心肌肌钙蛋白T与心肌缺血性损伤的研究

The relation between cardiac troponin T and myocardial ischemic injury

目的评价心肌肌钙蛋白T(CTnT)作为判断心肌缺血性损伤指标的敏感性和特异性。方法对40例心脏手术患者(20例瓣膜替换术、20例不停跳房室缺修补术)进行分析。他们分别于术前,关胸后1、2、24和48h记录心电图,并抽血测定肌酸激酶(CK)、肌酸激酶-MB(CK-MB)和CTnT。结果40例患者术前CTnT均在正常值范围内,其中20例瓣膜手术患者主动脉经过阻断后,心电图有缺血性改变,周围血液中的CK、CK-MB和CTnT均有明显升高(P<0.01),分别在关胸后2h达到高峰,数值分别为术前的11.6、8.4和242倍;20例不停跳房室缺修补术的患者术前和关胸后的心电图和血液中的CTnT基本正常,CK和CK-MB除2例患者关胸后出现明显变化外,余均未见改变。结论CTnT作为判断心肌损伤的指标,其敏感性和特异性良好,且均优于CK和CK-MB。

Objective To evaluate the sensitivity and specificity of cardiac Troponin T （CTnT） as a marker of myocardial ischemic injury. Methods 40 patients were included, valve replacement in 20 that using of aorta-clamping under cardiopulmonary bypass （CPB）,and Atrial septal defect and Ventricular septal defect in 20 that using of no aorta-clamping under CPB. Among them, 20 patients were candidates of valve replacement and 20 ASD and VSD patients had their blood samples taken before operation ,and 1 ,2,24 and 48 hours after closure of thorax for measurement of concentrations of CK,CK-MB and CTnT ,together with ECG recording. Results All of the 40 patients, concentrations of CTnT before operation were normal, Of the 20 valve replacement patients , ECG showed the myocardium was ischemic; CK,CK-MB and CTnT all rose significantly （P〈0.01） ,reaching the peak after closure of thorax. Of the other 20 ASD and VSD patients , the ECG and CTnT before operation and after closure of thorax were normal except 2 patients. Conclusion As a marker of myocardial ischemic injury ,CTnT is better than CK and CK-MB both in sensitivity and specifity.