CAJ | 학술논문

重症急性胰腺炎%心功能不全%心肌酶%心肌肌钙蛋白I%乳酸脱氢酶%天冬氨酸转氨酶%肌红蛋白%肌酸激酶MB型%急性病生理学和长期健康评价重癥急性胰腺炎%心功能不全%心肌酶%心肌肌鈣蛋白I%乳痠脫氫酶%天鼕氨痠轉氨酶%肌紅蛋白%肌痠激酶MB型%急性病生理學和長期健康評價
중증급성이선염%심공능불전%심기매%심기기개단백I%유산탈경매%천동안산전안매%기홍단백%기산격매MB형%급성병생이학화장기건강평개
severe acute pancreatitis%cardiac insufficiency%myocardial enzyme%cardiac troponin I%lactate dehydro-genases%aspartate aminotransferases%myoglobin%creatine kinase,MB form%APACHE

目的：探讨心肌酶对重症急性胰腺炎(SAP)并发心功能不全的诊断价值。方法将50例SAP患者按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，测量血清心肌肌钙蛋白I（cTnI）、肌红蛋白（MYO）、肌酸激酶MB型(CK-MB)、乳酸脱氢酶（LDH）、天冬氨酸转氨酶（AST），用ROC曲线评价心肌酶诊断SAP并发心功能不全的敏感性和特异性。记录患者的急性病生理学和长期健康评价（APACHE）Ⅱ分值，并评价心肌酶与APACHEⅡ评分之间的相关性。结果心功能不全组cTnI、LDH、AST水平均明显高于无心功能不全组（P＜0.05）， MYO、CK-MB与无心功能不全组差异无统计学意义。cTnI的ROC曲线下面积最大为0.940，cut-off值为0.07μg/L，敏感性和特异性分别为0.857和1.000。LDH、AST的ROC曲线下面积大于0.7，但LDH诊断敏感性仅为0.571，AST的特异性仅为0.778。MYO、CK-MB的ROC曲线下面积小于0.7。APACHEⅡ评分与心肌酶中cTnI、CK-MB、LDH呈正相关（r分别为0.639、0.451、0.552，均P＜0.05）。结论心肌酶cTnI可作为诊断SAP患者是否并发心功能不全的评价指标，并可反映SAP病情的严重程度。
목적：탐토심기매대중증급성이선염(SAP)병발심공능불전적진단개치。방법장50례SAP환자안시부병발심공능불전분위심공능불전조14례화무심공능불전조36례，측량혈청심기기개단백I（cTnI）、기홍단백（MYO）、기산격매MB형(CK-MB)、유산탈경매（LDH）、천동안산전안매（AST），용ROC곡선평개심기매진단SAP병발심공능불전적민감성화특이성。기록환자적급성병생이학화장기건강평개（APACHE）Ⅱ분치，병평개심기매여APACHEⅡ평분지간적상관성。결과심공능불전조cTnI、LDH、AST수평균명현고우무심공능불전조（P＜0.05）， MYO、CK-MB여무심공능불전조차이무통계학의의。cTnI적ROC곡선하면적최대위0.940，cut-off치위0.07μg/L，민감성화특이성분별위0.857화1.000。LDH、AST적ROC곡선하면적대우0.7，단LDH진단민감성부위0.571，AST적특이성부위0.778。MYO、CK-MB적ROC곡선하면적소우0.7。APACHEⅡ평분여심기매중cTnI、CK-MB、LDH정정상관（r분별위0.639、0.451、0.552，균P＜0.05）。결론심기매cTnI가작위진단SAP환자시부병발심공능불전적평개지표，병가반영SAP병정적엄중정도。
Objective To explore the clinical value of myocardial enzyme on diagnosis of cardiac insufficiency in patients with severe acute pancreatitis (SAP). Methods Fifty patients with SAP were classified as cardiac insufficiency group (n=14) and non-cardiac insufficiency group (n=36). The serum biochemical markers, such as cardiac troponin I (cTnI), myoglobin (MYO), creatine kinase, MB form (CK-MB), lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) were examined in two groups. ROC curve was used to evaluate the diagnostic sensitivity and specificity for cardiac insuffi-ciency using myocardial enzyme. The APACHEⅡscore was also calculated. The relationship between myocardial enzyme and APACHEⅡscore was analyzed in two groups. Results The levels of cTnI, LDH and AST were significantly increased in cardiac insufficiency group than those in non-cardiac insufficiency group (P<0.05). There were no significant differences in MYO and CK-MB between two groups of patients. The area under ROC curve for cTnI was 0.940, with a cut-off value of 0.07μg/L. The sensitivity and specificity of cTnI for diagnosing cardiac insufficiency in patients with SAP were 0.857 and 1.000, respectively. The area under ROC curve for LDH and AST was more than 0.7, with the low sensitivity for LDH (0.571) and the specificity for AST (0.778). The area under ROC curve for MYO and CK-MB was less than 0.7. APACHEⅡscore was positively correlated with cTnI, CK-MB and LDH (r= 0.639, 0.451 and 0.552,respectively, P<0.05). Conclusion The serum cTnI level can be used as the index for the diagnosis of cardiac insufficiency in patients with SAP, and can prefer-ably reflect the severity of SAP.