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目的探讨血清肌钙蛋白Ⅰ(cTnⅠ)对急性肺血栓栓塞症(APTE)危险分层及预后的临床价值。方法选择中国医科大学附属盛京医院第二呼吸内科2007年1月至2010年2月确诊APTE并行cTnⅠ检查42例患者,按照外周血cTnⅠ水平,分为cTnⅠ阳性组20例与阴性组22例。比较两组患者临床特点、高危及中危APTE发生率、右心功能障碍、心源性休克及病死率。结果阳性组高危APTE 7例(35.0%),中危APTE 13例(65.0%);阴性组高危APTE 2例(9.1%),中危APTE 4例(18.1%)。发生心源性休克分别为7例(35.0%)、1例(4.5%)。阳性组死亡2例(10%)。两组晕厥、低氧、大面积及次大面积肺栓塞、肺动脉高压、右室扩大右心功能不全、心源性休克经统计学处理差异具有统计学意义。结论cTnI可作为APTE患者独立的预后指标,指导APTE治疗。
Objective To investigate the clinical value of serum troponin Ⅰ (cTnⅠ) in the risk stratification and prognosis of acute pulmonary thromboembolism (APTE). METHODS: Forty-two patients diagnosed with APTE concurrent cTnⅠ confirmed by Department of Respiratory Medicine, Shengjing Hospital of China Medical University from January 2007 to February 2010 were divided into cTnⅠ-positive group (n = 20) and negative group (n = 22) according to the level of cTnⅠ in peripheral blood. The clinical features, incidence of high-risk and intermediate-risk APTE, right ventricular dysfunction, cardiogenic shock and mortality were compared between the two groups. Results High-risk APTE was found in 7 patients (35.0%) in the positive group and 13 (65.0%) in the intermediate-risk APTE group. In the negative group, 2 were high-risk APTE patients (9.1%) and 4 were moderate-risk APTE patients (18.1%). Cardiac shock occurred in 7 cases (35.0%), 1 case (4.5%). Positive patients died in 2 cases (10%). Two groups of syncope, hypoxia, large area and sub-large pulmonary embolism, pulmonary hypertension, right ventricular enlargement of right ventricular dysfunction, cardiogenic shock by statistical analysis, the difference was statistically significant. Conclusion cTnI can be used as an independent prognostic factor in patients with APTE to guide APTE treatment.