CK、CK-MB、TnT对再通后急性心肌梗死患者梗死面积的估测

Assessment of Infarct Size by CK,CK-MB and TnT after Reperfusion in Acute Myocardial Infarction

目的:探讨急性心肌梗死(AMI)直接经皮介入干预(direct PCI)后血清磷酸肌酸激酶(CK)及其同工酶(CK-MB)、心肌肌钙蛋白T(cTnT)的估测梗死(MI)面积的可行性。方法:对直接PCI成功的60例AMI患者入院后连续抽静脉血测定血清CK、CK-MB及TnT水平,入院10～30d内做核素心肌显像测定心肌梗死面积指数(infarct size inedx,ISI)。以测定的生化指标拟合释放曲线,分别以其峰值、所测定总值及术后16小时内曲线下面积与ISI做相关性比较。结果:直接PCI术后即刻血清CK、CK-MB以及TnT浓度迅速升高,与术前有显著性差异(P均小于0.05)。CK、CK-MB及TnT在发病24小时内释放曲线基本呈现出单峰特征。所测血清CK、CK-MB及TnT的峰值、累积值及释放曲线下面积与ISI都有相关性。多元回归分析发现TnT释放曲线下面积与ISI相关性最好(r=0.58;P=0.0012)。TnT释放曲线下面积与ISI的线性回归方程为:Y=1.39×10^(-4)X+0.20。以ISI=30％为界限将患者分为两组,两组间TnT释放曲线下面积做t检验,发现有显著性差异(P<0.01)。直接PCI术后16小时内TnT释放曲线下面积对ISI的临床估测价值为85.2％、特异度为84％、敏感度为100％。ISI小于30％的占88.46％(以ECT=30％,TnT-Area=688g·h/L为界限)。

Objective: This study aimed to detect the possibility of serum creatine phosphokinase (CK), CK isoenzyme MB (CK--MB) and troponin T (TnT) for assessing the infarct size after successful reperfusion in acute myocardial infarction (AMI). Meth- ods: Serum CK, CK--MB and TnT of 60 AMI patients after successful direct PCI were measured sequentially within 72 hours after di- rect PCI, and 99mTc--MIBI myocardial single photon emission computed tomography was performed within 30 days after permission to calculate the myocardial infarction score (ISI). The peak, sum total and area under curve within 16 hours of the biochemical indexes were compared with ISI with linear regression analysis and multiple stepwise regression analysis. Results: Serum CK, CK--MB and TnT increased rapidly after direct PCI (P<0.05); CK, CK--MB and TnT release curves were about monophonic within 24 hours; The peak, sum total and area under curve within 16 hours of CK, CK--MB and TnT correlated well with ISI; The area under curve within 16 hours of TnT correlated best wi ISI(r = 0.58, P < 0.01), its regression equation was Y = 1. 39×10^(-4)X+0. 20. Af- ter separated by ISI as 30% into 2 groups; there was obvious difference between the 2 groups (P < 0.01). The assess value of TnT area under curve within 16 hours to infarct size is 85. 2% (ISI = 30%, TnT AUC = 688 g ·h/L), the sensitivity was 100%, specifici- ty is 84%. Two of these patients studied had a relative normal 99mTc--MIBI myocardial perfusion as healthy people. Conclusion: The area under curve within 16 hours after direct PCI could be used to assess infarct size in AMI.