ).In IMS group,the rates of sudden cardiac death (SCD) and multiple organ dysfunction syndrome (MODS) were 23.08％(48/208),37.50％(78/208) respectively,while 4.24％(28/660),9.85％(65/660) in non-IMS group.The incidence of SCD and MODS of two groups had statistical significance (P ＜ 0.01 ).(2) According to IMS and non-IMS group,discriminant equation with independent variables of cTnI (X1), CK (X2) and CK-MB/CK (X3) was established:Y =-0.0014X1 + 0.0225X2 + 65.2376X3,F=21.4911,P ＜ 0.01.The discriminant critical value(Y0) was 2.8124.If Y ＜ 2.8124 belonged to IMS group and Y ≥2.8124 was in non-IMS group,the contribution rates of X1,X2 and X3 were 34.5％,25.4％ and 40.1％ respectively.The coincident rate of return was 91.26％.Conclusions CK-MB/CK change has negative correlation with poisoning degree of AOPP;cTnI level is positively correlated with AOPP poisoning degree.they may be used to assist the clinical classification,disease judgement and to guide the emergency,treatment and prognosis assessment of AOPP.The function equation with cTnI,CK and CK-MB/CK can be used as effective prediction indexes of IMS,MODS and SCD in early period.
