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目的分析肌酸激酶同工酶(CK-MB)和心肌肌钙蛋白Ⅰ(cTnⅠ)在尿毒症合并急性左心衰竭患者中的变化趋势和与预后的关系。方法连续选择2014年1月~2015年1月间于海军总医院接受维持性血液透析(MHD)治疗的尿毒症患者共130例,其中男性76例,女性54例。根据是否出现透析相关的急性左心衰竭分为心衰组(30例)和对照组(100例)。检测发生左心衰竭后不同时间点的CK-MB、cTnⅠ、血清肌酐(Scr)、尿素氮(BUN)水平。出院后随访1年,比较总死亡率和心源性死亡率。检测院内和随访期间(出院后1个月、6个月、12个月)的N末端脑钠肽前体(NT-proBNP)和左室射血分数(LVEF)水平。结果不同时间点心衰组的CK-MB和cTnⅠ水平均明显高于对照组,差异有统计学意义(P均<0.05),心衰组的CK-MB和cTnⅠ缓慢上升达平台期,无明显峰值和下降趋势。不同时间点,心衰组和对照组的Scr和BUN水平比较,差异均无统计学意义(P均>0.05)。心衰组院内、出院后1个月、出院后6个月、出院后12个月的NT-proBNP水平均明显高于对照组,差异有统计学意义(P均<0.05)。心衰组院内LVEF明显低于对照组,差异有统计学意义(P<0.05);而随访期间的LVEF值与对照组比较,差异均无统计学意义(P均>0.05)。心衰组的总死亡率和心源性死亡率均明显高于对照组,60.0%vs.30%,77.8%vs.46.7%,差异有统计学意义(P均<0.05)。结论 CK-MB和cTnⅠ在尿毒症合并急性左心衰竭患者中变化明显,与患者预后有关。
Objective To analyze the relationship between CK-MB and cTnI in uremic patients with acute left heart failure and its relationship with prognosis. Methods A total of 130 patients with uremia who underwent maintenance hemodialysis (MHD) at Naval General Hospital between January 2014 and January 2015 were selected, including 76 males and 54 females. According to whether dialysis-related acute left heart failure is divided into heart failure group (30 cases) and control group (100 cases). CK-MB, cTnⅠ, serum creatinine (Scr) and blood urea nitrogen (BUN) were measured at different time points after left heart failure. Followed up for 1 year after discharge from hospital, total mortality and cardiac mortality were compared. The levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and left ventricular ejection fraction (LVEF) were measured during the hospital and during follow-up (1 month, 6 months and 12 months after discharge). Results The levels of CK-MB and cTnⅠin the heart failure group were significantly higher than those in the control group at different time points (all P <0.05). CK-MB and cTnⅠin the heart failure group increased slowly to the plateau stage with no significant difference Peak and declining trends. At different time points, there was no significant difference in Scr and BUN levels between HF group and control group (all P> 0.05). The levels of NT-proBNP in the heart failure group, 1 month after discharge, 6 months after discharge and 12 months after discharge were significantly higher than those in the control group (all P <0.05). The LVEF in the heart failure group was significantly lower than that in the control group (P <0.05). However, there was no significant difference in LVEF between the two groups during follow-up (P> 0.05). The total mortality and cardiac death in the HF group were significantly higher than those in the control group, 60.0% vs.30%, 77.8% vs.46.7%, respectively. The difference was statistically significant (all P <0.05). Conclusions CK-MB and cTnI have obvious changes in patients with uremia complicated by acute left heart failure, which is related to the prognosis of patients.