摘要
目的:探讨血清肌钙蛋白I(cardiac troponin I,cTnI)水平升高对足月新生儿心肌损伤的诊断效果。方法:选择2020年8月至2022年8月南京医科大学附属儿童医院新生儿病房收治的入院24 h内治疗前cTnI水平>0.04 ng/mL的足月新生儿240例,检测治疗7 d后cTnI水平,将118例cTnI水平持续升高者纳入A组,将122例cTnI水平降低者纳入B组。对比2组临床资料、感染指标、心肌损伤指标、影像学检查指标及病因情况。结果:A组剖宫产率较B组高(P<0.05);A组新生儿性别、出生体重、日龄、围产期缺氧窒息史、临床症状、新生儿母亲孕期合并症与B组相比,差异均无统计学意义(均P>0.05);A组降钙素原(procalcitonin,PCT)水平较对照组高(P<0.05),A组C反应蛋白(C-reactive protein,CRP)、白细胞(white blood cell,WBC)水平与B组相比,差异无统计学意义(P>0.05);A组肌酸激酶(creatine kinase,CK)、肌酸激酶同工酶MB(creatine kinase MB,CK-MB)、B型钠尿肽(B-type natriuretic peptide,BNP)水平与B组比较,差异均无统计学意义(均P>0.05);A组心胸比值、左心扩大比例、ST-T改变、一过性窦性心动过缓、同时出现≥2种心率失常的比例均较B组高(均P<0.05);经多因素logistic回归分析,结果可见新生儿高胆红素血症、新生儿败血症最终进入回归方程(P<0.05)。结论:血清cTnI水平升高使心电图改变、心脏扩大、心脏磁共振改变概率上升,新生儿心肌损害持续存在,严重者可致预后不佳,新生儿败血症及新生儿高胆红素血症是新生儿心肌损害的主要影响因素,临床应加强对新生儿血清cTnI水平的监测。
Objective:To investigate the diagnostic effect of elevated cardiac troponin I(cTnI)level on myocardial injury in term neonates.Methods:A total of 240 full-term neonates whose cTnI level was greater than 0.04 ng/mL before treatment within 24 hours recorded in the neonatal ward of Children’s Hospital Affiliated to Nanjing Medical University from August 2020 to August 2022 were selected,and the cTnI level was measured after 7 days of treatment.One hundred and eighteen patients whose cTnI level continued to increase were included in Group A,and 122 patients whose cTnI level decreased were included in Group B.The clinical data,infection index,myocardial injury index,imaging examination index,and etiology of the 2 groups were compared.Results:The rate of cesarean section in Group A was higher than that in Group B(P<0.05).There was no significant difference in sex,birth weight,age in days,perinatal history of hypoxia and asphyxia,clinical symptoms,and maternal complications between Group A and Group B(all P>0.05).There was no statistically significant difference in the levels of C-reactive protein(CRP)and white blood cell(WBC)between Group A and Group B(P>0.05).The level of procalcitonin(PCT)in Group A was higher than that in the control group(P<0.05).The levels of creatine kinase(CK),creatine kinase MB(CK-MB),and B-type natriuretic peptide(BNP)in Group A were not significantly different from those in Group B(P>0.05).The cardiothoracic ratio,left ventricular enlargement ratio,ST-T change,transient sinus bradycardia,and≥2 kinds of arrhythmia in Group A were higher than those in Group B(P<0.05).Multivariate logistic regression analysis showed that neonatal hyperbilirubinemia and neonatal sepsis finally entered the regression equation(P<0.05).Conclusion:The increase of serum cTnI level can increase the probability of ECG changes,cardiac enlargement,and cardiac magnetic resonance changes.Myocardial damage persists in neonates,which may lead to poor prognosis in severe cases.Neonatal sepsis and neonatal hyperbilirubinemi
作者
赵芳
吴龙艳
林玲
ZHAO Fang;WU Longyan;LIN Ling(Neonatal Medical Center,Children’s Hospital Affiliated to Nanjing Medical University,Nanjing 210000,China)
出处
《临床与病理杂志》
CAS
2023年第5期907-913,共7页
Journal of Clinical and Pathological Research
关键词
肌钙蛋白I
足月新生儿
心肌损伤
诊断
cardiac troponin I
term newborn
myocardial injury
diagnosis
