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目的研究非心源性危重病患者血清心肌酶学标记物肌红蛋白(Mb)、肌钙蛋白Ⅰ(cTNI)、肌酸激酶(CK)及其同工酶(CK-Mb)、天冬氨酸转氨酶(AST)、乳酸脱氢酶(LDH)等的表达量;以APACHEⅡ评估体系和治疗结果为标准,分别探讨上述标记物在评估急诊监护病房的危重病患者病重程度及其预后的临床价值;初步探讨危重病的发病机制。方法选择自2005年4月至12月间收住EICU的所有134例患者,根据APACHEⅡ评分结果(APACHEⅡ<10,10～25,>25)分成三组,并根据临床转归分为两组,即出院组和死亡组。用固相层析免疫分析技术及化学发光技术定量检测全套心肌蛋白,同步检测常规血液生化指标,所有患者随访至病情稳定出院或死亡。数据主要采用协方差分析、秩和检验和卡方检验。结果随着APACHEⅡ分值的升高和病情的恶化,6项心肌酶谱测值均有不同程度的升高,以APACHEⅡ评估的轻、重、危三组间比较AST、LDH、CK、CK-Mb和Mb,差异具有统计学意义(P<0.01),其中Mb、CK在组间两两比较差异也具有统计学意义,轻、重、危三组Mb分别为(83.91±116.85)、(504.75±116.74)、(1302.23±189.75),CK分别为(51.77±165.12)、(663.56±164.97)、(1720.04±268.14)(P<0.05)。cTNI测值在轻、重、危三组间差异无统计学意义(P>0.05)。出院和死亡组间APACHEⅡ评分、Mb、LDH、CK、AST差异具有统计学意义(P<0.05),其中Mb、LDH与预后的相关性最好(P= 0.0001)。结论AST、LDH、CK和Mb能反映以APACHEⅡ为标准评估的疾病危重程度,能预测患者的生存率,其中Mb敏感性最高。Mb不仅能量化评估危重病程度和估测预后,而且与APACHEⅡ评分的关系最密切,适用于阶梯式划分和评估患者的病重状况和预后,是一种简单方便且有效的评估手段之一,值得进一步深入研究。
Objective To study the changes of serum myocardial enzyme markers such as myoglobin (Mb), cTNI, CK and isoenzyme (CK-Mb), aspartate (AST), lactate dehydrogenase (LDH) and other expression levels; APACHE Ⅱ evaluation system and the results of the treatment as the standard, respectively, to explore the above markers in the evaluation of critical care patients in emergency room ward and prognosis of clinical Value; Preliminary study of the pathogenesis of critical illness. Methods All 134 patients who received EICU from April 2005 to December 2005 were divided into three groups according to APACHEⅡscore (APACHEⅡ <10,10 ~ 25,> 25), and divided into three groups according to the clinical outcome. Ie discharge and death groups. Solid-phase chromatographic immunoassay and chemiluminescence techniques were used to quantitatively detect the full set of myocardial proteins. Simultaneous detection of routine blood biochemical parameters was followed up until all patients were stable and discharged or died. The data mainly use covariance analysis, rank sum test and chi-square test. Results With the increase of APACHEⅡscore and the deterioration of the condition, all the 6 myocardial enzymes were increased to some extent. The levels of AST, LDH, CK and CK- Mb and Mb, the difference was statistically significant (P <0.01), in which Mb and CK were also statistically significant differences between groups, Mb of light, heavy and risk groups were (83.91 ± 116.85), (504.75 ± 116.74, 1302.23 ± 189.75 respectively), CK (51.77 ± 165.12), (663.56 ± 164.97) and (1720.04 ± 268.14) respectively (P <0.05). There was no significant difference in cTNI between the three groups (P> 0.05). There were significant differences in APACHEⅡscore, Mb, LDH, CK, AST between discharge and death groups (P <0.05). The correlation between Mb, LDH and prognosis was the best (P = 0.0001). Conclusion AST, LDH, CK and Mb can reflect the severity of the disease evaluated by APACHEⅡ, and can predict the survival rate of patients, of which Mb has the highest sensitivity. Mb is not only able to quantify the severity of critical illness and prognosis of prognosis, but also has the most close relationship with APACHEⅡscore, which is suitable for the stepwise classification and evaluation of patients’sickness and prognosis. It is a simple, convenient and effective evaluation method, Worth further study.