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目的检测充血性心力衰竭(CHF)患者血清心肌肌钙蛋白I(cTnI)水平的变化,探讨其对心力衰竭严重程度判断及预后评估的价值。方法选择CHF患者(CHF组)共75例(包括缺血性心肌病25例,非缺血性心肌病50例),以体检及实验室检查无心脏病依据的40例作为对照组。测定两组cTnI水平,彩色多普勒超声心动图检测左心功能。按cTnI是否阳性分为阳性组和阴性组,比较两组间左室射血分数(LVEF)、左室舒张末期内径(LVDd)、心排血量(CO)值的差异。结果 CHF组血清cTnI测定值及其增高检出率均明显高于对照组(P<0.01),且心功能分级越差,血清cTnI水平及其增高的检出率越高;LVEF值较低组(LVEF≤35%),血清cTnI水平较高;LVEF值与cTnI水平呈显著负相关(r=-0.573,P<0.05)。彩色多普勒超声心动图测量各项指标阳性组与阴性组比较差异有统计学意义(P<0.01)。结论血清cTnI是CHF患者心肌损伤的高度敏感和特异的指标,它对评价心功能障碍的严重程度、危险分层及预后判断等可能有一定价值。
Objective To investigate the changes of serum cardiac troponin I (cTnI) levels in patients with congestive heart failure (CHF) and to evaluate the value of judging the severity of heart failure and prognosis. METHODS: A total of 75 CHF patients (including 25 with ischemic cardiomyopathy and 50 with non-ischemic cardiomyopathy) were enrolled in the study. Forty patients without heart disease undergoing physical examination and laboratory tests were selected as the control group. The levels of cTnI in both groups were measured and left ventricular function was detected by color Doppler echocardiography. According to whether positive cTnI was divided into positive group and negative group, the differences of left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVDd) and cardiac output (CO) between the two groups were compared. Results The serum cTnI and the increased detection rate of CHF in CHF group were significantly higher than those in control group (P <0.01). The worse the cardiac function was, the higher the detection rate of serum cTnI level and its elevation were. The lower the LVEF value was (LVEF≤35%), serum cTnI level was higher; LVEF value was negatively correlated with cTnI level (r = -0.573, P <0.05). Color Doppler echocardiography measurement of each index positive group and negative group difference was statistically significant (P <0.01). Conclusions Serum cTnI is a highly sensitive and specific marker of myocardial injury in CHF patients. It may have some value in assessing the severity of cardiac dysfunction, risk stratification and prognosis.