- 期刊
Clinical Implications of Cardiac Troponin I in Patients with Cerebrovascular Hemorrhage
心臟肌旋蛋白在腦出血病人的臨床意義
摘要
目的：肌旋蛋白為心肌所特有，臨床上為心肌梗塞判斷的重要參考。然而在非冠狀動脈急性發作的病患上，偶爾可見其不正常升高。腦出血的病人即為其中一項常見的可能原因，因此常造成診斷上的困擾。為探求肌旋蛋白的不正常升高在這類病患中所代表的臨床意義，為本研究的目的。方法：在連續18個月中，共有98個腦出血病患，因臨床上懷疑冠狀動脈症候群而檢驗心臟肌旋蛋白。我們剔除了有心臟疾病史及腎功能不良的病患。針對這 98個病人的心臟肌旋蛋白檢驗結果，分為兩組，紀錄並比較其血壓，心跳，心肌酶，大腦出血半球，神經傷害的程度，肺水腫發生及臨床預後等結果。結果：在98個病人中，共有12個(12%)有心肌旋蛋白升高的現象。不同肌旋蛋白的兩組病人中，無年齡，性別上的差異；就冠狀動脈危險因子（高血壓，糖尿病及高血脂）及患者的臨床表徵（血壓，心跳，心肌酶的升高，腦出血半球及神經損害的程度等）而言，在兩組病人中亦無統計學上意義的差別。而肌旋蛋白的不正常升高，顯示了病患的高死亡率（12個病人有8個死亡，67% vs 28%，p=0.007）及發生較高急性肺水腫的機率(33% vs 5%，p=0.0007)。結論：在腦出血病人中，不正常的肌旋蛋白升高，暗示病患的病危狀況及較高的死亡率。這類病人亦有較高的肺水腫發生率，而不正常的肌旋蛋白升高與冠狀動脈危險因子及患者的臨床表徵，並未有任何顯著相關。
並列摘要
Background and Purpose: Cardiac troponin I (cTnI) is very sensitive and highly specific to myocardial injury. However, it can be raised in some conditions other than acute coronary syndrome. Elevation of cTnI was frequently found in patients with cerebrovascular events with critical condition. For understanding the meaning of elevated cTnI after brain injury, the aim of this study was to find whether there was clinical implication in cerebrovascular hemorrhagic patients. Methods: Patients with cerebrovascular hemorrhage and measured cardiac biochemical markers (creatine kinase (CK), MB fraction (CK-MB) and cTnI) were selected. In a total of eighteen months, there were a total of 148 patients with CK/CK-MB and cTnI checked was available among 98 of the 148 patients. Results: In the 98 cTnI patients, there were a total of 12 (12%) patients with cTnI positive (upper reference limit was 1.0 microg/liter). The abnormal cTnI measurements was neither associated with cardiovascular risk factors such as diabetes mellitus, hypertension, and hyperlipidemia (p=0.28, 0.39, 0.20 respectively), nor peak blood pressure (BP) on arrival and heart rate (HR) (p=0.25, 0.16, 0.08 for systolic, diastolic BP and HR respectively). Furthermore, cTnI was not related to significant changes in CK or CK-MB fraction (p=0.23, 0.37 respectively). The abnormal cTnI concentration did not correlate with hemorrhagic hemisphere (right or left side). Mortality was higher in patients with elevated cTnI level (p=0.007). While raised cTnI correlated with pulmonary edema (p=0.0007). Deteriorated left ventricular function was detected in 3 of 8 (37.5%) pulmonary edema patients. Patients with pulmonary edema had a high mortality (p=0.02). Conclusion: In cerebrovascular hemorrhagic patients, elevated cTnI levels indicated critical condition with cardiac involved and strongly predicted high mortality. It was also associated with pulmonary edema but not hemodynamic data on arrival (peak BP and HR) or pre-existed cardiovascular risk factors. (Full Text in English)