【摘要】 目的　研究慢性心力衰竭(chronicheartfailure ,CHF)患者血清心肌肌钙蛋白I(cTnI)和室性心律失常严重性的关系。方法　本研究包括2 18例CHF患者,入院时抽血进行cTnI分析,根据血清cTnI将患者分为2组:cTnI阳性组(cTnI>或=0 .0 5ng ml)和cTnI阴性组(cTnI<0 .0 5ng ml)。急性心肌梗死和心肌炎等可引起cTnI升高的疾病除外。用2 4hHolter监测评估室性心律失常的严重性,事先确定室性心律失常严重性负荷指标。结果　2组患者的室性心律失常的危险因素水平相同。cTnI阳性CHF患者的所有室性心律失常的测量指标明显高于cTnI阴性CHF患者。平均每小时成对性室早(2 6±2 .6vs17±2 .9,P =0 .0 3)、平均每小时单发室早总数(182±2 7vs 15 3±2 8,P =0 .0 2 )和2 4小时室性心动过速发作次数(5 3±4 .7vs 2 4±5 .8,P =0 .0 1)都有明显差异。在包含临床变量和药物治疗的多变量分析中,cTnI和上述指标的肯定关系依然存在,他们的P值分别是0 .0 30、0 .0 35、0 .0 31。经多变量logistic回归分析,形成室性心动过速的危险在cTnI阳性组明显增高,校正比数比是2 .4 1(95 4 %CI,1.34to 3.4 2 ,p =0 .0 0 4 )。结论　CHF患者血清cTnI具有促室性心律失常的作用;这种作用可能是心衰自身不断发展的机制更多还原

【Abstract】 Objective The study was done to determine the relationship between serum cardiac troponin I(cTnI) and ventricular arrhythmia severity in patients with chronic heart failure(CHF). Methods The study group included 218 patients with CHF who had cTnI assay drawn at the time of initial presentation. Patients with acute myocardial infarction or myocarditis were excluded from analysis. Patients were divided into two groups: cTnI-positive with serum cTnI > or =0.05 ng/ml (n=110) and cTnI-negative with serum cTnI <0.05 ng/ml (n=110). The severity of ventricular arrhythmias was assessed by 24-h Holter monitoring, using prospectively defined measures of ventricular arrhythmic burden. Results Prevalence of ventricular arrhythmias risk factors was equal in both groups. All measures of ventricular ectopy were much higher in cTnI-positive patients. Mean hourly ventricular pairs (26±2.6 vs 17±2.9,p=0.03), mean hourly number of single ventricular ectopic beats (182±27 vs 153±28,p=0.02), and the frequency of ventricular tachycardia episodes per 24 h (53±4.7 vs 24±5.8,p=0.01) were higher in cTnI-positive patients. After inclusion of clinical variables and drug therapies in a multivariate analysis, the positive relationship between cTnI and the frequency of ventricular pairs (p=0.030), mean hourly number of single ventricular ectopic beats (p=0.035), and ventricular tachycardia (p=0.031) remained independent. In multivariate logistic regression, the risk of developing ventricular tachycardia was higher in patients with detectable cTnI levels with an adjusted odds ratio of 2.41 (95% CI, 1.34 to 3.42, p=0.004). Conclusions CTnI confers a proarrhythmic effect with regard to the occurrence of ventricular arrhythmias in the setting of CHF. Although the precise significance of this phenomenon requires further investigation, it may be the mechanism of the self-perpetuating for the CHF.更多还原