The research for efficacy of troponin T in evaluating the severity of fulminant myocarditis
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摘要: 本研究探索肌钙蛋白T(cTnT)对暴发性心肌炎病情评估的效能。通过回顾性分析2013年1月—2021年5月我院暴发性心肌炎患儿cTnT水平诊断不同病情严重程度的ROC曲线，根据约登指数计算其对病情严重程度评估最佳的界值，分析以界值分组的两组间患儿病情严重程度。最终82例患儿纳入研究，男42例，女40例; 年龄(4.97±4.66)岁; cTnT水平为1.32(0.25，4.94) ng/mL，发生死亡9例，ECMO治疗7例，撤机后存活5例，临时起搏治疗14例，未经ECMO治疗存活的病例68例，cTnT诊断死亡和需ECMO治疗的高危患儿AUC为0.84(0.73，0.96) ng/mL，诊断发生室性心动过速的AUC为0.79(0.61，0.95)，诊断高度房室传导阻滞的AUC为0.74(0.64，0.85); cTnT在临界值为1.0 ng/mL时预测高危组和低危组的灵敏度和特异度分别为92.31%和55.07%，cTnT≥1.0 ng/mL的患儿有更高的脏器功能损伤水平和恶性心律失常发生率(P< 0.05)。多因素logistic回归分析结果表明cTnT≥1.0 ng/mL是高危组的危险因素。cTnT≥1.0 ng/mL时，提示患儿有高危的可能，需评估及时转运至有行ECMO治疗条件医院。Abstract: The efficacy of troponin T in evaluating the severity of fulminant myocarditis is explored.Through retrospective analysis of the ROC curve of different disease severity diagnosed by troponin T level in children with fulminant myocarditis in our hospital from January 2013 to may 2021, the best cut-off value of disease severity was calculated according to Youden index, and the disease severity between the two groups grouped by bounds was analyzed. Eighty-two children with fulminant myocarditis were included in the study, including 42 males and 40 females, aged (4.97±4.66) years old; cTnT level was 1.32(0.25, 4.94) ng/mL, 9 cases died, 7 cases were treated with ECMO, and 5 cases survived after removing the machine, 14 cases were treated with temporary pacing therapy, 68 cases survived without ECMO treatment, the AUC of high-risk children diagnosed with cTnT and requiring ECMO treatment was 0.84(0.73, 0.96), and the AUC for the diagnosis of ventricular tachycardia was 0.79(0.61, 0.95), the AUC for the diagnosis of high-grade atrioventricular block was 0.74(0.64, 0.85). When the cut-off value was 1.0 ng/mL, the sensitivity and specificity of predicting the high-risk group and the low-risk group were 92.31% and 55.07% respectively, children with cTnT higher than 1.00 had a higher level of organ damage and the incidence of malignant arrhythmia(P< 0.05). Multivariate Logistic regression analysis showed that cTnT≥1.0 ng/mL was a risk factor for high risk group. When the cTnT≥1.0 ng/mL, it indicates that children have a higher risk. It is necessary to evaluate and transfer them to a hospital with ECMO treatment conditions in a timely manner.
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Key words:
- troponin T /
- acute fulminant myocarditis /
- children /
- ECMO
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表 1 cTnT对高危和低危患儿诊断最佳界值分析
界值/(ng·mL-1) 灵敏度/% 特异度/% 阳性预测值/% 阴性预测值/% 约登指数 0.5 100 40.58 24.07 100 0.41 1.0 92.31 55.07 27.91 97.44 0.47 1.5 84.62 62.32 29.73 95.56 0.46 
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表 2 最佳界值分组的两组间患儿病情严重程度的比较
X±S，M(P25，P75) 指标 cTnT≥1.0 ng/mL组(43例) cTnT < 1.0 ng/mL组(39例) Z/χ2 P 肌酸激酶/(U·L-1) 1029.16±804.98 424.55±795.08 5.21 0.00 肌酸激酶同工酶/(U·L-1) 83.35±76.40 68.76±103.69 2.98 0.00 乳酸水平/(mmol·L-1) 5.66±4.41 3.64±4.02 3.10 0.00 肌酐/(μmol·L-1) 69.63±45.51 35.87±18.14 4.90 0.00 尿素氮/(mmol·L-1) 8.74±5.38 5.83±2.56 2.81 0.00 谷草转氨酶/(IU·L-1) 212.80(86.20，383.40) 59.00(43.0，188.0) 4.05 0.00 血糖/(mmol·L-1) 7.01±2.77 5.86±2.06 2.16 0.03 NT-proBNP/(pg·mL-1) 21481.35±7056.17 18748.95±9607.03 1.37 0.17 存在恶性心律失常/例 32/43 7/39 26.15 0.00
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表 3 多种实验室指标与是否高危的多因素logistic回归分析
实验室指标 B 标准误差 瓦尔德 显著性 Exp(B) 95%CI 乳酸 4.25 1.26 11.48 0.00 70.35 6.01~823.58 NT-proBNP 2.47 1.43 2.98 0.08 11.80 0.72~194.53 肌酸激酶 2.50 1.17 4.55 0.03 12.23 1.22~122.17 肌酸激酶同工酶 1.12 0.91 1.54 0.22 3.08 0.52~18.15 谷草转氨酶 -2.09 1.07 3.80 0.05 0.13 0.02~1.01 cTnT 3.09 1.16 7.04 0.01 21.94 2.24~214.72 常量 -8.59 2.32 13.75 0.00 0.00
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