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目的:探讨肌钙蛋白I(cTnI)在急性心力衰竭(AHF)患者中水平和变化与基础病因及AHF预后的关系。方法:84例确诊的AHF患者,按病因分为缺血性心脏病(IHD)组(26例)、心脏瓣膜病(VHD)组(17例)、扩张型心肌病(DCM)组(25例)、高血压性心脏病(HHD)组(16例)。入院即刻与病情缓解时分别测定cTnI浓度。据入院即刻浓度分为cTnI(+)(14例)和cTnI(-)(70例)两组;据cTnI浓度分为入院即刻与病情缓解时均为cTnI(+)(1组)、入院即刻cTnI(+)与病情缓解时cTnI(-)(2组)、入院即刻与病情缓解时均为cTnI(-)(3组)3组。记录住院期间病情缓解时间,出院后1、3、6、12个月再入院及死亡例数,分析cTnI浓度与病因及其预后的相关性。结果:①入院即刻与病情缓解时IHD组cTnI浓度均较DCM、HHD两组明显升高(分别P<0.01、P<0.05);IHD、VHD、HHD 3组缓解时cTnI浓度均较入院即刻明显回降(分别P<0.05、P<0.01、P<0.05)。②cTnI(+)组缓解时间较cTnI(-)组长(P<0.01)。入院即刻cTnI浓度与缓解时间呈正相关(r=0.286,P<0.01)。③cTnI(+)组住院期间病死率高于cTnI(-)组(P<0.05);出院后12个月cTnI(+)组病死率明显高于cTnI(-)组(P<0.01)。cTnI(+)组住院期间及出院后12个月累积心源性病死率明显高于cTnI(-)组(P<0.01)。出院后1、3、6、12个月cTnI(+)组再入院率较cTnI(-)组明显升高(分别P<0.05、P<0.01、P<0.01、P<0.01)。治疗前后cTnI均阳性组住院期间及出院后12个月累积病死率较治疗前后阳转阴组和均阴性组明显升高(均P<0.01)。结论:AHF患者cTnI水平及治疗前后的变化与基础病因及其预后相关。
Objective: To investigate the relationship between the level and changes of troponin I (cTnI) in patients with acute heart failure (AHF) and the underlying etiology and prognosis of AHF. Methods: Eighty-four AHF patients were divided into two groups according to the cause: ischemic heart disease (IHD) group (26 cases), valvular heart disease group (17 cases), dilated cardiomyopathy group (25 cases ), Hypertensive heart disease (HHD) group (16 cases). CTnI concentration was determined separately at admission and when the condition was relieved. According to the concentration of cTnI, cTnI (+) (group 1) was divided into two groups: cTnI (+) (14 cases) and cTnI (-) (70 cases) cTnI (+) and cTnI (-) (two groups) when the disease was relieved were all cTnI (-) (three groups) immediately after admission and when the condition was relieved. The duration of inpatient remission, the number of hospitalizations and deaths at 1, 3, 6 and 12 months after discharge were recorded, and the correlation between cTnI concentration and etiology and prognosis was analyzed. Results: (1) The cTnI concentrations in IHD group were significantly higher than those in DCM and HHD group (P <0.01, P <0.05, respectively) immediately after admission and when the condition was relieved; the concentrations of cTnI in IHD, VHD, Back down (P <0.05, P <0.01, P <0.05, respectively). ② The response time of cTnI (+) group was longer than cTnI (-) group (P <0.01). The cTnI concentration at admission was positively correlated with the time of remission (r = 0.286, P <0.01). The mortality of cTnI (+) group was higher than that of cTnI (-) group (P <0.05). The mortality of cTnI (+) group was significantly higher than cTnI (-) group after 12 months of discharge (P <0.01). The cumulative CFR of cTnI (+) group during hospitalization and 12 months after discharge was significantly higher than that of cTnI (-) group (P <0.01). At 1, 3, 6 and 12 months after discharge, the readmission rates in cTnI (+) group were significantly higher than those in cTnI (-) group (P <0.05, P <0.01, P <0.01, P <0.01, respectively). Before and after treatment, the cumulative mortality of cTnI-positive group during hospitalization and 12 months after discharge was significantly higher than that before and after treatment (both P <0.01). Conclusion: The level of cTnI in AHF patients and the changes before and after treatment are related to the underlying etiology and prognosis.