Elevation of troponin I in sepsis and septic shock
Elevation of troponin I in sepsis and septic shock
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DOI：
10.1007/s001340100920
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发表时间：
2001-06-01
影响因子：
38.9
通讯作者：
Bertel, O
中科院分区：
文献类型：
--
作者：
Ammann, P;Fehr, T;Bertel, O
目的：在无急性冠脉综合征的患者中，通过cTnI测量检测严重全身炎症中的心肌损伤。设计：前瞻性病例对照研究。设置：三级转诊中心。参与者：20例脓毒症、脓毒性休克和全身炎症反应综合征（SIRS）患者接受检查，并与无冠状动脉疾病或心肌炎的对照组进行比较。测量和结果：评估了SIRS、脓毒症和脓毒性休克患者的cTnI水平。8名患者（2名女性/6名男性）发生脓毒性休克，9名患者（3名女性/6名男性）发生脓毒症而无休克，3名患者（3名男性）发生SIRS。17例患者（85%）显示cTnI升高（中位数0.57 mug/l; 0.17-15.4），而对照组中无患者显示cTnI升高（P < 0.0001）。6例患者（30%），3例感染性休克，3例败血症，在住院期间死亡，其中5例cTnI升高。五分之四的尸检显示冠状动脉正常。在10例cTnI阳性患者（59%）中，冠状动脉造影、尸检和负荷超声心动图排除了显著的冠状动脉疾病。在41%的cTnI阳性患者中，可以培养出肺炎链球菌，而cTnI阴性或对照患者均未显示出由于S.结论：在我们的研究中，85%的脓毒症、脓毒性休克或SIPS患者心肌肌钙蛋白I升高。高比例的感染是由S.肺炎。微生物以何种方式引起cTnI升高尚不清楚。
Objective: To detect myocardial damage in severe systemic inflammation by cTnI measurements in patients without acute coronary syndromes.Design: Prospective case control study.Setting: Tertiary referral center.Participants: Twenty patients with sepsis, septic shock, and systemic inflammatory response syndrome (SIRS) were examined and compared to controls without coronary artery disease or myocarditis.Measurements and results: cTnI levels were assessed in patients with SIRS, sepsis, and septic shock. Eight patients (two female/six male) suffered from septic shock, nine (three female/six male) from sepsis without shock, and three (three male) from SIRS. Seventeen patients (85 %) showed elevated cTnI (median 0.57 mug/l; 0.17-15.4), whereas no patient in the control group showed elevated cTnI (P < 0.0001). Six patients (30 %), - three with septic shock and three with sepsis - died during hospitalization, five of them with elevated cTnI. Four out of five autopsies showed normal coronary arteries. Coronary angiography, autopsy, and stress echocardiography ruled out significant coronary artery disease in ten cTnI-positive patients (59 %). In 41 % of cTnI-positive patients, Streptococcus pneumoniae could be cultured, whereas no cTnI-negative or control patient showed signs of infection due to S. pneumoniae.Conclusion: Cardiac troponin I was elevated in 85 % of patients with sepsis, septic shock or SIPS in our study. A high percentage showed infection caused by S. pneumoniae. In what way microorganisms cause cTnI elevations is not yet understood.