中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2010年
11期
724-727
,共4页
肌钙蛋白Ⅰ%预后%病死率
肌鈣蛋白Ⅰ%預後%病死率
기개단백Ⅰ%예후%병사솔
Cardiac troponin Ⅰ (CTN Ⅰ)%Prognosis%Mortality
目的 探讨肌钙蛋白Ⅰ(CTN Ⅰ)能否预测非心源性危重患者的28 d病死率. 方法 选取2006年10月20日至2007年10月20日北京朝阳医院431例急诊室非心源性危重患者,测量血中CTN Ⅰ浓度,记录各项生化指标并计算APACHE Ⅱ评分.随访28 d,记录患者是否存活,进一步分析人选时CTN Ⅰ水平与28 d病死率的关系. 结果 共200例患者CTN Ⅰ水平升高,与CTN Ⅰ水平正常组比较,CTN Ⅰ升高组患者的28 d病死率更高.CTN Ⅰ水平预测28 d死亡率的ROC曲线下面积是0.733,预测患者死亡率的最佳界值点是0.05 ng/L.多因素回归分析表明CTN Ⅰ升高>0.05 ng/L(HR 1.979,95%CI 1.398～2.802,P<0.001)、APACHE Ⅱ评分升高>16(HR 4.428,95%CI 3.019～6.494,P<0.001)、血浆白蛋白水平降低<25 g/L(HR 1.812,95%CI 1.276～2.573,P=0.001)是预测患者28 d死亡率的独立危险因素.进一步分析表明,CTN Ⅰ与APACHE Ⅱ评分均升高的患者28 d病死率最高. 结论 急诊非心源性危重患者的CTN Ⅰ水平升高是其28 d病死率的独立预测因子,同时CTN Ⅱ联合APACHE Ⅱ评分对于此类患者的预后有协同作用.
目的 探討肌鈣蛋白Ⅰ(CTN Ⅰ)能否預測非心源性危重患者的28 d病死率. 方法 選取2006年10月20日至2007年10月20日北京朝暘醫院431例急診室非心源性危重患者,測量血中CTN Ⅰ濃度,記錄各項生化指標併計算APACHE Ⅱ評分.隨訪28 d,記錄患者是否存活,進一步分析人選時CTN Ⅰ水平與28 d病死率的關繫. 結果 共200例患者CTN Ⅰ水平升高,與CTN Ⅰ水平正常組比較,CTN Ⅰ升高組患者的28 d病死率更高.CTN Ⅰ水平預測28 d死亡率的ROC麯線下麵積是0.733,預測患者死亡率的最佳界值點是0.05 ng/L.多因素迴歸分析錶明CTN Ⅰ升高>0.05 ng/L(HR 1.979,95%CI 1.398～2.802,P<0.001)、APACHE Ⅱ評分升高>16(HR 4.428,95%CI 3.019～6.494,P<0.001)、血漿白蛋白水平降低<25 g/L(HR 1.812,95%CI 1.276～2.573,P=0.001)是預測患者28 d死亡率的獨立危險因素.進一步分析錶明,CTN Ⅰ與APACHE Ⅱ評分均升高的患者28 d病死率最高. 結論 急診非心源性危重患者的CTN Ⅰ水平升高是其28 d病死率的獨立預測因子,同時CTN Ⅱ聯閤APACHE Ⅱ評分對于此類患者的預後有協同作用.
목적 탐토기개단백Ⅰ(CTN Ⅰ)능부예측비심원성위중환자적28 d병사솔. 방법 선취2006년10월20일지2007년10월20일북경조양의원431례급진실비심원성위중환자,측량혈중CTN Ⅰ농도,기록각항생화지표병계산APACHE Ⅱ평분.수방28 d,기록환자시부존활,진일보분석인선시CTN Ⅰ수평여28 d병사솔적관계. 결과 공200례환자CTN Ⅰ수평승고,여CTN Ⅰ수평정상조비교,CTN Ⅰ승고조환자적28 d병사솔경고.CTN Ⅰ수평예측28 d사망솔적ROC곡선하면적시0.733,예측환자사망솔적최가계치점시0.05 ng/L.다인소회귀분석표명CTN Ⅰ승고>0.05 ng/L(HR 1.979,95%CI 1.398～2.802,P<0.001)、APACHE Ⅱ평분승고>16(HR 4.428,95%CI 3.019～6.494,P<0.001)、혈장백단백수평강저<25 g/L(HR 1.812,95%CI 1.276～2.573,P=0.001)시예측환자28 d사망솔적독립위험인소.진일보분석표명,CTN Ⅰ여APACHE Ⅱ평분균승고적환자28 d병사솔최고. 결론 급진비심원성위중환자적CTN Ⅰ수평승고시기28 d병사솔적독립예측인자,동시CTN Ⅱ연합APACHE Ⅱ평분대우차류환자적예후유협동작용.
Objective To investigate the role of cardiac troponin Ⅰ (CTN Ⅰ) for predicting 28-day mortality of non-cardiogenic critically ill patients at emergency department (ED). Methods A total of 431 non-cardiogenic critically ill patients at ED were prospectively enrolled and blood samples obtained for CTN Ⅰ measurements. A variety of laboratory variables and the Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ scores were recorded. At Day 28, the survival status of each patient was ascertained and the association between CTN Ⅰ at presentation and mortality assessed. Results Two hundred patients had elevated CTN Ⅰ levels and 231 had normal levels. Compared with those with normal levels, the patients with elevated CTN Ⅰ levels had a higher 28-day mortality. The CTN Ⅰ concentration alone had an area under the receiver operating characteristic curve (AUC) of 0.733 for mortality prediction. The optimal CTN Ⅰ cut-off point for predicting the 28-day mortality was 0.05 ng/L By multivariate analysis, an elevated CTN Ⅰ level(>0.05 ng/L, HR 1.979,95% CI 1.398-2.802, P <0.001), a high APACHE Ⅱ score(> 16, HR 4. 428,95% CI 3.019-6.494, P < 0.001) and hypoalbuminemia (< 25 g/L, HR 1.812, 95% CI 1.276-2.573, P = 0.001)were the three most important independent predictors for a shorter survival. Combination analysis showed a shorter survival in patients with a high APACHE Ⅱ score plus elevated CTN Ⅰ levels than those with a high APACHE Ⅱ score or an elevated CTN Ⅰ level alone. Conclusion An elevated serum CTN Ⅰ level is a independent predictor of 28-day mortality in non-cardiogenic critically ill patients. And CTN Ⅰ level and APACHE Ⅱ score have an additive effect in outcome prediction.
