Elevated cardiac troponin I in sepsis and septic shock: no evidence for thrombus associated myocardial necrosis.
Elevated cardiac troponin I in sepsis and septic shock: no evidence for thrombus associated myocardial necrosis.
复制标题
DOI：
10.1371/journal.pone.0009017
复制
发表时间：
2010-02-03
期刊：
影响因子：
3.7
通讯作者：
Ammann P
中科院分区：
文献类型：
--
作者：
Altmann DR;Korte W;Maeder MT;Fehr T;Haager P;Rickli H;Kleger GR;Rodriguez R;Ammann P
严重脓毒症和脓毒性休克患者经常观察到心肌肌钙蛋白I（cTnI）升高。然而，这些患者cTnI释放的机制仍不清楚。迄今为止，尚无关于凝血障碍作为脓毒症期间cTnI释放的可能机制的数据。对全身炎症反应综合征（SIRS）、脓毒症或脓毒性休克但无急性冠脉综合征证据的连续性患者进行分析。在自体全血样本中评估凝血参数（凝血时间（CT）、凝块形成时间（CFT）、最大凝块硬度（MCF）、α角），并使用特定活化剂，通过旋转血栓弹力测定法（ROTEM）评价凝血途径的外源性和内源性以及纤维蛋白组分。纳入38例患者，22例（58%）cTnI阳性。TnI阳性和阴性患者的基线特征相似。两组之间的CT、CFT、MCF和α角相似，外源性和纤维蛋白活化的CT有缩短的趋势。我们发现cTnI阳性和阴性的SIRS、严重脓毒症和脓毒性休克患者之间的旋转血栓弹力图分析凝血参数无差异。这些结果表明，血栓相关心肌损伤以外的病理生理机制可能发挥重要作用，包括可逆性心肌膜渗漏和/或细胞因子介导的细胞凋亡在这些患者中。
Elevated cardiac troponin I (cTnI) is frequently observed in patients with severe sepsis and septic shock. However, the mechanisms underlying cTnI release in these patients are still unknown. To date no data regarding coagulation disturbances as a possible mechanism for cTnI release during sepsis are available. Consecutive patients with systemic inflammatory response syndrome (SIRS), sepsis or septic shock without evidence of an acute coronary syndrome were analyzed. Coagulation parameters (clotting time (CT), clot formation time (CFT), maximum clot firmness (MCF), α-angle) were assessed in native whole blood samples, and using specific activators to evaluate the extrinsic and intrinsic as well as the fibrin component of the coagulation pathway with the use of rotational thrombelastometry (ROTEM). Thirty-eight patients were included and 22 (58%) were cTnI-positive. Baseline characteristics between TnI-positive and -negative patients were similar. The CT, CFT, MCF and the α-angle were similar between the groups with trends towards shorter CT in the extrinsic and fibrin activation. We found no differences in coagulation parameters analyzed with rotational thrombelastometry between cTnI-positive and -negative patients with SIRS, severe sepsis, and septic shock. These findings suggest that pathophysiological mechanisms other than thrombus-associated myocardial damage might play a major role, including reversible myocardial membrane leakage and/or cytokine mediated apoptosis in these patients.
登录
查看更多内容
影响因子：
38.9
作者：
Ammann, P;Fehr, T;Bertel, O
通讯作者：
Bertel, O
影响因子：
15.1
作者：
Gonano, Christopher;Sitzwohl, Christian;Kettner, Stephan C.
通讯作者：
Kettner, Stephan C.
DOI：
10.1016/0735-1097(92)90325-h
发表时间：
1992-05-01
影响因子：
24
作者：
MAZEIKA, PK;NADAZDIN, A;OAKLEY, CM
通讯作者：
OAKLEY, CM
影响因子：
5.7
作者：
McCrath, DJ;Cerboni, E;Bennett-Guerrero, E
通讯作者：
Bennett-Guerrero, E
影响因子：
120.7
作者：
LEGALL, JR;LEMESHOW, S;SAULNIER, F
通讯作者：
SAULNIER, F