ObjectiveTo evaluate the predictive value of the high-sensitivity cardiac troponin I (hs-cTnI) in patients with acute pulmonary embolism (APE). MethodsIn a retrospective cohort study,272 consecutive patients with APE were reviewed and the 30-days death and in-hospital adverse events were evaluated. The patients were classified according to hs-cTnI value into a high hs-cTnI group and a low hs-cTnI group. The simple pulmonary embolism severity index (sPESI) was used for clinical risk determination. The adverse event was defined as intravenous thrombolytic therapy,noninvasive ventilator support to maintain oxygen saturation >90% and suffered with severe complications. The correlations of hs-cTnI with sPESI score,30-days adverse events and mortality were analyzed. The Kaplan-Meier curves and the log-rank test were used to compare time-to-event survival. Stepwise multivariate logistic regression analysis models were used to determine the incremental prognostic value of sPESI score and hs-cTnI. ResultsThe incidence of 30-day death (6.1%),renal failure (14.6%),bleeding (13.4%) and thrombolytic therapy (7.9%) were higher in the high hs-cTnI group than those in the low hs-cTnI group (P values were 0.009,<0.001,0.018 and 0.003,respectively). The patients with sPESI ≥1 and low hs-cTnI had greater free adverse events survival (P=0.005). hs-cTnI provided incremental predictive value for in-hospital adverse events,beyond the sPESI score (P<0.001). Conclusionhs-cTnI has excellent negative predictive value of APE prognosis,especially when used combined with sPESI score.
ObjectiveTo compare early postoperative outcomes of Chinese patients undergoing off-pump coronary artery bypass grafting (OPCAB) with or without preoperative discontinuation of aspirin. MethodsClinical data of 354 patients who underwent elective OPCAB in Department of Cardiac Surgery, People's Hospital of Peking University from 2011 to 2012 were retrospectively analyzed. There were 132 patients during year 2011 who discontinued aspirin more than 5 days before OPCAB and were defined as a discontinuation group, including 93 males and 39 females with their age of 36-83 (61.70±8.74) years. There were 222 patients during year 2012 who continued aspirin treatment before OPCAB and were defined as an aspirin group, including 162 males and 60 females with their age of 37-82 (63.26±8.94) years. Postoperative chest drainage, incidence of reexploration for bleeding, in-hospital morbidity and mortality were compared between the 2 groups. Serum cardiac troponin I (cTnI) levels during 4-6 hours, 12-18 hours and 24-48 hours after OPCAB were also compared. ResultsPreoperative clinical characters were not statistically different between the 2 groups (P>0.05). Average number of grafts in the discontinuation group was significantly smaller than that in the aspirin group (3.00±0.89 vs. 3.43±0.93, P=0.001). There was no significant difference in postoperative chest drainage (1 063.75±511.50 ml vs. 1 131.35±460.13 ml, P=0.201), incidence of reexploration for bleeding(0 case vs. 1 case, P=1.000), perioperative myocardial infarction(2 cases vs. 1 case, P=0.647), postoperative acute renal failure(4 cases vs. 7 cases, P=1.000), stroke(1 case vs. 4 cases, P=0.726), mechanical ventilation time(41.46±85.50 hours vs. 52.07±143.59 hours, P=0.441), length of ICU stay(81.46±116.90 hours vs. 79.07±136.43 hours, P=0.867), or in-hospital mortality(0.8% vs. 0.9%, P=1.000)between the 2 groups. Serum cTnI levels during 4-6 hours after OPCAB were not statistically different between the 2 groups (P=0.506). Serum cTnI levels during 12-18 hours and 24-48 hours after OPCAB were statistically different between the 2 groups (P=0.002 and P=0.000). The percentages of patients with cTnI level higher than 4.0 ng/ml during 12-18 hours and 24-48 hours after OPCAB in the aspirin group were significantly lower than those in the discontinuation group (5.4% vs. 16.7%, P=0.001;5.9% vs. 17.4%, P=0.000). ConclusionOPCAB without preoperative discontinuation of aspirin does not increase the risk of postoperative bleeding, in-hospital morbidity or mortality, but can decrease postoperative myocardial injury of Chinese patients undergoing OPCAB.
【摘要】 目的 探讨胎儿宫内窘迫对足月新生儿血清心肌酶变化的相关性分析。 方法 将2009年10月-2010年9月在我产科出生有宫内窘迫史而羊水和Apgar评分均正常的足月新生儿20例为观察组，同期出生的健康足月新生儿10例为对照组，分别测定两组出生后1、5 d血清肌酸激酶同工酶（CK-MB）及心肌肌钙蛋白I（cTnI）水平。 结果 观察组出生后1 d血清cTnI高于对照组（Plt;0.001），CK-MB两组差异无统计学意义（Pgt;0.05），出生后5 d血清CK-MB及cTnI均高于对照组（Plt;0.001）；观察组和对照组出生后5 d血清cTnI水平均较1 d时升高，差异有统计学意义（Plt;0.001），血清CK-MB浓度均低于1 d时（Plt;0.001）。观察组患儿经过治疗，1个月后复查血清cTnI除1例未恢复至正常水平外，其余血清CK-MB及心电图均恢复正常。 结论 单纯宫内窘迫可造成足月新生儿血清cTnI及CK-MB水平升高，常规检测血清cTnI及CK-MB能及时了解此类新生儿的心肌受损情况，从而尽早予以保护心肌治疗。【Abstract】 Objective To make a correlation analysis on effect of fetal distress on changes of cardiac enzyme in neonatal serum. Methods Twenty full-term newborns who met diagnostic criteria of fetal distress but were born with normal amniotic fluid and Apgar score between October 2009 and September 2010 were included in the observed group, another ten normal full-term newborns born at same period were in control group. The serum values of cardiac troponin I (cTnI) and creatine kinase (CK-MB) were collected and measured one and five days after birth. Results One day after the birth, the serum levels of cTnI was significantly higher in the observed group compared to that in the control group (Plt;0.001), but there was no difference in CK-MB between the two groups (Pgt;0.05). The values of cTnI five days after the birth were higher than those one days after the birth in both groups (Plt;0.001). The values of CK-MB were higher one day after birth than those five days after birth in both groups (Plt;0.001). In observation group after the treatment, serum cTnI in one patient did not return to normal, and the remaining neonatal serum CK-MB and ECG were normal. Conclusions Elevated level of serum cTnI and CK-mb could be caused by fetal distress in normal full-term newborns with normal amniotic fluid and Apgar score. Routine testing of serum cTnI and CK-MB may be useful to detect myocardial damage in newborns.
