血清肌钙蛋白T在原发性高血压患者运动负荷中的变化

Change of Serum Troponin T in Patients With Essential Hypertension After Treadmill Test

目的：通过研究原发性高血压（高血压病）患者运动负荷前后血清肌钙蛋白Ｔ（ＴｎＴ）的变化，拟间接推断高血压病患者合并心脏微血管及大血管病变的可能性。方法：对５４例高血压病患者（ＥＴ）进行次极量运动平板试验，并与冠心病患者及正常人进行对照，采用固相酶联免疫法进行运动前、后（６分钟及２４小时）血清ＴｎＴ的测定。对运动试验阳性及心电图有Ｔ波变化的高血压病、冠心病患者进行冠状动脉造影。结果：在运动试验阴性患者中，有Ｔ波改变的高血压病患者（冠状动脉造影阴性为９２％，阳性为８％）血清ＴｎＴ在运动后均高于运动前（Ｐ＜０．０５）。无Ｔ波变化患者仅于运动后６分钟时血清ＴｎＴ增高，２４小时血清ＴｎＴ恢复正常。高血压病患者运动试验阳性中（冠状动脉造影阴性为２６％，阳性为７４％）及冠心病、心绞痛组，运动负荷后血清ＴｎＴ６分钟及２４小时均有明显改变（Ｐ＜０．０１及Ｐ＜０．０５），并随着冠状动脉狭窄程度的加重，运动后血清ＴｎＴ值随之增高，呈正相关。结论：高血压病患者运动负荷后血清ＴｎＴ水平的检测有助于间接推断其心肌及冠状动脉受损的情况。

Objective:To evaluate indirectly the severity of cardiac vessel and microvessel lesions complicated in essential hypertensives by the changes of serum troponin T(TnT)before and after treadmill test. Methods:Fifty four cases of essential hypertension undertook sublimit treadmill test and compared with the patients of coronary heart disease or normal subjects.The coronary angiography was performed on those patients with positive treadmill test or T wave change in ECG.Serum TnT concentration was determined by solid phase enzyme link immunoassay before,6 min and 24 h after the exercise. Results:In hypertensive patients with T wave change and negative treadmill test,the negative and positive coronary angiogram accounted for 92% and 8%,respectively.TnT level in patients with T wave change after treadmill test (both 6 min and 24 h)was higher than before the test( p <0 05);but only high at 6 min after exercise in those without T wave change.The change of serum TnT was extremely significant in hypertensives with positive treadmill test( p <0 01 at 6 min and p <0 05 at 24 h after exercise);the negative and positive coronary angiogram accounted for 26% and 74%,respectively. Conclusion:Post exercise serum TnT detection might be useful to evaluate the severity of myocardial and coronary artery lesions in essential hypertensive patients.