扩张型心肌病患者运动前后血清肌钙蛋白Ⅰ水平变化

Analysis on level of cardiac troponin Ⅰ in patients with dilated cardiomyopathy in front and back on the sport

目的观察扩张型心肌病患者在症状限制性运动试验和运动训练期后心肌钙蛋白Ⅰ变化。方法20例扩张型心肌病中度心力衰竭患者[(NYHA分级Ⅱ～Ⅲ级,射血分数(31.7±9.3)%]与15例轻度心力衰竭患者及10例无心力衰竭受试者进行对比观察,他们均经历了症状限制性运动试验和单期运动训练(达最大心率的80%以上,持续时间30min),分别测定其基础cTnI值、症状限制性试验后和运动训练后1～5h时的cTnI值。结果症状限制性运动试验后,中度心力衰竭患者cTnI值由(38±19)pg/ml增加到(75±29)pg/ml,其中5例中度心力衰竭患者和4例轻度心力衰竭患者的cTnI值升高到100pg/ml以上。无心力衰竭的受试者无论是静息时或是运动后其cTnI值均较低(P<0.05)。结论扩张型心肌病中度心力衰竭患者在症状限制性运动试验后其cTnI值增加,其水平达到轻微的心肌损伤水平,这一现象对患者预后的影响值得进一步研究。

Objective To study whether an increase of cardiac troponin I can be observed after symptom-limited exercise and an exercise training session in patients with dilated cardiomyopathy and moderate heart failure. Methods 20 patients with dilated cardiomyopathy and moderate heart failure （NYHAⅡ-Ⅲ,ejection fraction 31.7%±9.3%）were compared with 15 patients with mild heart failure and 10 subjects without heart failure. All subjects underwent a symptom-limited test and a exercise training session at 〉80% of maximal heart rate over time 30 minutes. The plasma cTnI level were measured at baseline, after symptom-limited exercise hourly for 5 hours, and 1 to 5 hours after training. Results Patients with moderate heart failure showed an increase of cTnI from （38±19）pg/ml to（75±29）pg/ml（P〈0.01） after symptom-limited exercise. Five patients with moderate and two patients with mild heart failure and normal cTnI values at rest showed the increase of cTnI above 100 pg/ml after acute exercise but not after training. Subjects without heart failure had lower cTnI levels at rest and significantly lower values after symptom-limited exercise and training（P〈0.05 for each）.Conclusion Patients with dilated cardiomyopathy and symptomatic heart failure showed an increase of cTnI after symptom-limited exercise at levels that indicate minor myocardial damage. The prognostic impact of this finding should, therefore, be further investigated.