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目的观察急性肺血栓栓塞(PTE)患者血清酶学及肌钙蛋白 I(TnI)的变化,了解其与估测肺动脉收缩压、右心运动功能及预后的关系。方法 519例 PTE 患者来自北京24家医院参与的国家“十五”科技攻关课题——肺栓塞规范化诊治方法的研究。根据2001年5月中华医学会呼吸病学分会制定的《肺血栓栓塞症的诊断与治疗指南(草案)》的诊断标准确定大面积、次大面积、非大面积肺栓塞患者。大面积、次大面积肺栓塞患者采用溶栓治疗,非大面积肺栓塞患者采用抗凝治疗。按中心随机方法将患者分组,应用尿激酶和重组组织型纤溶酶原激活剂及普通肝素和低分子肝素。结果 (1)大面积肺栓塞患者治疗前血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、肌酸激酶(CPK)、乳酸脱氢酶(LDH)水平[(74±33)、(88±40)、(157±75)、(419±264)U/L]明显高于次大面积肺栓塞患者[(52±21)、(43±18)、(75±30)、(284±176)U/L]和非大面积肺栓寒患者[(38±13)、(35±11)、(78±24)、(239±178)U/L];(2)非大面积肺栓塞患者应用普通肝索治疗7 d 后血清ALT[(84±39)U/L]明显高于应用低分子肝素患者[(67±26)U/L];(3)519例患者中45例肺动脉收缩压≥80 mm Hg(1 mm Hg=0.133 kPa),治疗前存在右心运动功能减弱169例,预后不良48例。大面积肺栓塞患者中17例(41.5%)ALT 升高,次大面积中76例(45.5%),非大面积中26例(54.5%)。大面积肺栓塞患者中24例(54.4%)LDH 升高,次大面积中68例(40.2%),非大面积中15例(30.8%);(4)39例血清 TnI≥0.07μg/L 的患者中右心功能减弱24例(63.3%),预后不良者8例(24.2%)。结论 (1)急性 PTE 患者可出现血清 ALT、ASF、CPK、LDH 水平升高;(2)非大面积肺栓塞患者应用抗凝治疗,普通肝素较低分子肝素更易引起血清 ALT 升高;(3)血清 ALT、LDH 以及TnI 的升高与 PTE 患者的肺动脉收缩压、右心运动功能及预后密切相关,其变化可能有助于对急性肺栓塞患者进行危险分层。
Objective To observe the changes of serum enzymology and troponin I (TnI) in patients with acute pulmonary thromboembolism (PTE) and evaluate the relationship between pulmonary arterial systolic pressure and right ventricular function and prognosis. Methods A total of 519 cases of PTE patients from the Beijing 24 hospitals involved in national “fifteen ” scientific and technological topics - research on standardized treatment of pulmonary embolism. According to the Diagnostic Criteria for Diagnosis and Treatment of Pulmonary Thromboembolism (drafts) formulated by the Chinese Medical Association Respiratory Disease Branch in May 2001, the diagnostic criteria of large area, sub-large area and non-large area pulmonary embolism were determined. Large area, second largest area of pulmonary embolism using thrombolytic therapy, non-large area pulmonary embolism patients with anticoagulant therapy. The patients were divided into groups randomly according to the center method, and urokinase and recombinant tissue plasminogen activator and unfractionated heparin and low molecular weight heparin were used. Results (1) Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatine kinase (CPK) and lactate dehydrogenase (LDH) , (88 ± 40), (157 ± 75) and (419 ± 264) U / L, respectively, were significantly higher than those in sub-maxillary pulmonary embolism patients (52 ± 21 and 43 ± 18 and 75 ± 30, (28 ± 176) U / L and non-large-area patients with pulmonary embolism [(38 ± 13), (35 ± 11), (78 ± 24), (239 ± 178) U / The serum ALT level of (84 ± 39) U / L was significantly higher in patients with large pulmonary embolism after 7 days of treatment with common heparin ([67 ± 26] U / L]; (3) 45 cases of pulmonary systolic pressure ≥ 80 mm Hg (1 mm Hg = 0.133 kPa), 169 cases of pre-treatment right heart function weakening, poor prognosis in 48 cases. ALT increased in 17 (41.5%) of the patients with large pulmonary embolism, 76 (45.5%) in the sub-large area and 26 (54.5%) in the non-large area. LDH was elevated in 24 cases (54.4%) in large pulmonary embolism patients, with 68 cases (40.2%) in sub-large area and 15.8% (30.8%) in non-large area; (4) 39 cases serum TnI≥0.07μg / L (63.3%) of the patients with right ventricular dysfunction and 8 patients (24.2%) with poor prognosis. Conclusions (1) Serum levels of ALT, ASF, CPK and LDH may be elevated in patients with acute PTE. (2) Anticoagulation therapy in patients with non-maximal pulmonary embolism may lead to elevated ALT in patients with unfractionated heparin (LMWH) ) The elevation of serum ALT, LDH and TnI are closely related to pulmonary artery systolic pressure, right heart function and prognosis in patients with PTE, and the changes may contribute to the risk stratification in patients with acute pulmonary embolism.