摘要
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。
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.
出处
《中华临床医师杂志（电子版）》
CAS
2014年第12期42-45,共4页
Chinese Journal of Clinicians(Electronic Edition)
基金
安徽省教育厅自然科学研究重点项目(KJ2011A162)
关键词
有机磷化合物
中毒
肌钙蛋白I
心肌酶谱
脑钠肽前体
Organophosphoms compounds
Poisoning
Troponin I
Myocardium zymogram
N-Terminal pro-brain natriuretic peptide