Objective To evaluate the influences of myocardial injury markers on the short-term and long-term mortality after coronary artery bypass grafting (CABG), so as to provide valuable references for clinical prognosis assessment. Methods Literature was electronically searched in CBM, PubMed, OVID, EMbase and CNKI from the date of their establishment to August 2011, meanwhile the manual searches were also performed to systemize the papers. According to the Cochrane Handbook for systematic reviews, the studies were screened by two reviewers independently, the quality of the included studies was evaluated, the data were extracted, and meta-analysis was conducted using RevMan5.0 software. Results A total of 10 observational studies including creatine kinase-myocardial band (CK-MB) and cardiac troponin I (cTnI), and the patients involved were 10 793 totally. Results of meta-analysis showed that the increasing release of CK-MB was associated with an increasing short-term mortality risk of both on-pump (RR=2.88, 95%CI 1.94 to 4.28, Plt;0.000 01) and off-pump group (RR=3.64, 95%CI 1.07 to 12.42), P=0.04). Also the increasing release of CK-MB was associated with an increasing long-term mortality risk of both on-pump (RR=2.55, 95%CI 1.91 to 3.40, Plt;0.000 01) and off-pump group (RR=3.36, 95%CI1.46 to 7.72, P=0.004). The increasing release of cTnI was also associated with an increasing risk of both short-term mortality (RR=6.45, 95%CI 2.50 to 16.66, Plt;0.1) and long-term mortality (RR=4.18, 95%CI 2.78 to 6.28, Plt;0.1). Conclusion The evidence shows that the increasing release of both CK-MB and cTnI is associated with an increasing risk of the short-term and long-term mortality.
目的 探讨血浆脑钠肽（BNP）及血清肌钙蛋白I（cTNI）含量改变在老年患者发生充血性心力衰竭时的临床意义。 方法 选择2010年7月－2012年8月住院的各种老年心脏病患者117例，根据纽约心功能分级分为4组（心功能Ⅰ级组、Ⅱ级组、Ⅲ级组、Ⅳ级组），分别检测血浆BNP、血清cTNI及心肌酶[肌酸磷酸激酶（CK）、肌酸磷酸激酶同工酶（CK-MB）]进行组间比较，同时与健康老年组进行对比。 结果 ① 老年慢性充血性心力衰竭各组（心功能Ⅱ～Ⅳ级）血浆BNP水平均高于健康对照组及心功能正常组（心功能Ⅰ级组）；且心功能Ⅳ级组BNP水平＞心功能Ⅲ级组＞心功能Ⅱ级组。各组之间比较差异有统计学意义，但心功能Ⅰ级组与健康对照组血浆BNP水平无明显差异。② 各组之间CK及CK-MB水平差异均无统计学意义。③ 充血性心力衰竭各组（心功能Ⅱ～Ⅳ级组血清cTNI水平均高于健康对照组及心功能正常组（心功能Ⅰ级组）；且心功能Ⅳ级组cTNI水平＞心功能Ⅲ级组＞心功能Ⅱ级组。各组之间比较差异有统计学意义，而心功能Ⅰ级组及健康对照组血清cTNI水平差异无统计学意义。 结论 血浆BNP水平及血清cTNI水平在老年患者发生心力衰竭时随心力衰竭程度加重而逐渐升高，两者均对慢性充血性心力衰竭的临床诊断具有重要参考意义。
Objective To analyze the electrocardiogram (ECG) and troponin (cTnI) in patients with acute coronary syndrome (ACS), so as to assess their value in diagnosing the extent of vascular lesions. Methods The results of ECG, cTnI and coronary angiography (CAG) were analyzed in 37 patients with ACS. Chi-square test and a logistic regression model were used for statistical analysis. Results In patients with positive ECG or cTnI, the results of Chi-square test showed that the incidences of coronary occlusion (P=0.016, 0.003, respectively) and coronary stenosis (P=0.121, 0.013, respectively) were significantly higher than for those with negative ECG or cTnI. The results of logistic regression analysis indicated that only cTnI was significantly correlated with coronary occlusion (P=0.013) and moderate to severe coronary stenosis (P=0.021). ECG has significant consistency with cTnI (Kappa=0.617, Plt;0.001). Conclusion Both ECG and the qual itative cTnI test can reflect the extent of vascular lesions in patients with ACS.