论文部分内容阅读
目的 研究超敏肌钙蛋白Ⅰ(high-sensitivity cardiac troponin Ⅰ,hs-cTnI)和可溶性致癌抑制因子2(soluble suppression of tumorigenicity 2,sST2)对急性有机磷农药中毒(acute organophosphoruspesticide poisoning,AOPP)患者心肌损伤程度的早期诊断价值.方法 选择2014年3月至2018年10月衡水市人民医院住院治疗的AOPP患者168例,按照AOPP中毒诊断分级,分为轻度组45例、中度组55例及重度组68例.另选30例同期健康体检者为对照组.分别于入院后1、4、12h检测肌钙蛋白(cTnI)、hs-cTnI、N末端B型钠尿肽(NT-proBNP)和sST2水平.应用SPSS 21.0进行统计分析.计量资料采用均数±标准差(Mean土SD)表示,组间两两比较采用LSD-t检验,多组间比较采用单因素方差分析.相关性分析用Spearman相关检验.结果 入院后1h,不同中毒程度AOPP患者hs-cTnI均高于对照组,重度组高于轻中度组;组间比较差异有统计学意义(P＜0.05);但cTnI水平差异无统计学意义(P＞0.05).人院后4h、12h,随着中毒程度增加以及时间延长,cTnI、hs-cTnI水平均呈递增趋势,并且入院后12h水平显著高于入院后4h,组间比较差异有统计学意义(P＜0.05).入院后1h,中毒患者sST2水平高于对照组,重度组高于轻中度组;入院后4h、12h,sST2水平明显升高,以重度组最为显著;入院后12h,sST2水平显著高于入院后4h,组间比较差异有统计学意义(P＜0.05).人院后1 h NT-proBNP浓度在正常范围.人院后4h、12h,NT-proBNP随时间逐渐升高,重度组明显高于各组,组间比较差异有统计学意义(P＜0.05).相关性分析显示,AOPP患者hs-TnI和sST2呈正相关(r=0.776,P＜0.01).hs-TnI浓度和sST2浓度与AOPP病情程度均呈正相关(r=0.958,P＜0.01;r=0.844,P＜0.01).即患者中毒程度越重,hs-TnI和sST2浓度越高,心肌损伤越重.结论 尽早检测AOPP患者hs-cTnI、sST2水平,可早期识别心肌损害,客观评价心肌损害的程度.“,”Objective To study the early diagnostic value of high-sensitivity cardiac troponin Ⅰ(hs-cTnI) and soluble growth stimulating gene 2 protein (soluble suppression of tumorigenicity 2,sST2) in myocardial injury of acute organophosphorus pesticide poisoning (AOPP).Methods Totally 168 AOPP patients hospitalized from March 2014 to October 2018 were divided into the mild group (n=45),moderate group (n=55) and severe group (n=68).Another 30 healthy persons were served as the control group.The levels of cTnI,hs-cTnI,N-terminal B-type natriuretic peptide(NT-proBNP) and sST2 were detected at 4 h and 12 h after admission.SPSS 21.0 was used for statistical analysis.The measurement data were expressed by mean±standard deviation,two groups were compared by LSD-t test,and the multigroup comparison was made by single factor analysis of variance (ANOVA).The correlation analysis by Spearman correlation test (P＜0.05).Results At 1 h after admission,the hs-cTnI of AOPP patients with different degrees of poisoning was higher than that of control group,and that of severe group was higher than that of mild to moderate group.Comparison between groups was statistically significant (P＜0.05).However,there was no significant difference in the cTnI level (P＞0.05).At 4 h and 12 h after admission,the levels of cTnI and hs-cTnI increased with the increase of poisoning degree and the extension of time,and their level at 12 h after admission were significantly higher than those at 4 h after admission,with statistically significant difference between the two groups (P＜0.05).At 1 h after admission,the level of sST2 in the poisoned patients was higher than that in the control group,and the level in the severe group was higher than that in the mild to moderate groups.At 4 h and 12 h after admission,the level of sST2 was increased significantly,especially in the severe group.The level of sST2 at 12 h after admission was significantly higher than that at 4 h after admission (P＜0.05).The concentration of NT-proBNP was in normal range 1 h after admission,increased gradually at 12 h after admission,and the level of NT-proBNP in the severe group was significantly higher than that in the other groups (P＜0.05),and comparison between the groups was significantly different (P＜0.05).The correlation analysis showed that there was a positive correlation between hs-TnI and sST2 in AOPP patients (r=0.776,P＜0.01).hs-TnI and sST2 was positively correlated with the severity of AOPP (r=0.958,P＜0.01;r=0.844,P＜0.01).That is,the more severe the patient,the higher the concentration of hs-TnI and sST2,and the more serious myocardial injury.Conclusions Early detection ofhs-cTnI and sST2 levels in AOPP patients can identify early myocardial damage and objectively evaluate the extent of myocardial damage.