目的:探讨血清肌钙蛋白T（cTnT）在心源性休克（CS）患者接受静脉-动脉体外膜肺氧合（V-A ECMO）治疗中的变化趋势及对预后的预测价值。方法:回顾分析2015年3月至2020年5月在南京医科大学第一附属医院接受V-A ECMO治疗的CS患者的临床资料。记录入选病例的基本信息、ECMO相关参数以及ECMO转机后1、2、3 d的血清cTnT水平和重症监护病房（ICU）预后；将具有临床意义和单因素分析中差异有统计学意义的指标与临床结局进行二元多因素Logistic回归分析，同时绘制受试者工作特征曲线（ROC），分析ROC曲线下面积（AUC），并确定血清cTnT水平及其下降率预测临床结局的阈值、敏感度和特异度。结果:最终共72例患者纳入分析，其中ICU内存活42例，死亡30例，ICU病死率为41.7%。单因素分析结果：与存活组比较，死亡组患者急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）更高〔分：32（30，34）比29（25，30）〕，且ECMO上机前心搏骤停发生率（70.0%比31.0%）及ECMO转机过程中有创机械通气和连续性肾脏替代治疗的比例更高（96.7%比66.7%，83.3%比42.9%），差异均有统计学意义（均n P<0.05）。死亡组ECMO转机后2 d和3 d血清cTnT水平明显高于存活组〔ng/L：2 d为6 373.5（898.3，15 251.5）比1 760.5（933.0，4 257.8），3 d为6 202.0（758.9，16 554.3）比1 678.0（623.3，3 407.8），均n P<0.05〕；ECMO转机后2 d和3 d cTnT下降率也明显低于存活组〔2 d为17.3%（-44.2%，34.7%）比36.8%（18.1%，60.6%），3 d为32.4%（-30.0%，55.5%）比53.2%（38.3%，72.3%），均n P<0.05〕。二元多因素Logistic回归分析显示，ECMO上机前发生心搏骤停〔优势比（n OR）＝4.564，95%可信区间（95%n CI）为1.212～17.193，n P＝0.025〕和ECMO转机后2 d cTnT下降率（n OR＝1.617，95%n CI为1.144～4.847，n P＝0.026）是接受V-A ECMO治疗的CS患者ICU内死亡的独立危险因素。ROC曲线分析显示，ECMO转机后2 d cTnT下降率对接受V-A ECMO治疗的CS患者ICU内死亡有一定预测价值，AUC为0.704（95%n CI为0.584～0.824），最佳诊断阈值为40.0%，敏感度为86.7%，特异度为52.4%，阳性预测值为66.9%，阴性预测值为89.1%。n 结论:接受V-A ECMO治疗的CS死亡患者早期cTnT下降率低于存活患者，ECMO转机后2 d cTnT下降率是此类患者死亡的独立危险因素。“,”Objective:To explore the changing trend of cardiac troponin T (cTnT) in patients with cardiogenic shock (CS) receiving veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and its predictive value.Methods:A retrospective study was conducted. The data of patients with CS receiving V-A ECMO admitted to the First Affiliated Hospital of Nanjing Medical University from March 2015 to May 2020 were enrolled. The baseline data, ECMO related parameters, serum cTnT levels at 1, 2, 3 days after ECMO and intensive care unit (ICU) prognosis were recorded. The parameters with clinical significance and significant difference in univariate analysis were analyzed by binary multivariate Logistic regression analysis. Meanwhile, receiver operating characteristic (ROC) curve was drawn, area under ROC curve (AUC) was analyzed, and the threshold, sensitivity and specificity of serum cTnT level and its reduction rate for predicting clinical outcome were evaluated.Results:A total of 72 patients were enrolled, of which 42 survived and 30 died at ICU discharge, and the ICU mortality was 41.7%. Univariate analysis results: compared with the survival group, the patients in the death group had higher acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score [32 (30, 34) vs. 29 (25, 30)], and the incidence of cardiac arrest before ECMO (70.0% vs. 31.0%), the ratios of invasive mechanical ventilation and continuous renal replacement therapy during ECMO were higher (96.7% vs. 66.7%, 83.3% vs. 42.9%), and the differences were statistically significant (all n P < 0.05). Serum cTnT levels (ng/L) at 2 days and 3 days after ECMO in the death group were significantly higher than those in the survival group [2 days: 6 373.5 (898.3, 15 251.5) vs. 1 760.5 (933.0, 4 257.8), 3 day: 6 202.0 (758.9, 16 554.3) vs. 1 678.0 (623.3, 3 407.8), both n P < 0.05], and the decrease rates of cTnT within 2 days and 3 days after ECMO were significantly lower than those in the survival group [2 days: 17.3% (-44.2%, 34.7%) vs. 36.8% (18.1%, 60.6%), 3 days: 32.4% (-30.0%, 55.5%) vs. 53.2% (38.3%, 72.3%), both n P < 0.05]. Binary multivariate Logistic regression analysis showed that cardiac arrest before ECMO [odds ratio ( n OR) = 4.564, 95% confidence interval (95%n CI) was 1.212-17.193, n P = 0.025] and the decrease rate of cTnT level within 2 days after ECMO (n OR = 1.617, 95%n CI was 1.144-4.847, n P = 0.026) were independent prognostic risk factors for the ICU death of CS patients receiving V-A ECMO. ROC curve analysis showed that the decline rate of cTnT within 2 days after ECMO transfer had a certain predictive value for the ICU death of CS patients receiving V-A ECMO. The AUC was 0.704 (95%n CI was 0.584-0.824). The optimal diagnostic threshold was 40.0%, the sensitivity was 86.7%, the specificity was 52.4%, the positive predictive value was 66.9%, and the negative predictive value was 89.1%.n Conclusions:The early decline rate of cTnT in CS patients who received V-A ECMO treatment in death group was lower than that of survival patients. The cTnT decline rate 2 days after ECMO was an independent risk factor for the death of such patients.