中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2014年
12期
2234-2237
,共4页
胡鹏%朱庆祝%林涛%程庆荣
鬍鵬%硃慶祝%林濤%程慶榮
호붕%주경축%림도%정경영
有机磷化合物%中毒%肌钙蛋白I%心肌酶谱%脑钠肽前体
有機燐化閤物%中毒%肌鈣蛋白I%心肌酶譜%腦鈉肽前體
유궤린화합물%중독%기개단백I%심기매보%뇌납태전체
Organophosphorus compounds%Poisoning%Troponin I%Myocardium zymogram%N-Terminal pro-brain natriuretic peptide
目的：探讨脑钠肽前体（NT-proBNP）及肌钙蛋白I（cTnI）在老年急性有机磷农药中毒（AOPP）心肌损伤中的变化及病情判断、评估中的临床价值。方法102例老年患者按入院时中毒的程度分为轻度中毒24例（轻度组），中度中毒38例（中度组），重度中毒40例（重度组）。于患者入院后4 h、3 d、7 d抽取静脉血4 ml，同步测定NT-proBNP、cTnI、肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）值，与同期40例健康查体者（对照组）比较；合并发生中间型综合征（IMS）33例（IMS组），未发生IMS 69例（非IMS组），比较对照组、IMS组和非IMS组血清各项指标水平及心电监护情况。结果中、重度组老年AOPP患者的血清NT-proBNP、cTnI、CK、CK-MB较对照组显著升高（P＜0.05），且随中毒程度和病情加重而升高，各组间两两比较差异均有统计学意义（P＜0.05），血清NT-proBNP的敏感性和特异性均高于cTnI、心肌酶谱。IMS组入院后4 h内检测值显著高于非IMS组，差异均有统计学意义（P＜0.05）；IMS组较非IMS组出现心电图异常的比例更高。结论老年 AOPP 患者中毒越重，血清 cTnI、NT-proBNP 升高越显著，血清 NT-proBNP检测可以更详细地反映心肌的损害程度，早期联合检测可以更好地协助老年AOPP临床分级、病情判断、指导救治和预后评估。
目的：探討腦鈉肽前體（NT-proBNP）及肌鈣蛋白I（cTnI）在老年急性有機燐農藥中毒（AOPP）心肌損傷中的變化及病情判斷、評估中的臨床價值。方法102例老年患者按入院時中毒的程度分為輕度中毒24例（輕度組），中度中毒38例（中度組），重度中毒40例（重度組）。于患者入院後4 h、3 d、7 d抽取靜脈血4 ml，同步測定NT-proBNP、cTnI、肌痠激酶（CK）、肌痠激酶同工酶（CK-MB）值，與同期40例健康查體者（對照組）比較；閤併髮生中間型綜閤徵（IMS）33例（IMS組），未髮生IMS 69例（非IMS組），比較對照組、IMS組和非IMS組血清各項指標水平及心電鑑護情況。結果中、重度組老年AOPP患者的血清NT-proBNP、cTnI、CK、CK-MB較對照組顯著升高（P＜0.05），且隨中毒程度和病情加重而升高，各組間兩兩比較差異均有統計學意義（P＜0.05），血清NT-proBNP的敏感性和特異性均高于cTnI、心肌酶譜。IMS組入院後4 h內檢測值顯著高于非IMS組，差異均有統計學意義（P＜0.05）；IMS組較非IMS組齣現心電圖異常的比例更高。結論老年 AOPP 患者中毒越重，血清 cTnI、NT-proBNP 升高越顯著，血清 NT-proBNP檢測可以更詳細地反映心肌的損害程度，早期聯閤檢測可以更好地協助老年AOPP臨床分級、病情判斷、指導救治和預後評估。
목적：탐토뇌납태전체（NT-proBNP）급기개단백I（cTnI）재노년급성유궤린농약중독（AOPP）심기손상중적변화급병정판단、평고중적림상개치。방법102례노년환자안입원시중독적정도분위경도중독24례（경도조），중도중독38례（중도조），중도중독40례（중도조）。우환자입원후4 h、3 d、7 d추취정맥혈4 ml，동보측정NT-proBNP、cTnI、기산격매（CK）、기산격매동공매（CK-MB）치，여동기40례건강사체자（대조조）비교；합병발생중간형종합정（IMS）33례（IMS조），미발생IMS 69례（비IMS조），비교대조조、IMS조화비IMS조혈청각항지표수평급심전감호정황。결과중、중도조노년AOPP환자적혈청NT-proBNP、cTnI、CK、CK-MB교대조조현저승고（P＜0.05），차수중독정도화병정가중이승고，각조간량량비교차이균유통계학의의（P＜0.05），혈청NT-proBNP적민감성화특이성균고우cTnI、심기매보。IMS조입원후4 h내검측치현저고우비IMS조，차이균유통계학의의（P＜0.05）；IMS조교비IMS조출현심전도이상적비례경고。결론노년 AOPP 환자중독월중，혈청 cTnI、NT-proBNP 승고월현저，혈청 NT-proBNP검측가이경상세지반영심기적손해정도，조기연합검측가이경호지협조노년AOPP림상분급、병정판단、지도구치화예후평고。
Objective To investigate the changes significance of N-terminal pro-brain natriuretic peptide and cardiac troponin I simultaneously in the myocardium damage of elderly acute organophosphate poisoning patients and the clinical value in disease condition judgment.Methods 102 older acute organophosphate poisoning patients were divided into three groups according to the degree of poisoning on admission: mild poisoning 24 cases (mild), moderate poisoning 38 cases (moderate) and severe poisoning 40 cases(severe). All patients were extracted 4 ml of venous blood to determine CK, CK-MB, cTnI and NT-proBNP simultaneously at 4 h, 3 d and 7 d after poisoning. The result was compared with 40 healthy people(control group) in the same period.33 cases with intermediate myasthenia syndrome(IMS)(IMS group) and 69 cases without IMS(non-IMS group). Comparing the control group, the IMS and the non-IMS group, serum levels of the indicators and the status of ecg monitoring.ResultsThe CK, CK-MB, cTnI and NT-proBNP of moderate and severe poisoning groups after poisoning were significantly higher than those in control group(P<0.05), and rise with the poisoning degree and became seriously ill. Both two comparative differences between groups have statistical significance. The sensitivity and specificity of NT- proBNP were higher than in serum cTnI. The value of IMS group within 4 h after poisoning were significantly higher than those in non-IMS group, the differences were statistically significant (P<0.05). In IMS group, the rates of abnormal electrocardiogram (ECG) were higher. Conclusions Serum cTnI, NT- proBNP increase with the degree of AOPP. Serum NT-proBNP can reflect the degree of myocardial damage in more detail. Early joint detection maybe better to assist the elderly AOPP clinical classification, disease judgement and to guide the treatment and prognosis evaluation.
